Which hormonal findings are characteristic of sleep dysfunction in women?

Updated: Jan 31, 2019
  • Author: Gila Hertz, PhD, ABSM; Chief Editor: Selim R Benbadis, MD  more...
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Low estrogen levels may be responsible for affective symptoms, including depressed mood, anxiety, fatigue, forgetfulness, and decreased concentration.

Premenstrual insomnia

Sleep disturbances have been described as part of a constellation of physical and emotional symptoms—historically termed premenstrual syndrome (PMS)—occurring during the premenstrual (late luteal) phase of the menstrual cycle. Women who experience PMS report having sleep disturbances, including increased sleep latency and midsleep awakenings. They also report a significant increase in daytime sleepiness and increased difficulties in waking up. [36]

The hormonal fluctuations of the menstrual cycle have been recognized as possible contributors to the pathophysiology of mood disorders. In a small percentage of women, severe symptoms associated with PMS, including sleep disturbances, mood lability, irritability, and anxiety, may interfere with daily activities and cause a mood disorder. [37, 38]

In its current definition, as PMDD, the syndrome is included in the 1994 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Women with PMDD often show a pattern of advanced sleep phase with an earlier bedtime and early morning awakening.

Premenstrual hypersomnia

Premenstrual hypersomnia is a rare sleep disorder, occurring in association with the menstrual period, and is characterized by pronounced daytime sleepiness, which typically begins a few days prior to the onset of menstruation and ends a few days after the onset of menstruation.

Sleep in pregnancy

During the first trimester, an increase in total sleep time and daytime sleepiness is noted, whereas decreased sleep time and an increased number of nocturnal awakenings characterize the third trimester. The most common reasons for sleep disturbances given by pregnant women are frequent urination, heartburn, general discomfort, fetal movements, low back pain, leg cramps, and nightmares. [39, 40, 41]

Sleep disorders in menopause

These include the following:

  • Insomnia

  • SDB

  • Postmenopausal sleep disorders

Difficulties with sleep onset and sleep maintenance are common in menopausal women. In cases of severe hot flashes, women can wake up several times during the night with a sensation of heat, increased heart rate, and, occasionally, a feeling of anxiety. In turn, sleep fragmentation associated with hot flashes can cause daytime fatigue, mood lability, irritability, and memory lapses. For some menopausal women who do not experience distressing vasomotor symptoms, insomnia may be associated with menopause-related mood syndrome. [42]

Increased body mass and decreased endogenous estrogen and progesterone levels, combined with loud snoring, may increase the likelihood of upper airway obstruction, leading to SDB. Women with SDB are more likely than men to have insomnia complaints and frequently have concomitant depression and other major sleep disorders, such as RLS.

As women age, sleep becomes lighter and more fragmented. While maintaining long hours of uninterrupted sleep becomes more difficult, maintaining long hours of wakefulness during the day also becomes more difficult. This can result in waking periods during the night and increased daytime fatigue. Compared with young people, older individuals go to sleep early in the evening and get up earlier in the morning.

Health issues and chronic conditions, together with the aging process, can further disturb sleep. Arthritis and other painful conditions, chronic lung disease, certain medications, heartburn, and frequent trips to the bathroom have been shown to be detrimental to sleep continuation. The use of hypnotics increases with age, with usage by women significantly higher than that by age-matched men.

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