Sleep in Women

ABSTRACT

The timing and continuity of sleep in healthy individuals is regulated by the synchronous function of the sleep homeostasis and the endogenous circadian rhythms. Multiple factors affect these two processes and the way they interact. Sleep disorders may manifest differently in men and women and these differences are particularly notable during pregnancy, lactation, and menopause. Insomnia may occur relatively commonly during pregnancy and in the postpartum, and may be the result of either a primary sleep disorder, such as obstructive sleep apnea (OSA), movement disorders such as restless legs syndrome (RLS), or sometimes depression, especially in the postpartum period. Obstructive sleep apnea may contribute to a higher risk of hypertension during pregnancy and doubles the risk for preeclampsia and preterm birth. Snoring, a frequent symptom of OSA, increases in frequency during pregnancy. Restless legs syndrome is more common in pregnant women, is more frequent in the third trimester of pregnancy, and tends to improve dramatically after delivery. Factors associated with increased RLS in pregnancy may be related to iron and folate metabolism. Risk for OSA increases after menopause and presentation with insomnia can delay the diagnosis of OSA. Various treatment options for sleep disorders in women are discussed.

KEYWORDS

Sleep - pregnant - women - biologic rhythms

REFERENCES

• 1 Czeisler C A, Duffy J F, Shanahan T L et al.. Stability, precision, and near-24-hour period of the human circadian pacemaker.  Science. 1999;  284 (5423) 2177-2181
• 2 Kalinchuk A V, Urrila A S, Alanko L et al.. Local energy depletion in the basal forebrain increases sleep.  Eur J Neurosci. 2003;  17 (4) 863-869
• 3 Dijk D J, Czeisler C A. Contribution of the circadian pacemaker and the sleep homeostat to sleep propensity, sleep structure, electroencephalographic slow waves, and sleep spindle activity in humans.  J Neurosci. 1995;  15 (5 Pt 1) 3526-3538
• 4 The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Darien, IL: American Academy of Sleep Medicine; 2007
• 5 McCarley R W. Neurobiology of REM and NREM sleep.  Sleep Med. 2007;  8 (4) 302-330
• 6 Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults.  N Engl J Med. 1993;  328 (17) 1230-1235
• 7 Driver H S, Baker F C. Menstrual factors in sleep.  Sleep Med Rev. 1998;  2 (4) 213-229
• 8 Hedman C, Pohjasvaara T, Tolonen U, Suhonen-Malm A S, Myllylä V V. Effects of pregnancy on mothers' sleep.  Sleep Med. 2002;  3 (1) 37-42
• 9 Driver H S, Shapiro C M. A longitudinal study of sleep stages in young women during pregnancy and postpartum.  Sleep. 1992;  15 (5) 449-453
• 10 Kapsimalis F, Kryger M. Sleep breathing disorders in the U.S. female population.  J Womens Health (Larchmt). 2009;  18 (8) 1211-1219
• 11 Winkelmann J, Wetter T C, Collado-Seidel V et al.. Clinical characteristics and frequency of the hereditary restless legs syndrome in a population of 300 patients.  Sleep. 2000;  23 (5) 597-602
• 12 Lee K A, Zaffke M E, McEnany G. Parity and sleep patterns during and after pregnancy.  Obstet Gynecol. 2000;  95 (1) 14-18
• 13 Manconi M, Govoni V, De Vito A et al.. Pregnancy as a risk factor for restless legs syndrome.  Sleep Med. 2004;  5 (3) 305-308
• 14 Lee K A, Zaffke M E, Baratte-Beebe K. Restless legs syndrome and sleep disturbance during pregnancy: the role of folate and iron.  J Womens Health Gend Based Med. 2001;  10 (4) 335-341
