Sleep Apnea and Diabetes: Bad Combo for Eye Health

Diabetes impacts all parts of your body and the eye is no exception. If you have both sleep apnea and diabetes, it can be devastating to your overall health. Diabetes affects the eyes in several ways, but the most common and serious form of eye complication is diabetic retinopathy. It is important to have regular retinal screenings and eye tests if you are diabetic. Likewise, sleep apnea affects millions of people. In the US alone the figure is projected at more than 12 million. Despite a large number of people afflicted, about 80 percent are undiagnosed; while a greater number of those who are diagnosed have yet to seek treatment.

When sleep apnea and type 2 diabetes coexist, they have identical shared risk factors like impaired glucose tolerance, obesity, and hypertension. If sleep apnea remains untreated in an individual with type 2 diabetes, the level of sugar control becomes poor. A study performed in the UK suggests that having type two diabetes and sleep apnea doubles the risk of worsening retina disease compared to diabetic people without sleep apnea. Those who had mild eye problems at the beginning of the study but had sleep apnea experienced advanced eye problems. The mechanism how sleep apnea induces diabetic retinopathy is still unclear, and that is why corroborative studies are carried out to find the link between the diabetic retinopathy and obstructive sleep apnea (OSA).

Research revelations

Many researchers have tried to explore the relationship between sleep apnea and diabetes on how it impacts the progress of diabetic retinopathy. One study found that 42.9 percent of people with sleep apnea had a greater incidence of retinopathy than those without apnea at 24.1 percent.

According to the Review of Optometry published on May 15, 2009, by Carlo J. Pelino, OD, and Joseph J. Pizzimenti, OD, a 53-year old male complained of an onset of red floaters in the right eye. He had type 2 diabetes and later was diagnosed with OSA. To make matters worse, he smoked 4 cigars per day. During a comprehensive eye exam, pre-retinal and retinal heme were detected in his right eye. The hemoglobin A1C and blood pressure tests indicated his blood sugar was not under control. Begging the question, was sleep apnea an aggravating factor? The patient underwent grid laser photocoagulation therapy in both eyes to correct his macular edema. Also, CPAP was used to treat OSA to restore his vision and eye health.

Challenges in the trials and research

• Research subjects fewer people, so there may be varied results.
• Clinician error may occur since some individual clinicians struggle to practice medicine.

Can treating sleep apnea help?

Have you ever found yourself coming out of a deep sleep or waking up completely gasping for air at night? You may not be aware of these episodes, but the consequences are felt the next day. Obstructive sleep apnea partially or completely blocks your airways as you sleep. Sleep apnea keeps disrupting the sleep cycles and interfering with the possibility to reach the fifth stage of your sleep the entire night. With less REM sleep, you lose an important process that rejuvenates your eyes.

The tear ducts replenish themselves, cleaning and renewing parts of the eyes. When you lack the deep sleep, the processes are skipped altogether. You miss out on the natural eye liquid that lubricates and protects your eyes. Fatigued and dried eyes are vulnerable to infection. Chronic dry eyes fail to produce tears that cleanse your eyes at night, which is why they are unprotected against infection. When you sleep at night, blood flows to your eyes. Sleep apnea will make you lose sleep consistently, causing poor blood flow to the eyes. You will begin experiencing sharp pain coupled with unclear sight because of damage to the optic nerve.

According to a research study in Canada, a large percent of the adult population sleeps for less than six hours every night, which is below the recommended eight hours per night. The implication of diagnosing a patient for OSA opens a window of opportunity to detect if a person is at high-risk, giving the health experts space to apply any kind of preventive measures and treatment strategies.

According to a UK research study carried out by Dr. Tahrani from the University of Birmingham involving 230 participants with type 2 diabetes, none of them had sleep apnea or respiratory conditions at the beginning of the study. The Tahrani team embarked on sleep monitoring and found 63% of the patients had OSA. Patients with sleep apnea and type-2 diabetes are not only at risk of advanced retinopathy, but also risk the decline in kidney function.

Sleep apnea and glaucoma

Did you know glaucoma is the second leading cause of blindness? If untreated, it can cause irreversible blindness. Shulin Liu, M.D and colleagues conducted a research involving 2.3 million participants to establish a connection between sleep apnea and glaucoma. In their observations, the group without OSA had less risk of glaucoma than those with OSA especially Chinese-OSA were more vulnerable than people from other countries. Also, younger persons and females were at higher risk than other groups. Even though the connection between glaucoma and OSA was unclear, it is was meant to encourage those suffering from OSA to have comprehensive eye exams to test pressure reading in their eye and an elevated pressure could be a sign of glaucoma.

Common eye symptoms for lack of sleep

• Red eyes or blood shot
• A blurry vision
• Eye twitches – eye spasm
• Dry eyes and irritated
• Eyes sensitive to light
• Baggy or swollen eyes
• Glaucoma – it is projected that about 20-57 percent of people who have OSA suffer glaucoma
• Papilledema – your optic nerve swells in both nerves because of enhanced pressure in the skull leading to loss of vision.

Common eye problems due to diabetes

• Blurry vision
• Glaucoma – fluid inside your eye does not drain properly instead build in your eye. It damages the nerves and vessels in your eye.
• Retinopathy – damages to blood vessels in your retina due to high sugar levels
• Cataracts
• Eye pain (aches)
• Vision loss
• Watery eyes
• Night blindness

Closing thoughts

Everyone with diabetes is at risk of developing retinopathy whether or not they are suffering from sleep apnea. Retinopathy results from poorly controlled sugar. When excess sugar is retained in your blood, it blocks tiny blood vessels in your eyes, therefore, cutting blood supply to your retina. To compensate for the low blood supply, the body develops brand new blood vessels in your eye. Sadly, the new blood vessels can simply leak, becoming a source of added problems.

Getting enough sleep is an important step in controlling sleep apnea. Train your mind to understand that the bed is used for sleeping only. Engage yourself in other activities instead of tossing and turning in bed. If you have type 2 diabetes and experience eye problems stated above, test for sleep apnea. Surprisingly enough, you may discover you have a sleeping disorder that affects your breathing system at night and drives your sugar level to the roof. Always consult your optometrist physician and get your eyes examined on a regular basis.