Sleep In Women Research Articles

Duration of sleep and breast cancer risk in a large population‐based case–control study

One important function of sleep may be its contribution to the maintenance of the immune system and regulation of the circadian rhythms by melatonin. Researchers have speculated that disruption of immune functions involving cortisol levels and natural killer cell activity may increase breast cancer risk whereas increased melatonin exposure may protect against breast cancer. We conducted a multistate population-based case-control study of 4,033 women with invasive breast cancer and 5,314 community women without breast cancer in which we inquired about women's sleep habits in the recent past and during adult lifetime. Relative to women who slept 7.0-7.9 h/night, the multivariate odds ratio for developing breast cancer among women who slept an average of 9 h or more per night approximately 2 years prior to interview was 1.13 (95% CI 0.93-1.37). The multivariate-adjusted odds ratio for the continuous term was 1.06 (95% CI 1.01-1.11), suggesting a 6% increase in risk for every additional hour of sleep. Similar patterns were observed for average lifetime adult sleep duration. We found little evidence that sleeping few hours per night was associated with breast cancer risk. The results of this study suggest that increasing sleep duration is modestly associated with an increased breast cancer risk. In contrast, short duration of sleep (<7 h/night) is not substantially associated with increased risk. Further research in this area is warranted.

Assessment of Sleep in Women With Night Eating Syndrome

Evaluation of sleep in subjects with night eating syndrome (NES). Polysomnographic and questionnaire comparisons between subjects with NES and controls. Fifteen women with NES (mean +/- SD = 41 +/- 8 years) and 14 women (comparable age and weight) without NES (39 +/- 10 years) were studied in the laboratory for 3 days. N/A. Subjects with NES did not differ from controls in timing of sleep onset or offset. They had less stage 2 sleep than controls (minutes, p = .012; percentage, p = .016) and less stage 3 sleep (p = .023), which contributed to their having a lower total sleep time (p = .05) and reduced sleep efficiency (p = .03). Subjects with NES did not have more awakenings than controls, but 93.3% of them ate on awakening during all 3 nights, while 92.9% of controls did not eat on any night. Logistic discriminant analyses identified a multiple sleep parameter model associated with increased likelihood of NES that had sensitivity of 84.6% and specificity of 76.9%. Patients with NES were more depressed than controls (p < .001) and reported greater sleep disturbance that included lower sleep quality (p < or = .001), reduced sleep duration (p < or = .001), and increased number of awakenings (p < or = .001). Patients with NES appear to have sleep maintenance insomnia rather than sleep-related eating disorder or a parasomnia. The maintenance of normal timing for sleep-wake behavior in the presence of a phase delay in the timing of caloric intake suggests this disorder reflects a state of internal circadian desynchrony associated with significant sleep complaints. It remains unknown whether the sleep disturbance precedes the abnormally timed eating.

Book Reviews

Book Reviews

Women's sleep in health and disease

A huge amount of knowledge about sleep has accumulated during the last 5 decades following the discovery of rapid eye movement (REM) sleep. Nevertheless, there are numerous areas of considerable ignorance. One of these concerns the particularities of sleep in women. Most basic and clinical studies have been performed in male subjects, and only very recently research groups around the world have addressed women's sleep in health and disease. In this review, we summarize the present knowledge on the influence of oestrogens on the brain and on the distinctive changes of sleep across the menstrual cycle, during pregnancy and menopause. In addition, studies in female rodents are reviewed as well as the knowledge on female peculiarities regarding the interactions between sleep regulation and age-related changes in circadian rhythms. We also address specific aspects of sleep loss and sleep disorders in women. Finally, very recent studies on the sociology of sleep are summarized and future directions in the field are discussed.

