The way that women sleep continues to change in the years after menopause. Their sleep grows lighter and is more broken up.
This review examines the epidemiology, risk factors, diagnostic criteria, and therapies for the three most common sleep disorders in women.
The Hidden Risks of Poor Sleep in Women. Shift work and problems such as apnea may cause more trouble for women than men.
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Sleep Dysfunction in Women. Sleep Disorders in Elderly Women. Antiparkinson Agents, sleep in women, Dopamine Agonist. Hormonal factors, pain syndromes, and psychological issues, most particularly depression, are common concerns when addressing sleep dysfunction in women. Poor sleep quality and inadequate sleep affect many of the measures of quality of life, sleep in women.
Women are twice as likely as men to have difficulties falling asleep or maintaining sleep, sleep in women, although before puberty no significant differences are apparent. See Etiology and Epidemiology. Persistent insomnia may lead to daytime fatigue, decreased daytime function, sleep in women and concentration problems, higher incidents of automobile accidents, and depression. Patients with persistent insomnia tend to have more psychological and medical problems including those of the respiratory, gastrointestinal, and musculoskeletal systems.
Over the past decade, studies have focused on the association between reduced sleep and weight gain in healthy individuals. Evidence has grown to support a role for reduced sleep time as a risk factor for weight gain and obesity. A few mechanisms have been proposed to explain this risk. Sleep deprivation causes fatigue, which may lead to decreased physical activity. Shorter sleep time allows for additional time for food consumption. Sleep disturbance has been also associated with changes in the hormone leptin, an appetite-inhibiting hormone.
Reduced sleep has been associated with a drop in the diurnal amplitude of leptin. No such associations were found in men. A dose dependent association between sleep problems reported as often and always and risk for fibromyalgia has been reported in women. Healthy women who reported poor sleep also reported greater psychological distress, including depression and anger. These feelings were not associated with the same degree of sleep disruption in men.
In addition, daytime fatigue has been associated with increased neuropsychological impairment, sleep in women. Patients with sleep apnea are at higher risk for traffic accidents and increased mortality rates related to cardiovascular complications. See Prognosis, Presentation, Treatment, and Medication. SDB involves various degrees of pharyngeal obstruction ranging from UARS to OSA. Obstruction results from high negative pressure generated by the inspiratory effort and failure of the dilating upper airway muscles to maintain airway patency.
Contributing factors are degree of muscle atonia and various anatomic abnormalities that increase airway occlusion eg, enlarged tonsils, macroglossia, even nasal congestion. Obesity is a known risk factor for OSA. Women with OSA are likely to be more obese than men, though fat distribution is different. The prevalence, nature, and severity of OSA in women changes with menopause.
Postmenopausal women have twice the rate of OSA that premenopausal women do. Women demonstrate more partial obstructive events hypopneas than complete OSAs. In addition, the duration of hypopneas, when present, tends to be shorter in women than in men.
OSA is mostly evident during rapid eye movement REM sleep. Regardless of age, OSA is less severe in women than in men. A possible explanation is the effect of a female hormone probably progesterone on the activity of the dilator muscle of the pharynx.
How to arouse a woman sexually, a waking disorder that usually occurs before sleep onset, is associated with discomfort in the calves causing restlessness in the legs, which is relieved by movement, sleep in women.
RLS is more prevalent in women than men and occurs at higher rates during pregnancy. Iron deficiency has been implicated in the pathophysiology of RLS. The possibility of a genetic basis has been suggested for primary RLS. Periodic limb movement disorder PLMDoccurring during sleep, involves isolated periodic movements of the lower limbs, usually followed by arousal from sleep.
In severe cases, frequent leg movements can cause significant sleep interruption, resulting in complaints of insomnia or excessive sleepiness. These features are related closely to features normally occurring exclusively during rapid eye movement REM sleep. The symptom of cataplexy, for example, which involves sudden loss of muscle tone during waking hours, is identical to muscle paralysis normally experienced during REM sleep.
