CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2024; 84(11): 1043-1049
DOI: 10.1055/a-2371-0763
GebFra Science
Review

Sleep Disorders in Women: What Should a Gynecologist Know?

Schlafstörungen bei Frauen: Was sollte ein Gynäkologe wissen?
Alperen Aksan
1   Ankara Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Turkey (Ringgold ID: RIN146997)
,
Berna Dilbaz
1   Ankara Etlik Zübeyde Hanım Kadın Hastalıkları Eğitim ve Araştırma Hastanesi, Ankara, Turkey (Ringgold ID: RIN146997)
› Author Affiliations

Abstract

Women often face sleep disturbances during key life stages such as adolescence, pregnancy, postpartum period, and perimenopause, influenced by hormonal fluctuations and conditions like polycystic ovary syndrome (PCOS) and premenstrual syndrome (PMS). The goal is to explore women’s sleep disorders as classified in the International Classification of Sleep Disorders-3 (ICSD-3). Through a literature review, this study assesses the management of sleep disorders in women, particularly focusing on the link between gynecological disease and sleep disorders. It scrutinizes landmark research in diagnosing and treating women’s sleep disorders. Observations indicate that physiological changes during adolescence, pregnancy, postpartum, and perimenopause can cause sleep issues, commonly addressed by gynecologists. Conditions like PCOS and PMS are notably linked to increased sleep disorder occurrences. The conclusion underscores the importance of gynecologists’ awareness of the heightened risk of sleep disturbances in women, who often present these issues during consultations.

Zusammenfassung

In wichtigen Lebensabschnitten wie Adoleszenz, Schwangerschaft, Kindbett und Perimenopause werden Frauen oft mit Schlafstörungen konfrontiert, die durch Hormonschwankungen und Krankheiten wie polyzystisches Ovarsyndrom (PCOS) und prämenstruelles Syndrom (PMS) hervorgerufen werden. Das Ziel war, Schlafstörungen, die in der Internationalen Klassifikation von Schlafstörungen (ICSD-3) aufgeführt sind, bei Frauen zu erforschen. Mithilfe eines Literaturüberblicks bewertet diese Studie das Management von Schlafstörungen bei Frauen und richtet ein besonderes Augenmerk auf den Zusammenhang zwischen gynäkologischen Erkrankungen und Schlafstörungen. Wegweisende Studien zur Diagnose und Behandlung von Schlafstörungen bei Frauen wurden untersucht. Alle Beobachtungen deuten darauf hin, dass physiologische Veränderungen in der Adoleszenz, in der Schwangerschaft, im Kindbett und in der Perimenopause zu Schlafstörungen führen können, mit denen sich Gynäkolog*innen oft befassen müssen. Krankheiten wie PCOS und PMS sind bekanntlich mit einem erhöhten Auftreten von Schlafstörungen verbunden. Die Schlussfolgerung hebt hervor, wie wichtig es ist, dass sich Gynäkolog*innen das höhere Risiko von Schlafstörungen bei Frauen bewusst sind, da Frauen dieses Problem oft während der Untersuchung ansprechen.



Publication History

Received: 28 March 2024

Accepted after revision: 21 July 2024

Article published online:
15 August 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
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  • References