Inspiratory Airflow Dynamics During Sleep in Women with Fibromyalgia

To determine whether women with fibromyalgia have inspiratory airflow dynamics during sleep similar to those of women with upper-airway resistance syndrome (UARS). A descriptive study of consecutive female patients with fibromyalgia. An academic sleep disorders center. Twenty-eight women with fibromyalgia diagnosed by rheumatologists using established criteria. Fourteen of the women gave a history of snoring, while 4 claimed to snore 'occasionally' and 10 denied snoring. The comparison group comprised 11 women with UARS matched for age and obesity. Eighteen of the 28 women with fibromyalgia and all of the women with UARS had a full-night polysomnogram. All participants had a nasal continuous positive airway pressure (CPAP) study with quantitative monitoring of inspiratory airflow and effort between atmospheric pressure and therapeutic CPAP. Fourteen patients with fibromyalgia and all patients with UARS had a successful determination of pharyngeal critical pressure. Twenty-seven of 28 women with fibromyalgia had sleep-disordered breathing. One of the 27 had obstructive sleep apnea hypopnea while 26 had milder inspiratory airflow limitation with arousals. One patient had no apnea or hypopnea or inspiratory airflow limitation during sleep. While the patients were sleeping at atmospheric pressure, apnea-hypopnea index, arousal index, the prevalence of flow-limited breaths, and maximal inspiratory flow were similar between groups. The pharyngeal critical pressure of the patients with fibromyalgia was -6.5 +/- 3.5 cmH2O (mean +/- SD) compared to -5.8 +/- 3.5 cmH2O for patients with UARS (P = .62). Treatment of 14 consecutive patients with nasal CPAP resulted in an improvement in functional symptoms ranging from 23% to 47%, assessed by a validated questionnaire. Inspiratory airflow limitation is a common inspiratory airflow pattern during sleep in women with fibromyalgia. Our findings are compatible with the hypothesis that inspiratory flow limitation during sleep plays a role in the development of the functional somatic syndromes.

Understanding women's sleep management: beyond medicalization‐healthicization: A response to Simon Williams

Understanding women's sleep management: beyond medicalization‐healthicization: A response to Simon Williams

Understanding women's sleep management: beyond medicalization‐healthicization?

This paper addresses sleep, which to date has been a neglected area within the sociology of health and illness. We explore the extent to which the concepts of medicalization and healthicization provide appropriate models for understanding the management of women's sleep disruption. The prescription of sleeping pills remains as an indicator of the medicalization of sleep, while the trend towards the healthicization of sleep as part of healthy lifestyle practice is reflected in the increased focus of the media, pharmaceutical and complementary health care industries on sleep. The paper analyses qualitative data on women aged 40 and over to argue that the medicalization-healthicization framework fails to encapsulate a complete understanding of how women manage sleep disruption within the social context of their lives. It suggests that by looking inside the world of women's sleep we uncover a hidden dimension of self-directed personalized activity which plays a key role in women's response to sleep disruption. We propose an alternative model for the management of women's sleep which incorporates a core of personalised activity, linked to strategies associated with healthicization and medicalization.

Menopausal hormone therapy informed consent

A little over a year ago now, the large hormone therapy clinical trial of the Women’s Health Initiative came to an abrupt halt. The publication of the results rocked the medical community and our patients because a class of drugs once thought to be associated overwhelmingly with benefit was found to cause more harm than good. Now doctors have the dilemma of how to inform patients of the results of the Women’s Health Initiative in a way that will help them make the best decision for themselves of whether they should use of these agents for hot flashes, night sweats, vaginal dryness, or prevention of osteoporosis. In the thousands of daily conversations on this topic, the scenario used to look like this: The patient came to the office asking questions about menopause. When the practitioner determined the patient was going through the menopausal transition, the doctor wrote a prescription for hormone pills or patches, saying they would address her concerns by replacing the hormones her body used to make. They would abolish her hot flashes, slow her bone loss, and reduce her risk of a heart attack. The patient asked if the pills caused breast cancer. Probably in some women, the doctor would acknowledge, but argued that the benefits to the heart and bones were worth taking the chance. Now the patient comes to the office and asks about the confusing information she has been reading on the increased risk of heart attack, strokes, blood clots, and dementia with hormone use. The doctor acknowledges the information has changed and is very important, but the decision to use or not to use hormones is up to her. She has menopausal symptoms and wants a solution. However, she is looking for something safe that does not cause more problems than it solves.