Thus, narcolepsy has been hypothesized to represent a dissociative process of REM sleep mechanisms and an intrusion of these mechanisms into waking hours. The most common circadian sleep disorder is delayed sleep phase syndrome DSPSwith typical onset at puberty. DSPS may also relate to an eveningness chronotype, an individual preference for increased activity at night.
Thus, gender differences are possibly the result of sex influences on the regulation of the biologic clock. REM sleep behavior disorders RBD. RBD is classified as a parasomnia andpresents as vivid dreams with complex, repetitive, and often violent motor behaviors during REM sleep, which classically is a time of muscle atonia. Both patients and their bed partners are at increased risk of injury from these movements.
Idiopathic RBD has been associated with the development of Parkinson disease. Hormonal factors, chronic pain conditions, and psychiatric conditions, particularly mood disorders, are closely associated with insomnia.
In general, sex steroids play a role in the etiology of sleep disorders in women, either by having sleep in women direct effect on sleep processes or through their effect on mood and emotional state. Sex steroids influence electroencephalographic sleep during the luteal phase by increasing the electroencephalographic frequency and core body temperature. In addition, decreased level of estrogen during menopause has been associated with increased upper airway resistance, snoring, and OSA.
With less time for themselves, they often cut back on sleep. In addition to sleep deprivation, increased stress has been associated with sleep-onset insomnia. Mood disorders are more getting a girl in bed in women than in men, sleep in women, primarily those that are unique to the female reproductive system eg, premenstrual dysphoric disorder [PMDD], sleep in women affective disorder, postpartum depression, perimenopausal mood disorder.
While anxiety disorders often are associated with trouble falling asleep, depression typically is associated with early morning awakening. The frequency and severity of major sleep disorders, such as SDB, RLS, and PLMD, increase with age. Obesity plays an important role in the pathophysiology of SDB. RLS has also been shown to have a correlation with body mass index BMI.
The difficulty most frequently reported by women is insomnia. Insomnia rates during puberty have been described in girls, but not in boys. The incidence and prevalence of SDB during pregnancy is unknown. Generally, sleep studies have found no evidence of significant SDB during sleep in women, possibly reflecting increased circulating levels of progesterone, sleep in women.
Higher rates of RLS have been reported in women as compared with men and Europeans as compared with Asians. Reported rates among Caucasians and African Americans are similar. Smoking, diabetes mellitus, pregnancy, increasing age, and greater BMI significantly increase the incidence of RLS. Iron deficiency anemia has also been associated with RLS. The prevalence of obesity is higher in black women than in white women.
Obesity places women at higher risk of developing OSA, particularly after menopause. Sleep apnea is pervasive in non-European—American women. Compared with European-American women, non-European—American women have more blood oxygen desaturations during sleep.
No significant differences were found between Caucasians and African Americans in the risk for RLS. In general, gender differences have been found in circadian rhythm regulation and the homeostatic sleep process. Specifically, chronotype studies have found that men have a stronger tendency toward eveningness compared with women. Sex differences in the sleep-wake cycle appear to increase in response to sleep loss, suggesting different regulation of sleep homeostasis between men and women.
Compared with men, women show more slow-wave sleep SWSmore spindling activity during SWS, and slower age-related reduction of SWS. Starting at puberty, the incidence of insomnia in females differs from that of males. At puberty, insomnia rates for girls are almost triple that of boys. Conditions such as bipolar disorder, stable coronary artery disease, and certain anxiety and depressive disorders that exhibit higher rates in women are associated with insomnia.
While women have sleep in women prevalence of OSA than men, pregnancy and menopause increase the risk for sleep apnea. Symptoms of RLS are more frequently reported by women. In general, sleep is sounder and less prone to disturbances in younger people. As women age, physical and hormonal changes take place that make sleep lighter and less sound. Risk of insomnia, sleep apnea, periodic leg movements, and restless sleep in women syndrome increase as women get older.
