Daily sleep quality and daily stressors in couples coping with type 1 diabetes.

What is it about?

Individuals diagnosed with type 1 diabetes (T1D) encounter sleep disruptions as a result of symptoms of T1D (e.g., hyperglycemia, hypoglycemia, and glucose variability) and its management (Farabi, 2016). Adults with T1D report more sleep problems compared to individuals without T1D (van Dijk et al., 2011). Sleep problems are especially problematic among patients with T1D, as they may negatively affect insulin sensitivity, disease progression, and development of complications (Donga et al., 2010; Farabi, 2016). Patients’ sleep problems and the daily management of T1D likely affect their partners’ sleep as well (Brod, Pohlman, Wolden, & Christensen, 2013). Despite this hypothesized association, research has not yet examined daily sleep processes among couples coping with TID. This paper examines the influence of daily sleep quality in patients with type 1 diabetes (T1D) on that of their spouses and to investigate the influence of couples’ sleep quality on patients’ diabetes-specific stressors and couples’ general stressors the following day.

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Why is it important?

This study is the first to examine the extent to which the sleep quality of patients with T1D affects that of their spouses, and how both couple-members’ sleep quality affects the experience of next-day diabetes-specific and general stressors. To rule out other directions of effects, we also examined the effects of daily stressors on subsequent daily sleep quality as well. Consistent with recent work examining the dyadic nature of sleep among couples without T1D (e.g., Kane et al., 2014), this study demonstrated positive associations between daily sleep quality of patients with T1D and their spouses. With respect to the association between daily sleep quality and daily diabetes-specific stressors, patients’ sleep quality and spouses’ sleep quality, respectively, were associated with patients’ diabetes-specific stressors. However, when both the effects of patient and spouse sleep quality were examined simultaneously, only patients’ sleep quality uniquely predicted patients’ diabetes-specific stressors. This finding suggests that patients’ sleep quality is most predictive of their own daily diabetes-specific stressors in the context of couple relationships. However, our findings indicate that there is overlap in patient and spouse sleep quality, suggesting that patients’ sleep quality reflects, in part, spouses’ sleep quality as well. In addition, this study found that daily general stressors of patients with T1D are affected not only by their own daily sleep quality, but also by their spouses’ sleep quality. These findings point to the interdependence of sleep quality for couples in everyday life (Bradbury & Karney, 2014). Furthermore, these findings suggest that dyadic data approaches can provide a more complete picture of the daily sleep quality of coupled individuals than approaches in which data is collected from only one partner. The dyadic nature of daily sleep quality may be especially salient and critical for couples coping with T1D, as sleep disturbance is highly prevalent due to diabetes-related issues (e.g., responding to a CGM alarms during sleep time; Barnard et al., 2016). These findings hold some useful clinical implications. First, the interdependence of daily sleep quality of patients with TID and spouses and the effect of daily sleep quality on daily general stressors emphasize the importance of addressing sleep quality issues within the context of couple relationships. A couple-based approach to intervention may be a useful adjunct to individual interventions. Second, process-oriented investigations between daily sleep quality and daily stressors hold the potential to identify targets for prevention and intervention efforts to optimize daily sleep quality among couples coping with T1D. In particular, because within-person sleep quality was associated with next-day stressors, interventions could target sleep quality via improvements in sleep hygiene and addressing possible factors contributing to insomnia. Additionally, patients could work with their endocrinologists to improve daily sleep quality by attempting to better manage diabetes prior to sleep, thus precluding the disruption of diabetes management behaviors during sleep. It is possible that targeting sleep quality could improve daily life among couples coping with T1D, possibly by reducing the number or perceived severity of subsequent stressors experienced (Barnard et al. 2016).

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