  • 1 Tao MF, Sun DM, Shao HF. et al. Poor sleep in middle-aged women is not associated with menopause per se. Braz J Med Biol Res 2016; 49: e4718
  • 2 American Psychiatric Association. Sleep-wake disorders: DSM-5® selections. Washington, D.C.: American Psychiatric Association Publishing; 2015
  • 3 Bruyneel M. Sleep disturbances in menopausal women: Aetiology and practical aspects. Maturitas 2015; 81: 406-409
  • 4 Otte JL, Rand KL, Landis CA. et al. Confirmatory factor analysis of the Pittsburgh Sleep Quality Index in women with hot flashes. Menopause 2015; 22: 1190-1196
  • 5 Hsu HC, Tsao LI, Lin MH. Improving sleep quality interventions among menopausal women with sleep disturbances in Taiwan: a preliminary study. Appl Nurs Res 2015; 28: 374-380
  • 6 Sagayadevan V, Abdin E, Binte Shafie S. et al. Prevalence and correlates of sleep problems among elderly Singaporeans. Psychogeriatrics 2017; 17: 43-51
  • 7 Monterrosa-Castro Á, Portela-Buelvas K, Salguedo-Madrid M. et al. Instruments to study sleep disorders in climacteric women. Sleep Sci 2016; 9: 169-178
  • 8 Zhou Y, Yang R, Li C. et al. Sleep disorder, an independent risk associated with arterial stiffness in menopause. Sci Rep 2017; 7: 1904
  • 9 Chen ZY, Zhang LF, Zhang YQ. et al. Blood tests for prediction of deep endometriosis: A case-control study. World J Clin Cases 2021; 9: 10805-10815
  • 10 Manber R, Armitage R. Sex, steroids, and sleep: a review. Sleep 1999; 22: 540-555
  • 11 Ohayon MM, Carskadon MA, Guilleminault C. et al. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep 2004; 27: 1255-1273
  • 12 Akberzie W, Kataria L. Sleep Disorders and Aging in Women. Clin Geriatr Med 2021; 37: 667-682
  • 13 Richardson HL, Walker AM, Horne RS. Sleeping like a baby–does gender influence infant arousability?. Sleep 2010; 33: 1055-1060
  • 14 Thordstein M, Löfgren N, Flisberg A. et al. Sex differences in electrocortical activity in human neonates. Neuroreport 2006; 17: 1165-1168
  • 15 Hagenauer MH, Perryman JI, Lee TM. et al. Adolescent changes in the homeostatic and circadian regulation of sleep. Dev Neurosci 2009; 31: 276-284
  • 16 Roenneberg T, Kuehnle T, Pramstaller PP. et al. A marker for the end of adolescence. Curr Biol 2004; 14: R1038-R1039
  • 17 Bailey M, Silver R. Sex differences in circadian timing systems: implications for disease. Front Neuroendocrinol 2014; 35: 111-139
  • 18 Cain SW, Dennison CF, Zeitzer JM. et al. Sex differences in phase angle of entrainment and melatonin amplitude in humans. J Biol Rhythms 2010; 25: 288-296
  • 19 Nelson HD. Menopause. Lancet 2008; 371: 760-770
  • 20 Xu Q, Lang CP. Examining the relationship between subjective sleep disturbance and menopause: a systematic review and meta-analysis. Menopause 2014; 21: 1301-1318
  • 21 American Academy of Sleep Medicine. The International Classification of Sleep Disorders. Diagnostic and coding Manual. Westchester, IL: American Academy of Sleep Medicine; 2005
  • 22 Sateia MJ. International classification of sleep disorders – third edition: highlights and modifications. Chest 2014; 146: 1387-1394
  • 23 Morin CM, Drake CL, Harvey AG. et al. Insomnia disorder. Nat Rev Dis Primers 2015; 1: 15026
  • 24 Johnson EO, Roth T, Schultz L. et al. Epidemiology of DSM-IV insomnia in adolescence: lifetime prevalence, chronicity, and an emergent gender difference. Pediatrics 2006; 117: e247-e256
  • 25 Blank M, Zhang J, Lamers F. et al. Health correlates of insomnia symptoms and comorbid mental disorders in a nationally representative sample of US adolescents. Sleep 2015; 38: 197-204
  • 26 Calhoun SL, Fernandez-Mendoza J, Vgontzas AN. et al. Prevalence of insomnia symptoms in a general population sample of young children and preadolescents: gender effects. Sleep Med 2014; 15: 91-95
  • 27 Zhang J, Chan NY, Lam SP. et al. Emergence of Sex Differences in Insomnia Symptoms in Adolescents: A Large-Scale School-Based Study. Sleep 2016; 39: 1563-1570
  • 28 Sloan EP. Sleep deprivation and postpartum mental health: case report. Arch Womens Ment Health 2011; 14: 509-511
  • 29 Luo M, Li J, Tang R. et al. Insomnia symptoms in relation to menopause among middle-aged Chinese women: Findings from a longitudinal cohort study. Maturitas 2020; 141: 1-8
  • 30 de Zambotti M, Colrain IM, Baker FC. Interaction between reproductive hormones and physiological sleep in women. J Clin Endocrinol Metab 2015; 100: 1426-1433
  • 31 de Zambotti M, Goldstone A, Colrain IM. et al. Insomnia disorder in adolescence: Diagnosis, impact, and treatment. Sleep Med Rev 2018; 39: 12-24
  • 32 Haufe A, Baker FC, Leeners B. The role of ovarian hormones in the pathophysiology of perimenopausal sleep disturbances: A systematic review. Sleep Med Rev 2022; 66: 101710
  • 33 Nowakowski S, Meers J, Heimbach E. Sleep and Women’s Health. Sleep Med Res 2013; 4: 1-22
  • 34 Wu R, Bao J, Zhang C. et al. Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia. Psychother Psychosom 2006; 75: 220-228
  • 35 Woods NF, Mitchell ES. Sleep symptoms during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women’s Health Study. Sleep 2010; 33: 539-549