Physical and mental fullness as descriptors that influence sleep in women with HIV.

Through individual interviews, this qualitative study examined the subjective experience of sleep quality in the lives of 6 women with HIV infection. Three major themes emerged: living differently, sleep patterns, and strategies to normalize sleep. The women in this study revealed that they were living differently than before their infection and their experience of sleep had similarly changed. Four adaptive mechanisms were used to normalize sleep: automaticized behaviors, processing alternatives, yielding to a lack of control, and vigilant self-monitoring. This article includes discussion and implications for future research.

The influence of sleep and activity patterns on fatigue in women with HIV/AIDS.

The cause of HIV-related fatigue is most likely multifactorial. When presented as a chief complaint, clinicians often include an assessment of stress level, depression, anemia, infection, and amount of sleep and activity. The empirical bases for these evaluations vary in their validity and implementation in clinical practice, but the basis for evaluating adequate amounts of sleep and activity currently lacks empirical research. The purpose of this study was to describe HIV seropositive women's sleep and activity patterns related to their fatigue experience. Sleep and activity were assessed with wrist actigraphy to obtain objective measures of total sleep time, number of awakenings, and sleep efficiency, as well as level of daytime activity, 24-hour activity rhythm, and naps. This sample of 100 women with HIV/AIDS averaged only 6.5 hours of sleep at night, and 45% of the sample napped. CD4 cell counts were unrelated to sleep and fatigue measures. Compared to the low-fatigue group, the women with high fatigue had significantly more difficulty falling asleep, more awakenings from nighttime sleep, poorer daytime functioning, and a higher frequency of depressive symptoms. Findings from this study provide clinicians with empirically based support for detailed clinical evaluations of sleep and activity patterns, as well as anxiety and depression, in clients who complain of fatigue. Findings also provide data for potential interventions to improve sleep and activity in persons living with HIV/AIDS and to reduce fatigue and depressive symptoms.

The Influence of Sleep and Activity Patterns on Fatigue in Women With HIV/AIDS

The cause of HIV-related fatigue is most likely multifactorial. When presented as a chief complaint, clinicians often include an assessment of stress level, depression, anemia, infection, and amount of sleep and activity. The empirical bases for these evaluations vary in their validity and implementation in clinical practice, but the basis for evaluating adequate amounts of sleep and activity currently lacks empirical research. The purpose of this study was to describe HIV seropositive women's sleep and activity patterns related to their fatigue experience. Sleep and activity were assessed with wrist actigraphy to obtain objective measures of total sleep time, number of awakenings, and sleep efficiency, as well as level of daytime activity, 24-hour activity rhythm, and naps. This sample of 100 women with HIV/AIDS averaged only 6.5 hours of sleep at night, and 45% of the sample napped. CD4 cell counts were unrelated to sleep and fatigue measures. Compared to the low-fatigue group, the women with high fatigue had significantly more difficulty falling asleep, more awakenings from nighttime sleep, poorer daytime functioning, and a higher frequency of depressive symptoms. Findings from this study provide clinicians with empirically based support for detailed clinical evaluations of sleep and activity patterns, as well as anxiety and depression, in clients who complain of fatigue. Findings also provide data for potential interventions to improve sleep and activity in persons living with HIV/AIDS and to reduce fatigue and depressive symptoms.

Parity and Sleep Patterns During and After Pregnancy

In Brief Objective To describe changes in women's sleep patterns from prepregnancy to postpartum. Methods Polysomnography was done in women's homes for 2 consecutive nights. Forty-five women were studied during the follicular and luteal phases of their menstrual cycles, and 33 conceived and were studied during each trimester of pregnancy. Twenty-nine were studied at 1 and 3 months postpartum. Results Compared with prepregnant sleep characteristics, significant changes in sleep patterns were evident by 11–12 weeks' gestation, with a significant increase in total sleep time but less deep sleep and more awakening during sleep. By the third month postpartum, there was improvement in sleep characteristics; however, sleep efficiency remained significantly lower than baseline prepregnancy values. Conclusion Sleep disturbance was greatest during the first postpartum month, particularly for first-time mothers. Changes in sleep occur early in pregnancy, but the 1st month postpartum is particularly disturbing for first-time mothers compared with experienced mothers.

