Is sleep disorder treatment appropriate for premenstrual syndrome?

Abstract

Acta Obstet Gynecol Scand 2003; 82: 99. © Acta Obstet Gynecol Scand 2003 Sir , Medical literature suggests that the symptoms of irritable bowel syndrome (IBS) are analogous with the gastrointestinal and sleep disorder-related mood symptoms of premenstrual syndrome (PMS). The literature reports that IBS is secondary to sleep disorders (1). Consequently this suggests that sleep disorder treatment would alleviate both the gastrointestinal and mood symptoms of PMS and improve the quality of life of PMS patients. Violent diaphragm action during respiratory events (VDA), a characteristic common to upper airway resistance syndrome (UARS) and obstructive sleep apnea (OSA), underlies irritable bowel syndrome (IBS) (1). The clinician evaluates the symptoms of IBS unaware that the symptoms of two disorders have melded. The gastrointestinal symptoms of PMS are similar to the symptoms of an IBS patient who is in remission during the menstrual cycle follicular phase. Some mood symptoms of sleep apnea are depression, irritability, mood swings and concentration difficulties (2). Nocturia, headache and fatigue are some of the physical symptoms (2, 3). The synchronism of PMS with altered bowel habits in female IBS patients (4) is impossible for male IBS patients. Altered bowel habits in IBS patients are associated with the previous night's sleep disturbances (5). However, women are diagnosed with IBS more than twice as often as men (6) despite sleep apnea being about twice as prevalent in men as in women (7). For this prevalence reversal to occur, a unique factor that increases sleep disturbance must exist in females. Lower sleep efficiency during the luteal phase than the follicular phase of the menstrual cycle (8) is consistent with increased sleep disturbance experienced by IBS patients during PMS. In PMS, bowel habits change on a monthly cycle. If sleep disorders are a factor in such changes, sleep quality would vary between the follicular and luteal phases of the menstrual cycle. Again, lower sleep efficiency during the luteal phase than the follicular phase of the menstrual cycle (8) is consistent with increased sleep disturbance experienced during PMS. The luteal phase of the menstrual cycle should be included with respiratory allergies, alcohol consumption (2) and supine sleeping (9) as exacerbators of OSA. The exacerbators of a sleep disorder precipitate altered sleep disturbances and consequently could lead to changed bowel habits. Irritable bowel syndrome, premenstrual syndrome, chronic pelvic pain, chronic fatigue syndrome and Fibromyalgia are the diagnoses for the same set of symptoms depending on the specialty of the physician consulted (10). Whether IBS is different from PMS, patients of either disorder experience sleep disturbances, which change their bowel habits. Therefore, treatment for sleep disorders would alleviate the sleep disorder and gastrointestinal symptoms of PMS. There is precedence for utilizing sleep disorder treatments to manage menstrual cycle associated symptoms. Continuous positive airway pressure (CPAP) successfully treated dysmenorrhea and amenorrhea (11). CPAP is a treatment for both OSA and upper airway resistance syndrome (UARS). With CPAP the prescription fixed pressure is determined during a sleep study. However, considering the nightly variations in sleep disturbance the patient would be more likely to comply with a device that adjusted the treatment pressure based on the patient's need. As the various manufacturers' models of automatic adjusting positive airway pressure machines use different methods of detecting the patient's instantaneous pressure requirement, patient compliance will be best with a machine whose detection algorithm matches that patient's unique characteristics.