Publications

Winter 2004

WOMEN AND SLEEP

MANGALA NADKARNI, M.D.
Medical Director, The Kazmir Center for Sleep Disorders at Saint Barnabas Medical Center

Sleep isn't just "time out" from daily life. It is an active state that is important for renewing our mental and physical health each day. When we sleep, our bodies rest but our brains are active. Sleep lays the groundwork for a productive day ahead. Research has shown that a lack of restful sleep results in daytime sleepiness, increased accidents, problems concentrating, poor performance on the job and in school, and possibly, increased sickness.

Women are twice as likely as men to have difficulty falling asleep or staying asleep and even then their sleep complaints are often not taken seriously by health care workers. In the young adulthood of women, sleep disturbances are usually associated with the menstrual cycle, pregnancy and motherhood. In the menopausal years, research has shown, a woman's sleep pattern is susceptible to hormonal changes.

The Menstrual Cycle and Sleep

Some women awake more frequently and experience other sleep disturbances during their premenstrual state, while others report excessive daytime sleepiness, fatigue and longer sleep hours. Usually these problems disappear when menstruation begins, although some women may continue to have lingering problems.

Changes in women's bodies occur at different times in the menstrual cycle and may affect sleep. A National Sleep Foundation (NSF) poll found that 50 percent of menstruating women reported bloating that disturbed their sleep. On average, these women reported disrupted sleep for two to three days each menstrual cycle. Poor quality sleep is more likely at the beginning of the menstrual cycle when bleeding starts. While a healthy sleeper spends about 15-20 percent of his or her sleep time in deep sleep, NSF research suggests that women with PMS experience less deep sleep (about 5 percent of their total sleep) all month long.

Pregnancy and Sleep

Pregnancy-related sleep disturbances are well known and well accepted. In a NSF poll, 78 percent of women reported more disturbed sleep during pregnancy than at other times. Sleep-related problems also become more prevalent as the pregnancy progresses.

Most women report daytime fatigue and the need for longer nighttime sleep. Overall sleep efficiency - the proportion of time spent actually asleep - begins to decrease by the second trimester and continues to decrease in the third trimester. In the third trimester several things can cause sleep disturbances: leg cramps, backache, heartburn, movement of the fetus and increased frequency of urination. Once the baby is born; physical stresses of pregnancy are replaced by demands of the baby's feeding schedule and awakenings. After delivery, getting enough rest continues to be very important as severely disturbed sleep has been linked to postpartum depression and child abuse.

Pregnancy Sleep Tips:

• Special "pregnancy" pillows may help you sleep better. Or, use regular pillows to support your body.
• Naps may help. A NSF poll found that 51 percent of pregnant women reported at least one weekday nap; 60 percent reported at least one weekend nap.
• In the third trimester, sleep on your left side to allow for the best blood flow to the fetus and to your uterus and kidneys. Avoid lying flat on your back for a long period.
• To prevent heartburn, do not eat large amounts of spicy, acidic (such as tomato products), or fried foods. If heartburn is a problem, sleep with your head elevated.
  

Menopause and Sleep

In the perimenopausal period many women experience sleep disturbances with changing levels of sex hormones. Overall amount of deep sleep decreases, sleep becomes lighter and more awakening occurs during the night. Hot flashes (unexpected feelings of heat all over the body) and night sweats can cause repeated awakenings and feeling of anxiety. The resultant sleep deprivation may cause daytime fatigue, irritability and depression.

Decreasing levels of estrogen cause hot flashes, which are usually accompanied by sweating. In a NSF poll, 36 percent of menopausal and postmenopausal women reported hot flashes during sleep. On average, they occurred three days per week and interfered with sleep five days per month. Hot flashes persist for an average of five years. While total sleep time may not suffer, sleep quality does. Hot flashes may interrupt sleep; frequent awakenings cause fatigue the next day.

Deciding what, if any, product to use to alleviate these symptoms and, if so, for how long, are questions a woman should discuss with her physician. The answer will depend on personal and family medical history.

Other Sleep Disorders

These sleep disorders/manifestations are more prevalent in women. They include:

• Restless Leg Syndrome: Patients describe this condition in several ways including leg cramps, tingling, numbness in legs, electric sensation or a Charlie Horse. In young women one of the common causes of this condition is iron deficiency anemia. Iron deficiency anemia can occur during pregnancy or due to heavy bleeding from uterine fibroids. In older populations this may represent a disorder by itself.
• Sleep Disordered Breathing: There are two forms for this condition. Patients with Increased Upper Airway Resistance Syndrome generally experience loud snoring and excessive fatigue and/or daytime sleepiness. Sleep Apnea Syndrome is less common in women during the premenopausal period unless the female is overweight or obese. It has also been linked to polycystic ovaries. In the postmenopausal period the prevalence of sleep apnea syndrome in women is almost equal to men.
• Depression: One of the features of endogenous depression (depression due to chemical imbalance and not necessarily to circumstances alone) is early morning awakenings. Patients usually wake up around 3 a.m. and cannot return to sleep.
• Nocturnal Eating/Drinking Syndrome: This syndrome is thought to be an illness by itself; although, some patients report that they are attempting strict daytime dieting.

The presence of one sleep disorder does not exclude another coexisting sleep disorder, therefore, patients benefit by having a comprehensive evaluation and, if necessary, a sleep study. Improving sleep quality results in improved quality of life. After all, the key to a long, happy, healthy life is to sleep well, eat well and exercise.

For an appointment with The Kazmir Center for Sleep Disorders at Saint Barnabas, please call (973) 322-6600.

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