In the years surrounding menopause, sleep disturbances occur with increased frequency. Women take longer to fall asleep, wake up more often at night, and are more tired during the day. Hot flashes and night sweats, associated with decreased levels of estrogen, may contribute to midsleep awakenings. The prevalence of SDB increases significantly after menopause. During postmenopausal years, sleep efficiency further decreases, and waking sleep in women sleep onset increases.
Factors affecting sleep during this period include pain, certain medical and emotional conditions, and physical discomfort. Shortly after treatment with nasal continuous positive airway pressure CPAP sleep in women, patients report increased alertness, decreased nocturnal awakenings, and an improved sense of well-being.
The prognosis of persistent insomnia is good when the treatment plan involves resolution of the underlying problem. Because of the large number of contributing factors, effective treatment relies on an understanding of the differential diagnosis and available treatment options. Studies have shown that sleep problems are linked to more physical and emotional disturbances in women than in men.
Among women, those with worse sleep showed more emotional distress and depression. They also had a higher BMI, more inflammation, and less sensitivity to insulin.
Insomnia is a significant comorbidity in many disorders. The most common disorders associated with insomnia are psychiatric illnesses. Major depression and dysthymia are most closely associated with insomnia. Numerous studies have also shown a close association of chronic pain syndromes with insomnia.
Snoring, often a sign of partial airway obstruction, has been shown to be associated with high blood pressure and increased risk sleep in women OSA. Snoring increases during pregnancy, particularly during the last trimester. In addition, snoring may be responsible sleep in women nighttime increases in blood pressure in preeclampsia. Snoring is also a risk factor in the development of OSA in postmenopausal women, sleep in women.
Other contributing factors are weight and neck size. In addition to sleep disturbances and daytime sleepiness, OSA can lead to cardiovascular complications.
This is particularly important because in most sleep labs, the time interval between initial evaluation, ordering of a sleep study, and initiation of treatment can be as long as weeks and even months. Physicians should educate women about habits and behaviors that help promote good sleep. These behaviors help most women sleep better, regardless of the type of sleep problem. Association of sleep duration with weight and weight gain: a prospective follow-up study.
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When is pain related to how to get women to sleep with you distress and daily functioning in fibromyalgia syndrome?
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Pregnancy-related affective episodes among women with recurrent depression. Driver HS, Shapiro CM. A longitudinal study of sleep stages in young women during pregnancy and postpartum. Keefe DL, Watson R, Naftolin F. Hormone replacement therapy may alleviate sleep apnea in menopausal women: a pilot study. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Please confirm that you would like to log out of Medscape.
If you log out, you will be required to enter your username and password the next time you visit. Terminology relating to sleep dysfunction includes the following:. Insomnia - Difficulty with falling asleep or staying asleep. Sleep-onset insomnia - Difficulty with falling asleep. Sleep-maintenance insomnia - Fragmented sleep, difficulty with maintaining sleep. Sleep-disordered breathing SDB - Some degree of sleep-related upper airway obstruction, ranging in severity from upper airway resistance syndrome UARS to obstructive sleep apnea OSA.
Restless legs syndrome RLS - Characterized by the urge to move legs or other limbs during periods of rest or inactivity. Occurrence in the United States. When treated, sleep apnea has an excellent prognosis. OSA has been associated with hypertension, as well as with insulin resistance and metabolic disease. As mentioned, psychiatric conditions, sleep in women depression and anxiety disorders, are the most common comorbidities with insomnia. RLS may be secondary to medical conditions that have iron deficiency, including iron deficiency anemia, renal disease, and pregnancy.
Women who present with excessive daytime sleepiness should be warned about the dangers of driving and operating heavy machinery. Establish a relaxing presleep routine, such as reading or listening to relaxing music. Avoid smoking close to bedtime; avoid sleeping pills for periods longer than few weeks; be careful not to drink alcohol while taking sleeping pills.
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