Understanding pre-diabetes and sleep apnoea

Diabetes is a term for a group of separate health conditions. The main three types are: type 1 diabetes, type 2 diabetes and gestational diabetes (which occurs in some pregnancies).

In a person who is not living with diabetes, carbohydrate from food is broken down into glucose in the blood. When their blood glucose rises, their pancreas releases insulin, which transfers the glucose from their blood into the muscle cells to be used as energy.

People living with type 1 diabetes do not produce insulin. In type 2 diabetes or gestational diabetes, insulin is only produced in small amounts or does not work properly. This results in glucose building up in the bloodstream, which can eventually damage blood vessels and nerves.

There is an associated condition called pre-diabetes, which is where a person’s blood glucose levels are higher than recommended but not high enough to be diagnosed as type 2 diabetes. Pre-diabetes is serious: it increases the risk of developing type 2 diabetes by between 10 and 20 times. However, in up to 58% of cases, the onset of type 2 diabetes prevented or delayed. This can be achieved by adopting sustainable healthy habits.

Sleep apnoea, which is also known as obstructive sleep apnoea (OSA), is a disorder where a person briefly stops breathing while they’re asleep. It occurs when the muscles in the back of the throat relax, causing the upper airway (the section of the respiratory system that extends from the nose to the larynx) to become narrowed or blocked. This impairs airflow. The brain senses this and wakes the person up so that they can reopen their airway. These awakenings impact the quality of a person’s sleep.OSA can also cause:

  • snoring
  • waking up with a dry mouth, sore throat or headache
  • irritability
  • depression.

Research has shown that not only are pre-diabetes and sleep apnoea linked but that the link goes in two directions. The risk of pre-diabetes can rise as a result of sleep apnoea-related insulin resistance, which is where our cells do not react well to the hormone; and, on the other hand, the changes in metabolic processes caused by pre-diabetes can make sleep apnoea symptoms worse.

Poor sleep quality in people with pre-diabetes has been associated with the increased blood glucose levels that can lead to type 2 diabetes. The closest associations are with sleep apnoea, insomnia and a condition known as restless legs syndrome.


Insomnia is where a person consistently has problems sleeping. You have insomnia if you regularly:

  • find it hard to go to sleep
  • wake up multiple times during the night
  • wake up early and cannot go back to sleep
  • feel tired after waking up
  • find it hard to nap during the day even though you’re tired
  • feel tired and irritable during the day
  • find it difficult to concentrate because you’re tired.

Although the amount of sleep that a person needs varies, on average:

  • adults need 7 to 9 hours 
  • children need 9 to 13 hours 
  • toddlers and babies need 12 to 17 hours.

Restless legs syndrome (RLS)
Restless legs syndrome is a condition of the nervous system that triggers uncontrollable urges to move your legs. Unmanaged high blood glucose levels in people with pre-diabetes can cause nerve damage, and damage to the nerves of the feet and lower leg contributes to the development of RLS. RLS is often worse at night and can significantly disrupt sleep.

Effects of poor sleep on pre-diabetes
It is thought that poor sleep can cause insulin resistance, which is a key element in the development and progression of pre-diabetes. Poor sleep also affects the hormones that control appetite, and this can lead to night-time snacking, which can cause blood glucose levels to fluctuate. 

Coping with sleep issues for people with pre-diabetes

If sleep issues are affecting your everyday life and general well-being, speak to your doctor. They will help you develop a treatment plan based on effective sleep management strategies.

Obstructive sleep apnoea
There are several ways of managing OSA. These include increasing the amount of physical exercise that you do, eating nutritious foods and avoiding sleeping on your back. If those do not work, continuous positive airway pressure (CPAP) devices can be used. CPAPs provide continuous positive airway pressure through a mask while you sleep, which prevents your airways from closing.

Restless legs syndrome
A variety of strategies can be used to manage RLS. These include:

  • increasing your level of physical activity
  • eating healthy and nutritious food
  • reducing/eliminating caffeine, alcohol and tobacco
  • practising yoga and meditation. 

Restless legs syndrome can also be managed with sleep medication.

How to improve sleep quality

Sleep disorders can be improved by positive sleep hygiene practices (meaning habits that help you get a good sleep).

These include:

  • maintaining a healthy diet
  • exercising regularly during the day
  • not eating big meals late at night
  • consistently going to bed and getting up at the same times
  • getting up at your usual time if you’ve had a bad night’s sleep
  • not smoking or drinking alcohol, tea or coffee for at least six hours before going to bed
  • not having a phone or computer in the bedroom
  • creating a relaxing bedtime routine that starts at least one hour before you go to bed
  • having a cool, quiet and dark bedroom
  • making sure your mattress and pillows are comfortable.

Lifestyle changes to improve sleep and prevent type 2 diabetes

Lifestyle changes that promote good sleep also tend to be beneficial for blood glucose management. To improve your sleep while reducing your risk of developing type 2 diabetes, it can be beneficial to focus on:

  • Getting regular exercise: regular physical activity can help regulate blood glucose levels and promote better sleep.
  • Having a healthy diet: a balanced diet that is rich in fruits, vegetables, proteins and whole grains can help manage blood glucose levels and improve sleep quality. 
  • Maintaining a healthy weight: this can reduce the risk of type 2 diabetes and sleep disorders like sleep apnoea. 
  • Practising stress management: high stress levels can disrupt sleep and affect blood glucose control. Techniques such as deep breathing, yoga or mindful meditation can be beneficial.
  • Limiting alcohol and caffeine: both can interfere with the quality of sleep and affect blood glucose control.
  • Quitting smoking: smoking is linked to a higher risk of type 2 diabetes and can cause sleep disturbances.


Sleep disorders can contribute to insulin resistance, which affects blood glucose-level management. That in turn can lead to pre-diabetes, which can lead to type 2 diabetes. The key to preventing or delaying the onset of type 2 diabetes is making sustainable lifestyle changes.

But it’s not easy doing that on your own. Most of us know that we have to eat well, exercise more and lose weight, but it’s easier said than done. A great way to achieve this is to join a healthy lifestyle program and to have the support of health professionals.

Life! is a free healthy lifestyle program that helps you improve your eating habits, increase your physical activity and manage stress. You can choose from a group course or our telephone health coaching service.

The Life! program will support you to reduce your risk of developing type 2 diabetes, heart disease and stroke.

Life! is run by experienced health professionals, including dietitians and exercise physiologists, who guide and support you to make realistic healthy lifestyle changes that suit your needs. The program includes 7 sessions delivered over a 12-month period.

Since 2007, over 75,000 Victorians have learnt more about living a healthy life with the Life! program. It is the largest prevention program of its kind in Australia.

Life! is funded by the Victorian government and managed by Diabetes Victoria.

You can check your eligibility for the Life! program by taking a quick online test here


Associations between poor sleep and glucose intolerance in prediabetes – PubMed

Insomnia – Causes, Symptoms and Different Types – Health Direct
Diabetes and Sleep: Sleep Disturbances & Coping – Sleep Foundation

Does diabetes have a negative effect on sleep? – Medical News Today

Sleep disorders in people with type 2 diabetes and associated health outcomes: a review of the literature – PubMed

The Impact of Poor Sleep on Type 2 Diabetes – Blog – NIDDK

The Link Between Diabetes and Sleep – Healthline

Understanding Diagnosis and Treatment of Diabetes – WebMD