CGM Alarm Fatigue in Type 1 Diabetes: How Your Alerts Are Wrecking Your Sleep
How many times did your CGM alarm last night? If you have to guess, or if you're honestly not sure because your arm is doing the silence-and-go-back-to-sleep thing on autopilot, that's alarm fatigue. And it's a documented, peer-reviewed...
The episode, word for word
When did you last look at your CGM alarm thresholds?
Not to use them. Not to silence them. Actually look at them. The numbers. The settings. When did you last sit down and go through the whole thing?
Take a second. Think about it.
If your answer is "when I set up the device," I want you to know a few things have changed since then. Your management has changed. Your comfort level has changed. Your time in range has probably changed.
Your thresholds haven't.
My name is Neil Greathouse, and this is Your Best T1D Year.
All right. Practical Wednesday. We're staying concrete today.
I want to talk about alarm thresholds. What they are, why they matter for sleep, and specifically: why the settings you're running right now might not be calibrated for the person you are today.
OK. So. Your CGM thresholds. Low alert, high alert, urgent low, urgent low soon, all of it. These are numbers you, or someone on your care team, set at some point. And those numbers were set based on what was happening in your diabetes management at that time. Your control, your comfort level, your history, your patterns. All of that.
But here's the thing. It's been a while.
Your alarm thresholds are basically like your Netflix password before the crackdown. You set them, you shared them with the whole household, everyone made peace with them, and then life moved on and you just... kept them. Nobody looked at them again. And now something is different, your management is different, your numbers are tighter or looser, your A1C is in a different place, and the thresholds are still from 2022.
The low alert you set when you first started CGM might be higher than it needs to be for where you are now. Which means it's firing in ranges that are technically fine, at times you're supposed to be sleeping, creating an arousal that disrupts your sleep architecture without actually protecting you from anything.
The high alert might be set in a spot that makes sense for managing daytime control but fires all night because you run slightly elevated overnight and nobody's come up with a different plan for that.
I want to say something, and I want to say it carefully, because this is the part where I need to be clear: I'm not telling you what your thresholds should be. I am not a clinician. I am a person who has been doing this for thirty-four years and I have strong opinions about some things, but the specific numbers for your body, your management, your overnight patterns? That's a conversation with your endocrinologist or diabetes care team.
What I AM telling you is that it's worth having the conversation. Ask the question: given where my management is right now, are my alarm thresholds still set in the right place? That question takes sixty seconds. The appointment to have that conversation might take six weeks and forty-five minutes on hold. I know. I'm sorry. I still think it's worth it.
Because here's the thing. You cannot manage your sleep and also have your device alarming seven times a night on thresholds that were set for a different version of your management. These two things are in conflict. And the sleep cost of unnecessary alarms is not small. It compounds. Every night.
One more thing. A lot of CGM apps also have "quiet hours" settings or do-not-disturb options that let you silence non-urgent alerts during certain windows. If you haven't looked at those settings, look at those settings. They exist. They are usually somewhere in the menu that requires three taps and a scroll that nobody warned you about, but they exist.
Your thresholds are not permanent. They are not a fixed feature of having T1D. They are a setting. Settings can be adjusted.
Open your CGM app right now. Or tonight before bed.
Find the alarm threshold settings. Just look at the numbers. When were they last changed? Do they match where your management actually is today?
You don't have to change anything yet. Just know what's there.
To the person who's been sleeping through alarms without knowing it. Who's been waking up to alerts that didn't need action and then wondering why they're exhausted by Thursday.
Your device can be adjusted. Your settings are not your diagnosis. You can work with this.
You're not doing a bad job. You're doing a difficult job with equipment you haven't had time to fully optimize. That's not failure. That's just next. I'm proud of you.
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.