Effects of Prior Fluoxetine Treatment on EEG Sleep in Women with Recurrent Depression

We examined whether fluoxetine treatment has persistent effects on electroencephalographic sleep after drug discontinuation in patients with recurrent major depression. Age-matched groups of 23 women were treated with interpersonal psychotherapy alone (IPT) or fluoxetine plus interpersonal psychotherapy (IPT + FLU). Sleep studies were conducted when patients were depressed, and again at remission, at least four weeks after fluoxetine discontinuation. The groups did not differ in depression ratings pre- to post-treatment. Significant group*time interaction effects were noted for REM sleep (p = .04) and slow wave sleep (p = .02). REM percentage and phasic REM activity increased in the IPT + FLU group but decreased in the IPT group. The effects of fluoxetine treatment on electroencephalographic sleep can be observed for at least four weeks after drug discontinuation and appear to represent both drug discontinuation and neuroadaptation effects.

Sleep patterns of sheltered battered women.

To describe sheltered battered women's sleep patterns and resulting daytime fatigue. The model for symptom management framed this study to describe one component of the model--symptom experience. Beginning evidence suggests that sheltered battered women experience disturbed sleep and fatigue that can interfere with vital activities. Descriptive using a convenience sample of 50 ethnically diverse women residing at least 21 days in battered women's shelters located in one western U.S. city. The study was done in 1997. The Pittsburgh Sleep Quality Index (PSQI), the Mini Motionlogger Actigraph, a sleep diary, the Visual Analogue Scale for Fatigue, and an open-ended interview were used to collect data. Descriptive and inferential statistics were used to analyze the quantitative data. Qualitative data were analyzed to determine patterns and themes. Seventy percent of the women had global PSQI scores of greater than five indicating poor sleep and 17 (34%) had a sleep efficiency index of 80% or less. Fourteen (28%) of the women went to bed very fatigued (> 66 mm) and 20 (40%) woke up very fatigued (> 33 mm). The majority of sheltered battered women experienced disturbed sleep and daytime fatigue. Both personal and environmental variables were found to significantly affect sleep patterns. Sheltered battered women can benefit from information about sleep disturbances and sleep enhancing self-care strategies.

Changes in sleep patterns of young women from late pregnancy to postpartum: relationships to their infants' movements.

We studied changes in the sleep patterns of ten young women from late pregnancy (36 weeks) to the sixth postpartum week, focusing on the relationship between the women's sleep patterns and their infants' movements. The mothers' polysomnograms and their infants' ankle actigrams were simultaneously recorded using a Medilog 9000 at home in three sessions, during the first, third, and sixth postpartum weeks. The mother-infant pairs slept in close proximity. Two subjects had difficulty with their infants and were dealt with as a separate group. Analysis for the eight subjects who adapted well to the postpartum period showed that wake time after sleep onset increased significantly during the postpartum period compared with late pregnancy given responsibility for feeding. Stage 3 + 4 and Stage REM did not change across the four sessions (pregnancy, first, third, and sixth postpartum weeks), but Stage 2 decreased significantly from pregnancy to postpartum. There was a high synchronization between infants' movements and mothers' wakefulness. Eight mothers did not complain of sleep disturbance, while the two mothers who had difficulty with their infants did. We suggest that mothers who tolerate well sleep interruption arising from feeding and maintain their Stages 3 + 4 and REM should not be considered as suffering from sleep disturbance. Mothers who have difficulty with their infants and complain of sleep disturbance should be considered as suffering from sleep disturbance.

