PCOS is the most common cause of female infertility. It affects as many as 5 million U.S. women of reproductive age. But PCOS affects women long after their child-bearing years too.

Studies have found links between PCOS and other health problems, including sleep apnea.

The connection between PCOS and sleep apnea

Obstructive sleep apnea (OSA) is a common and serious sleep disorder that causes you to stop breathing during sleep. When you have OSA, your airway becomes blocked repeatedly during sleep. This limits the amount of air reaching your lungs.

One study reports that the risk for OSA is at least 5-to-10-fold higher in women with PCOS compared to those without PCOS.

Long-term, untreated sleep apnea can contribute to a range of health problems, including type 2 diabetes.

This is important because women with PCOS are often insulin resistant, which increases their risk for developing type 2 diabetes. In fact, more than half of women with PCOS develop type 2 diabetes by age 40.

Research has found that women with PCOS may be more likely to experience poor sleep quality or chronic daytime sleepiness. These may be symptoms of OSA.

If you feel tired or unrefreshed after waking up even though you have had a full night of sleep, it may be due to OSA. During the day, you may feel fatigued, have difficulty concentrating or may even unintentionally fall asleep. This is because your body is waking up many times during the night when you have OSA.

Untreated sleep apnea may worsen other PCOS symptoms. Researchers have suggested that treating OSA may positively impact the health and quality of life with PCOS by reducing the risk of health problems such as type 2 diabetes, obesity, and cardiovascular disease.

The leading treatment for sleep apnea is continuous positive airway pressure (CPAP) therapy.

If you’re experiencing symptoms of OSA, contact an accredited sleep center near you for an evaluation.

Medical review by Reeba Mathew, MD, FCCP

Related:

• Sleep & women
• Sleep-disordered breathing & intimacy
• The sound of silence: women keep quiet about snoring, sleep apnea
• Women with OSA and cardiac symptoms have high incidence of cardiac dysfunction

Authored by:

Kate Robards

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What is seasonal affective disorder?

SAD is a type of depression that occurs at the same time each year. Often beginning in late fall or early winter, SAD is treatable and usually resolves within a few months.

How do know if you have SAD? The symptoms are like those of depression. Many people experience sadness, hopelessness, a loss of interest in activities, fatigue, and social withdrawal.

More than 10 million people in the U.S. may have seasonal depression, and it’s more common in women, young people, and those who live far from the equator. Shorter days and fewer hours of sunlight may cause a hormonal imbalance that makes you feel depressed.

How does SAD affect sleep?

If you have SAD, you may experience sleep problems. People with SAD often feel excessively sleepy during the day and sleep longer than usual at night. According to research, people with SAD sleep two hours longer or more per night in the winter compared with the summer.

You may have difficulty waking from a long sleep or feel the need to nap repeatedly throughout the day. Napping may not provide relief from feeling sleepy, though.

Also, nightmares are common among people with SAD. One study found that 16% of participants with SAD had frequent nightmares compared with 2.4% of participants without SAD.

Healthy sleep is essential to your overall health. It helps you balance your mood and emotions. Without healthy sleep, you’re more likely to struggle with feelings of depression and anxiety.

How to combat SAD

Although SAD usually resolves within a few months when the seasons change, there are treatment options available. The most common treatment is light therapy. During light therapy, a bright artificial light mimics sunshine exposure that’s missing during winter months. Research shows that daily light therapy may reduce depressive symptoms as much as 83% after one month.

Added attention to self-care also may help. Going outdoors, getting regular exercise, eating energy-boosting foods, and engaging in social interactions may reduce symptoms.

Establishing healthy sleep habits can help if you have difficulty sleeping as a result of seasonal depression. Adjusting your daily behaviors and routines can impact your quality of sleep. Follow these sleep hygiene tips to improve your ability to fall asleep and stay asleep.

If light therapy and self-care don’t resolve your symptoms, cognitive behavioral therapy or use of antidepressant medications are also treatment options.

If you continue to experience poor sleep along with symptoms of depression, seek help from your health care provider.

