Dr. Ellen E. Goldstein, DDS ,

This article explains what nighttime hypoglycemia is, why it happens, and who is most at risk, with clear guidance for people with diabetes, their families, and caregivers. It outlines common triggers—such as long-acting insulin or sulfonylureas, missed or smaller evening meals, alcohol, late-day exercise, illness, and overly aggressive basal dosing—and highlights subtle overnight clues like restless sleep, sweating, nightmares, morning headaches, or unexpectedly high fasting readings. Readers will find practical, evidence-based steps to prevent lows: checking glucose before bed, setting safe bedtime targets, adjusting medications with a clinician, choosing a balanced bedtime snack, planning exercise and alcohol wisely, using CGM alerts and data sharing, and keeping glucagon accessible. The piece also offers an easy action plan for treating overnight lows and when to seek help, empowering patients and caregivers to sleep more confidently and safely.