Alterations in sleep during pregnancy and postpartum: a review of 30 years of research

Pregnancy, childbirth, and early motherhood physiologically and psychologically affect a woman's sleep. Hormonal alterations during early pregnancy, enlargement of the fetus during late pregnancy, and a newborn with random sleep-wake patterns all contribute to disrupted sleep. Since the initial study of sleep and pregnancy in 1968, fewer than 20 articles have been published which address alterations in sleep architecture related specifically to childbearing women. Furthermore, many of these studies suffer from small sample sizes and lack statistical power for consistent interpretation and replication of findings. While almost all of these studies included both nulliparas and multiparas in their samples, rarely have effects of parity been reported. The majority of older studies were cross-sectional designs, with comparisons to age-matched healthy controls. More recent studies have been longitudinal designs to describe changes in sleep during the course of pregnancy. However, women's baseline, prepregnancy sleep patterns or sleep histories have not been considered. With very few published reports of sleep changes related to mental health outcomes, we are no closer to understanding the implications of altered sleep patterns on postpartum depression or other women's health outcomes than we were when it was originally questioned 30 years ago.

REM latency and the recovery from depression: getting over divorce

The authors' goal was to address five questions: 1) What is the frequency of early REM sleep in subjects in the process of divorce who meet diagnostic criteria for major depressive disorder? 2) What is the frequency of this sign in subjects in the process of divorce who are not depressed? 3) How often does this sign persist following remission of depressive symptoms? 4) What is the predictive value of early REM sleep among depressed subjects for later adjustment to the process of divorce? and 5) What is the role of a family history of depression or alcoholism in the presence and persistence of early REM sleep? Two hundred fourteen volunteers undergoing marital separation were recruited; 70 of these subjects were selected for a 3-night sleep study. Forty of the 70 subjects met criteria for depression and 30 did not; 61 (87%) returned for repeat studies 1 year later. Fifteen (38%) of the 40 depressed subjects had short REM latency. Seven of these continued to have short REM latency 1 year later, but none of these met the criteria for depression at that time. A higher proportion of these subjects had made a good adjustment to their new life than did depressed subjects whose initial and follow-up REM latencies fell within the normal range. These data suggest that depressed individuals with normal REM latency may need more aggressive treatment intervention.

Sex Hormones and the Sleep of Women

Sex Hormones and the Sleep of Women

Relationship between sleep characteristics and depressive symptoms in last trimester of pregnancy.

Sleep problems during pregnancy may cause many complications that reduce quality of life. This study aims to determine the relationship between pregnant women's sleep characteristics and depressive symptoms. A hospital-based, cross-sectional study was conducted. Pregnant women were selected from the population by using the an improbable random sampling method. This study sample included 436 pregnant women who met the study's inclusion criteria. To collect data, this study used an information form that was developed by the researcher after reviewing relevant literature, the Women's Health Initiative Insomnia Rating Scale (WHIIRS), and the Beck Depression Inventory (BDI). The researchers used face-to-face interviews method to collect data from the participants, pregnant women who were examined in the polyclinic. This study found that 36% of participating pregnant women reported insomnia, and 38.1% experienced depressive symptoms. It also determined that participants who had problems with insomnia, who experienced a change in sleep habits, and who did not wake up feeling rested experienced depressive symptoms 1.64, 2.79, and 2.59 times more than those who didn't have these problems, respectively. who experienced a decrease in sleep, who experienced an increase in sleep, and who did not wake up feeling rested experienced depressive symptoms 1.61, 3.22, 3.53, and 2.59 times more, respectively, than those who did not have insomnia, who did not experience a change in sleep habits in pregnancy, and who woke up feeling rested, respectively. This study determined that there is a relationship between insomnia and depressive symptoms and that pregnant women experiencing insomnia presented with more depressive symptoms.

CLINICAL STUDY OF NONBARBITURATE SEDATIVE.

Insomnia is a common complaint of variable severity. Among a selected group of 20 institutionalized women the hypnotic effect of ethchlorvynol (Placidyl) was found superior to that of a matching placebo. The hypnotic effect of the placebo was also established. The character of each woman's sleep was determined principally by her own response. Persons with minimal insomnia are poorly suited for this type of subjective evaluation of sleep.