Medical review by Lawrence Epstein, MD

Authored by:

Kate Robards

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A recent study found that 36 percent of women in their third trimester had restless legs syndrome (RLS). Half of the women with RLS had moderate to severe symptoms.

The study involved 1,563 pregnant women in their third trimester of pregnancy. Those with RLS were twice as likely to report poor sleep quality and poor daytime function. Pregnant women with RLS were also more likely to have extreme daytime sleepiness. Results are published in the July 15 issue of the Journal of Clinical Sleep Medicine.

Restless legs syndrome is a sleep disorder that causes an intense desire to move your legs. The unpleasant, tingling sensation of RLS can make it hard to fall asleep at night. Women are almost two times as likely as men to develop the disorder.

Data from the study show that RLS is strongly associated with poor sleep quality, daytime sleepiness, and poor daytime function. These symptoms are frequent complaints during pregnancy.

Doctors may overlook patient complaints of poor sleep, lead author Galit Levi Dunietz, PhD, said in a press release. This study suggests that such symptoms could be signs of RLS. Identifying and treating RLS during pregnancy can help minimize uncomfortable symptoms, Dunietz noted.

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New research involved 97 women with advanced breast cancer. The women had an average age of 55 years.

They wore a wrist actigraph for three days. The device records activity patterns to identify sleep and wakefulness. Overall, participants spent about eight hours in bed at night, but slept for only 6.5 hours.

Results show that higher SE was significantly associated with lower death over the next six years. Average survival was 68.9 months for efficient sleepers. The average survival rate was 33.2 months for participants with poor SE. Further study found a 10 percent increase in SE reduced the risk of death by 32 percent.

“Good sleep seems to have a strongly protective effect, even with advanced breast cancer,” said Dr. Oxana Palesh.  She is assistant professor in the Department of Psychiatry and Behavioral Sciences at Stanford University and research director of the Stanford Cancer Survivorship.

The National Cancer Institute projects about 40,000 will die from breast cancer in the U.S. this year.

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The research team, led by Primary Investigator Elma Baron, MD, presented their data this spring at the International Investigative Dermatology Meeting in Edinburgh, Scotland in an abstract titled “Effects of Sleep Quality on Skin Aging and Function.”

“Our study is the first to conclusively demonstrate that inadequate sleep is correlated with reduced skin health and accelerates skin aging. Sleep deprived women show signs of premature skin aging and a decrease in their skin’s ability to recover after sun exposure,” said Dr. Baron, Director of the Skin Study Center at UH Case Medical Center and Associate Professor of Dermatology at Case Western Reserve University School of Medicine. “Insufficient sleep has become a worldwide epidemic. While chronic sleep deprivation has been linked to medical problems such as obesity, diabetes, cancer and immune deficiency, its effects on skin function have previously been unknown.”

Skin functions as an important barrier from external stressors such as environmental toxins and sun-induced DNA damage. The research team set out to determine if skin function and appearance is also impacted by sleep quality, which is vital to the growth and renewal of the body’s immune and physiological systems.

The study involved 60 pre-menopausal women between the ages of 30 and 49, with half of participants falling into the poor quality sleep category. The classification was made on the basis of average duration of sleep and the Pittsburgh Sleep Quality Index (PSQI), a standard questionnaire-based assessment of sleep quality. The study involved a visual skin evaluation and participation in several non-invasive skin challenge tests including UV light exposure and skin barrier disruption. Additionally, participants filled out a sleep log for one week to quantify sleep duration.

The researchers found statistically significant differences between good and poor quality sleepers. Using the SCINEXA skin aging scoring system, poor quality sleepers showed increased signs of intrinsic skin aging including fine lines, uneven pigmentation and slackening of skin and reduced elasticity. In this system, a higher score means a more aged appearance. The average score in the good quality sleepers was 2.2 versus 4.4 in poor quality sleepers. They found no significant difference between the groups in signs of extrinsic aging, which are attributed primarily to sun exposure, such as coarse wrinkles and sunburn freckles.