  • 36 Sivertsen B, Omvik S, Pallesen S. et al. Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA 2006; 295: 2851-2858
  • 37 Heinzer R, Vat S, Marques-Vidal P. et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 2015; 3: 310-318
  • 38 Thannickal A, Brutocao C, Alsawas M. et al. Eating, sleeping and sexual function disorders in women with polycystic ovary syndrome (PCOS): A systematic review and meta-analysis. Clin Endocrinol (Oxf) 2020; 92: 338-349
  • 39 Simon S, Rahat H, Carreau AM. et al. Poor Sleep Is Related to Metabolic Syndrome Severity in Adolescents With PCOS and Obesity. J Clin Endocrinol Metab 2020; 105: e1827-e1834
  • 40 Liblau RS, Vassalli A, Seifinejad A. et al. Hypocretin (orexin) biology and the pathophysiology of narcolepsy with cataplexy. Lancet Neurol 2015; 14: 318-328
  • 41 Melzi S, Prevot V, Peyron C. Precocious puberty in narcolepsy type 1: Orexin loss and/or neuroinflammation, which is to blame?. Sleep Med Rev 2022; 65: 101683
  • 42 Dzaja A, Arber S, Hislop J. et al. Women’s sleep in health and disease. J Psychiatr Res 2005; 39: 55-76
  • 43 Campos-Rodriguez F, Queipo-Corona C, Carmona-Bernal C. et al. Continuous Positive Airway Pressure Improves Quality of Life in Women with Obstructive Sleep Apnea. A Randomized Controlled Trial. Am J Respir Crit Care Med 2016; 194: 1286-1294
  • 44 Ishizuka Y, Pollak CP, Shirakawa S. et al. Sleep spindle frequency changes during the menstrual cycle. J Sleep Res 1994; 3: 26-29
  • 45 Baker FC, Waner JI, Vieira EF. et al. Sleep and 24 hour body temperatures: a comparison in young men, naturally cycling women and women taking hormonal contraceptives. J Physiol 2001; 530: 565-574
  • 46 Baker FC, Driver HS, Paiker J. et al. Acetaminophen does not affect 24-h body temperature or sleep in the luteal phase of the menstrual cycle. J Appl Physiol (1985) 2002; 92: 1684-1691
  • 47 Bentley AJ, Rosman KD, Mitchell D. Gender differences in the presentation of subjects with restless legs syndrome. Sleep Med 2006; 7: 37-41
  • 48 Pengo MF, Won CH, Bourjeily G. Sleep in Women Across the Life Span. Chest 2018; 154: 196-206
  • 49 Baker FC, Driver HS. Self-reported sleep across the menstrual cycle in young, healthy women. J Psychosom Res 2004; 56: 239-243
  • 50 Kravitz HM, Janssen I, Santoro N. et al. Relationship of day-to-day reproductive hormone levels to sleep in midlife women. Arch Intern Med 2005; 165: 2370-2376
  • 51 Driver HS, Dijk DJ, Werth E. et al. Sleep and the sleep electroencephalogram across the menstrual cycle in young healthy women. J Clin Endocrinol Metab 1996; 81: 728-735
  • 52 Culnan E, McCullough LM, Wyatt JK. Circadian Rhythm Sleep-Wake Phase Disorders. Neurol Clin 2019; 37: 527-543
  • 53 Srivanitchapoom P, Pandey S, Hallett M. Restless legs syndrome and pregnancy: a review. Parkinsonism Relat Disord 2014; 20: 716-722
  • 54 Ohayon MM, O’Hara R, Vitiello MV. Epidemiology of restless legs syndrome: a synthesis of the literature. Sleep Med Rev 2012; 16: 283-925
  • 55 Innes KE, Selfe TK, Agarwal P. Prevalence of restless legs syndrome in North American and Western European populations: a systematic review. Sleep Med 2011; 12: 623-634
  • 56 Garcia-Borreguero D, Silber MH, Winkelman JW. et al. Guidelines for the first-line treatment of restless legs syndrome/Willis-Ekbom disease, prevention and treatment of dopaminergic augmentation: a combined task force of the IRLSSG, EURLSSG, and the RLS-foundation. Sleep Med 2016; 21: 1-11
  • 57 Jahani Kondori M, Kolla BP, Moore KM. et al. Management of Restless Legs Syndrome in Pregnancy and Lactation. J Prim Care Community Health 2020; 11: 2150132720905950
  • 58 Manconi M, Ulfberg J, Berger K. et al. When gender matters: restless legs syndrome. Report of the “RLS and woman” workshop endorsed by the European RLS Study Group. Sleep Med Rev 2012; 16: 297-307
  • 59 Fulda S, Stalla GK, Wetter TC. Prevalence of the restless legs syndrome in transsexual patients: the hormonal hypothesis revisited. J Neurol 2007; 254: 1748-1749
  • 60 Meharaban Z, Yahya S, Sadegniiat K. Restless Legs Syndrome During Pregnancy and Preterm Birth in Women Referred to Health Centers of Ardabil. Iran Red Crescent Med J 2015; 17: e24438
  • 61 Oyieng’o DO, Kirwa K, Tong I. et al. Restless Legs Symptoms and Pregnancy and Neonatal Outcomes. Clin Ther 2016; 38: 256-264
  • 62 Chen SJ, Shi L, Bao YP. et al. Prevalence of restless legs syndrome during pregnancy: A systematic review and meta-analysis. Sleep Med Rev 2018; 40: 43-54
  • 63 Zink N. Restless-Legs-Syndrom: Eisenstoffwechsel optimieren!. MMW Fortschritte der Medizin 2023; 165: 12-14
  • 64 Heidbreder A, Trenkwalder C. et al. Restless Legs Syndrom, S2k-Leitlinie, 2022; Deutsche Gesellschaft für Neurologie und Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (DGSM) (Hrsg.), Leitlinien für Diagnostik und Therapie in der Neurologie. Accessed January 30, 2024 at: www.dgn.org/leitlinien
  • 65 Winkelman JW, Armstrong MJ, Allen RP. et al. Practice guideline summary: Treatment of restless legs syndrome in adults: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 2016; 87: 2585-2593