• 15 Cornelius J R, Tippmann-Peikert M, Slocumb N L, Frerichs C F, Silber M H. Impulse control disorders with the use of dopaminergic agents in restless legs syndrome: a case-control study.  Sleep. 2010;  33 (1) 81-87
• 16 Goksan B, Gunduz A, Karadeniz D et al.. Morning headache in sleep apnoea: clinical and polysomnographic evaluation and response to nasal continuous positive airway pressure.  Cephalalgia. 2009;  29 (6) 635-641
• 17 Schutte S, DelConte A, Gross A et al.. Self reported snoring and sleep in high risk pregnancies.  Sleep Res. 1995;  24 342
• 18 Franklin K A, Holmgren P A, Jönsson F, Poromaa N, Stenlund H, Svanborg E. Snoring, pregnancy-induced hypertension, and growth retardation of the fetus.  Chest. 2000;  117 (1) 137-141
• 19 Pien G W, Fife D, Pack A I, Nkwuo J E, Schwab R J. Changes in symptoms of sleep-disordered breathing during pregnancy.  Sleep. 2005;  28 (10) 1299-1305
• 20 Champagne K, Schwartzman K, Opatrny L et al.. Obstructive sleep apnoea and its association with gestational hypertension.  Eur Respir J. 2009;  33 (3) 559-565
• 21 Louis J M, Auckley D, Sokol R J, Mercer B M. Maternal and neonatal morbidities associated with obstructive sleep apnea complicating pregnancy.  Am J Obstet Gynecol. 2010;  202 (3) 261, e1–e5
• 22 Poyares D, Guilleminault C, Hachul H et al.. Pre-eclampsia and nasal CPAP: part 2. Hypertension during pregnancy, chronic snoring, and early nasal CPAP intervention.  Sleep Med. 2007;  9 (1) 15-21
• 23 Teichtahl H, Wang D. Sleep-disordered breathing with chronic opioid use.  Expert Opin Drug Saf. 2007;  6 (6) 641-649
• 24 Walker J M, Farney R J, Rhondeau S M et al.. Chronic opioid use is a risk factor for the development of central sleep apnea and ataxic breathing.  J Clin Sleep Med. 2007;  3 (5) 455-461
• 25 Webster L R, Choi Y, Desai H, Webster L, Grant B J. Sleep-disordered breathing and chronic opioid therapy.  Pain Med. 2008;  9 (4) 425-432
• 26 Pavlova M K, Duffy J F, Shea S A. Polysomnographic respiratory abnormalities in asymptomatic individuals.  Sleep. 2008;  31 (2) 241-248
• 27 Young T, Finn L, Austin D, Peterson A. Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study.  Am J Respir Crit Care Med. 2003;  167 (9) 1181-1185
• 28 McDaid C, Durée K H, Griffin S C et al.. A systematic review of continuous positive airway pressure for obstructive sleep apnoea-hypopnoea syndrome.  Sleep Med Rev. 2009;  13 (6) 427-436
• 29 Young T, Rabago D, Zgierska A, Austin D, Laurel F. Objective and subjective sleep quality in premenopausal, perimenopausal, and postmenopausal women in the Wisconsin Sleep Cohort Study.  Sleep. 2003;  26 (6) 667-672
• 30 Saletu B. Sleep, vigilance and cognition in postmenopausal women: placebo-controlled studies with 2 mg estradiol valerate, with and without 3 mg dienogest.  Climacteric. 2003;  6 (Suppl 2) 37-45
• 31 Anderer P, Semlitsch H V, Saletu B et al.. Effects of hormone replacement therapy on perceptual and cognitive event-related potentials in menopausal insomnia.  Psychoneuroendocrinology. 2003;  28 (3) 419-445
• 32 Saletu B, Anderer P, Gruber D, Metka M, Huber J, Saletu-Zyhlarz G M. Hormone replacement therapy and vigilance: double-blind, placebo-controlled EEG-mapping studies with an estrogen-progestogen combination (Climodien, Lafamme) versus estrogen alone in menopausal syndrome patients.  Maturitas. 2002;  43 (3) 165-181
• 33 Budhiraja R, Budhiraja P, Quan S F. Sleep-disordered breathing and cardiovascular disorders.  Respir Care. 2010;  55 (10) 1322-1332 discussion 1330-1332