The researchers found that good quality sleepers recovered more efficiently from stressors to the skin. Recovery from sunburn was more sluggish in poor quality sleepers, with erythema (redness) remaining higher over 72 hours, indicating that inflammation is less efficiently resolved. A Transepidermal Water Loss (TEWL) test was used at various time points to determine the ability of the skin to serve as an effective barrier against moisture loss. In measurements 72 hours after a skin barrier stressor (tape-stripping), the recovery of good quality sleepers was 30% higher than poor quality sleepers (14% vs. -6%) demonstrating that they repair the damage more quickly.

Additionally, poor quality sleepers were significantly more likely to have a higher Body Mass Index (BMI). For example, 23 percent of good quality sleepers were obese compared to 44 percent of poor quality sleepers. Not surprisingly, self perception of attractiveness was significantly better in good quality sleepers (mean score of 21 on self evaluation) vs. poor quality sleepers (mean score of 18).

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Although exercise is known to improve sleep for people in general, studies in menopausal women haven’t been conclusive. That’s why the researchers at the Pittsburgh site of the Study of Women’s Health Across the Nation (SWAN) focused exclusively on women with hot flashes or night sweats and also drew the distinction between leisure time and household activity.

The 27 white and 25 African American women in the study, who were 54 to 63 years old, kept diaries rating their sleep and wore sleep monitors. They also completed questionnaires about their physical activity, including routine household and caregiving chores requiring light, moderate, or vigorous effort as well as sports and exercise.

The results showed that the women who had higher levels of activity reported better sleep and fewer nighttime awakenings. The positive effects were mainly associated with household and caregiving activity rather than sports or exercise.

But there were significant racial and body mass differences: The advantages were mainly in women who were white and not obese. More study needs to be done to find out why African American and obese women may not get the same sleep benefits, but it will likely be important to distinguish between leisure and non-leisure time activity to do so, said the authors.

Many medical problems hinder a woman’s ability to sleep well. Treating an underlying medical problem often will lead to improved sleep. These are some of the most common medical problems that affect the sleep of women:

•Acid reflux
•Arthritis
•Asthma
•Back pain
•Epilepsy
•Fibromyalgia
•Multiple sclerosis
•Parkinson’s disease

If you are experiencing any of these problems and feel like they are affecting your sleep, AASM encourages you to talk to your doctors about sleep problems or visit www.sleepeducation.com for a searchable directory of sleep centers.

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The study, published in the March issue of Occupational and Environmental Medicine, included 1,101 women with the most common form of advanced ovarian cancer, 389 women with borderline ovarian cancer and 1,832 women that were part of a healthy comparison group.

Among the women with advanced cancer, about one quarter had ever worked the night shift, compared with a third of the women with early-stage cancer and a fifth of the healthy comparison group.

Night shift work was associated with a 24 percent higher risk of advanced ovarian cancer and a 49 percent higher risk of early-stage ovarian cancer, the researchers found. However, the risk of cancer was 7 percent lower in women who described themselves as night types.

“We found evidence suggesting an association between shift work and ovarian cancer,” the researchers, led by Dr. Parveen Bhatti, an epidemiology researcher at the Fred Hutchinson Cancer Research Center, wrote in the study. “However, there was suggestive evidence of a decreased risk of ovarian cancer among women reporting a preference for activity during evenings rather than mornings.”

Approximately 22,000 women are diagnosed with ovarian cancer every year in the United States, according to the study, and over 15,000 of them will die from the disease. There are very few known risk factors, the researchers wrote in the study, which makes further research to better understand how shift work raises your risk crucial.

The researchers suggested that melatonin, a hormone that is typically produced at night and regulates reproductive hormones such as estrogen, may be to blame for the increased risk. Melatonin suppresses estrogen levels, but is not produced in the presence of ambient light, such as the kind shift workers would be exposed to, according to the study.

To learn more about shift work disorder and other common sleep disorders, visit www.sleepeducation.com.

