What Type 1 Diabetes Actually Does to Your Sleep Architecture | Episode 200
200 episodes. Neil didn't plan on this. He definitely didn't plan on spending episode 200 explaining what your liver does at 3am without your permission. And yet here we are. This is the episode that contains the most important thing Neil...
The episode, word for word
How many times did your CGM alarm last night?
Don't guess. If you have to guess, that's data.
Was it once? Three times? Enough times that you stopped fully waking up for them and just started doing that half-asleep, eyes closed, arm reach, silence the alarm, go back to sleep thing? Where you weren't even really conscious but your arm somehow knew exactly where the phone was?
Yeah. We need to talk about that.
My name is Neil Greathouse, and this is Your Best T1D Year.
All right. Welcome back. Today I want to talk about CGM alarms. Which is a topic that every T1D person has feelings about. Strong feelings. Complicated feelings. Feelings that are hard to categorize because the alarms are simultaneously lifesaving and absolutely maddening.
OK. So here's the situation.
CGM alarms exist for a very good reason. They catch lows you might not feel. They catch overnight patterns you'd otherwise miss entirely. They have, conservatively, saved a lot of lives. I am not telling you to turn them off. Please do not go turn them off. That's not where this is going.
What I am telling you is that there is a documented, peer-reviewed, published research phenomenon called alarm fatigue. Which is exactly what it sounds like. Your brain gets very efficient at processing recurring alarms that don't require action, and eventually starts treating all alarms as potentially not requiring action, including the ones that actually do.
This is basically the boy who cried wolf. Except the wolf is real. And it will eventually show up. So the story has worse stakes than the original.
Here's how alarm fatigue happens in practice. Night one: alarm fires. You wake up. You check. It's a false low. You silence it. You go back to sleep. Night two: same thing. Night fifteen: your brain has run this script enough times that it starts running it on autopilot. You're doing the arm reach, the silence, the checking, the going back to sleep, and you are genuinely not fully awake for any of it. Your brain learned: alarm means check, check means nothing, nothing means sleep. It automated the whole process.
That's not you being negligent. That's your brain being extremely efficient at exactly the wrong thing.
And here's the sleep cost. Every alarm, even the ones you don't fully wake up for, disrupts your sleep architecture. Your brain goes: alarm, partial arousal, reassess, settle back down. You might not remember it in the morning. Your sleep tracker might not even flag it. But the deep sleep you were in got interrupted. And you're now starting the climb back down from a lighter stage.
Now. Here's the thing I want to be careful about.
The answer is not "turn off your alarms." The answer is calibration. There is a real, researched, documented difference between alarm thresholds that are set appropriately for your current management and alarm thresholds that are set for wherever you were when you first set them up. And for a lot of T1D people, those are two different places.
Your alarm settings are not a fixed feature of the device. They are a variable you can adjust. We're going to talk about how to think about that on Wednesday.
But for right now, I just want you to know: the alarm fatigue is real. The sleep disruption is real. The half-asleep arm reach is real. And there's something you can actually do about it.
Also, if it helps: you are not alone. There is an actual peer-reviewed paper with the title "I've Had an Alarm Set for 3:00 A.M. for Decades." That is not a chapter heading. Not a quote. The actual title. Published. In a journal. Someone submitted that title, an editor approved it, it went through peer review. I find this very comforting.
Tonight, count your alarms.
Not to do anything about them yet. Just write down how many times your CGM alarmed last night. Was it zero? Two? Five? Honestly unsure because you're not fully waking up for them anymore?
Just get the number.
Hey, to the person who's been waking up to alarms that didn't need action and quietly wondering why they're so tired. Who's been doing the arm reach in their sleep for months. Who's been running on interrupted sleep and calling it "just T1D."
It's not just T1D. It's a specific problem with a specific fix. And we're about to work on it.
You're not doing a bad job. I'm proud of you. Nobody remembers easy.
Type 1 diabetes is relentless, but managing it doesn't have to be. New episodes every Monday, Wednesday, and Friday. You're not doing a bad job, you're doing a difficult job. Nobody remembers easy.
This is the script as read on the mic, lightly tidied for reading. Education, not medical advice. Talk to your care team before you change anything about your insulin.