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“Physicians need to address the presence of sleep disturbance among their survivors, and modifiable risk factors, e.g., hot flashes, urinary urgency, and bowel complaints, should be addressed,” Dr. Shannon Westin from the University of Texas MD Anderson Cancer Center in Houston told Reuters Health by email.

Dr. Westin and her team presented their results March 9 at the Society of Gynecologic Oncology‘s annual meeting in Los Angeles.

Sleep disturbance has a huge impact on quality of life, work functioning, economic health, and psychosocial functioning. In addition, it can negatively impact a patient’s health and immune system, the researchers said.

Their survey of 1,018 patients found that 557, or 55%, had trouble sleeping – and 64% of those said sleep loss began during or after cancer treatment.

A few factors may coincide with the risk of sleep loss, the study found. Younger patients and patients with ovarian and cervical cancers were more likely to sleep poorly.

When the researchers analyzed data from more than one variable, they found other factors linked to sleep problems, including hot flashes, bowel and bladder issues and past treatment with chemotherapy, radiation or both.

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“We discovered that these women had more restless sleep than the always married women,” said Wendy Troxel, PhD, the study’s lead author. “We speculate that these findings may reflect a ‘newlywed effect.’ These women may be less adjusted to sleeping with their partner than the ‘stably married’ women.”

This study, which originally was published in the July 2010 issue of the journal SLEEP, involved 360 middle-aged women with an average age of 51 years. They reported their relationship status at annual visits. Their sleep also was monitored for three nights.

Results show that women who were stably married had better subjective and objective sleep than unmarried women. Women who lost a partner during the eight-year follow-up period had the worst sleep.

The sleep of women who gained a partner during the study was similar to that of women in stable marriages. But study author Wendy Troxel, PhD, told the AASM that newlyweds were more restless.

“Troxel and colleagues offer additional support for the notion that the underlying causes of sleep disorders are socially determined, and are a part of a causal chain between social experience and health,” Lauren Hale, PhD, Department of Preventive Medicine, State University of New York in Stony Brook, N.Y., wrote in a commentary on the study.”This idea that sleep is a mechanism through which social factors affect health considerably broadens the scope of sleep research to include social, environmental, policy and cultural factors. Studying sleep through a social epidemiological perspective may create opportunities to design treatments, policies, and interventions that may simultaneously improve population sleep and health.”

AASM encourages patients to talk to their doctors about sleep problems or visit our searchable directory of sleep centers.

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OSA is characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. These pauses can last from at least ten seconds to minutes, and may occur five to 30 times or more an hour; this can lead to cardiovascular disease. The objective of the trial was to measure the incidence of OSA among pregnant and reproductive women.

“We found a 31 percent incidence of abnormal echocardiograms among symptomatic women with obstructive sleep apnea,” said Laura K.P. Vricella, MD, fellow, Maternal-Fetal Medicine at MetroHealth Medical Center. “Further investigation is needed to understand the relationship between obstructive sleep apnea and cardiovascular disease and their impact on pregnant women.”

The cohort was made up of 1,265 women between the ages of 15-45 who met the Apnea-Hypopnea Index (AHI) criteria for OSA based on nocturnal polysomnogram testing. Data was gathered from 2005-2012 at a tertiary care center. Sleep lab data and individual transthoracic echocardiogram reports were reviewed.

The results for the 1,265 women were broken into three categories of AHI:

•665 (53%) mild
•305 (24%) moderate
•295 (23%) severe

Those with mild and severe AHI were similar in age, race and Body Mass Index.

Research revealed that women who all had cardiac symptoms had a 31 percent incidence of cardiac dysfunction. It was determined than an echocardiogram should be considered during the clinical management of these women.

February is American Heart Month. According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death for both men and women, but heart disease is preventable and controllable.

Risk factors for heart disease include high blood pressure, high cholesterol, smoking, diabetes, being overweight or obese, poor diet, physical inactivity and excessive alcohol use.

One often overlooked risk factor for heart disease is obstructive sleep apnea. If you think you might have sleep apnea, it’s important for you to talk to your doctor or visit www.sleepeducation.com for a searchable directory of sleep centers.

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