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Sleep Medicine

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Sleep apnoea may make it hard for you to remember simple things, such as where you parked your car or left your house keys, a small study suggests.

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Researchers believe that disrupted circadian clocks are the reason that shift workers experience higher incidences of type 2 diabetes, obesity and cancer. The body's primary circadian clock, which regulates sleep and eating, is in the brain. But other body tissues also have circadian clocks, including the liver, which regulates blood glucose levels.

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In recent research is has been found that disruption to rapid eye-movement (REM) sleep caused by sleep apnoea, may affect an individual’s capacity to form new spatial memories.

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Office workers with more light exposure at work had longer sleep duration, better sleep quality, more physical activity and better quality of life compared to office workers with less light exposure in the workplace.

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Can you be sleep deprived without knowing it? Sleep is not always prioritised however the implications can be devastating. Even one night sleep deprived can be impacting your body on a variety of different levels; physically and psychologically. The only way to know if you are getting consolidated sleep is to monitor with specialised equipment what is happening when you are asleep.

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In what may be the largest study of sleep problems among individuals with multiple sclerosis (MS), researchers at UC Davis have found that widely undiagnosed sleep disorders may be at the root of the most common and disabling symptom of the disease: fatigue. Study paticipant reports of sleep disorder frequency, sleep patterns and complaints of excessive daytime sleepiness suggest that sleep problems may be a hidden epidemic in the MS population.

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Sleep and Women

How well a woman sleeps significantly affects her quality of life. Being a woman, you are probably aware that for years very little research has been available concerning gender specific sleep problems. You may have found healthcare professionals did not always take your sleep complaints seriously. Recent studies, however, have paid a lot more attention to women’s sleep patterns, needs and special problems. Did you know, for instance, that women are twice as likely as men to have difficulties falling asleep or staying asleep?

How does a woman’s sleep change over time?

Sleep and Women

Research has also shown that women’s sleep changes over time. In general, women sleep most soundly and are least prone to sleep disturbances during young adulthood. Sleep disturbances in your adulthood are usually associated with the menstrual cycle, pregnancy and motherhood. Also, young women who live a fast paced lifestyle often cut back on sleep and ignore signs of fatigue which can lead to daytime sleepiness, poor concentration and other daytime problems.

As women age, physical and hormonal changes affect the quality of sleep. Older women get less deep sleep and are more likely to wake up at night. Physical factors such as arthritis, disorders of breathing or hot flashes may also disturb their sleep.

Additionally, when women feel stress, depression, fear or other strong emotions their sleep may be disturbed.

Getting enough sleep is enormously important to everyone’s life. Women tackling multiple responsibilities of home, work and family should know that sleep can positively impact concentration, job performance, social interaction and overall well being.

Sleep and the Menstrual Cycle

Women’s menstrual cycles may bring discomfort and sleep changes. Some women experience an increased number of awakenings and other sleep disturbances during the premenstrual period. At this point their dreams are often more frequent and more vivid.

Other women report excessive daytime sleepiness, fatigue and longer sleeping hours during their premenstrual period.

Premenstrual symptoms such as abdominal cramping, irritability, bloating, headaches and emotional changes can also directly affect women’s sleep. While these sleep problems generally disappear a few days after menstruation begins, some women who suffer more severe symptoms, such as increased tension and irritability, may experience lingering sleep problems and even chronic insomnia.

If you have experienced menstrual related sleep disorders you should pay careful attention to your sleep needs, maintain a regular sleep/wake schedule, eat a healthy diet and try to reduce your stress.

If sleep problems interfere with your daily functioning, you should seek medical advice from your healthcare professional.

Sleep and Pregnancy

Most women report daytime fatigue and the need for longer night time sleep. Increasing levels of the hormone progesterone probably causes this common change in women’s sleep requirement during pregnancy.

Later in pregnancy, particularly during the last trimester, women often notice poor sleep quality. Certain changes in sleep patterns have been confirmed by studies: the amount of slow-wave sleep (deep stages of sleep) decreases and the number of awakenings increases.

Women may find it difficult to sleep in certain positions. Overall sleep efficiency and the proportion of time spent actually asleep begins to decrease by the second trimester and continues to decrease in the third trimester.

In the later stages of pregnancy there are many causes for sleep disruption:

  • leg cramps
  • backache
  • heartburn
  • movements of the foetus
  • general discomforts of pregnancy
  • increased frequency of urination

Once the baby is born, the physical stresses of pregnancy on sleep may be replaced by the demands of the baby’s feeding schedule and frequent awakenings at night.

Throughout pregnancy women need to make sure they get enough sleep, maintain regular sleep/wake schedules and avoid stress as much as possible. Because sleeping pills and alcohol should be avoided during pregnancy other measures to improve sleep should be considered. Importantly, alcohol should not be used as a sleep aid even when not pregnant. Muscle relaxation techniques may be effective in promoting better sleep and reducing the discomforts of pregnancy. Maintaining a balanced diet and avoiding heavy meals and spicy foods within two or three hours of bedtime should help prevent heartburn.

After delivery, getting enough sleep continues to be very important, as severely disturbed sleep has been linked to postpartum depression and child abuse. Mothers are encouraged to consider engaging a helper during the day and or at night, especially in the early postpartum period to help the new mother get more sleep at night and naps during the daytime.

Sleep and Menopause

Some natural changes in sleep accompany women’s aging process. The amount of deep sleep decreases, sleep becomes lighter and more awakenings occur during the night.

In the years surrounding menopause many women experience sleep disturbances with increased frequency.  A gradual change in their sex hormone levels impacts their sleep directly, and indirectly, by affecting other important hormones that are related to sleep.

Hot Flashes

They may find that hot flashes and night sweats – associated with decreased levels of oestrogen – causes repeated awakenings due to the sensation of heat and sweating, increased heart rate and feelings of anxiety.  Although hot flashes usually last only a few minutes, in severe cases a woman may wake up hourly.  The sleep disturbance and resultant sleep deprivation generated by hot flashes may result in daytime fatigue, irritability and depression.

The following suggestions may help alleviate sleep disturbances associated with hot flashes:

  • Control the temperature in your bedroom; cooler is better. Use light and comfortable (preferably cotton) bed linen.
  • Eliminate caffeine, sugar and alcohol from your diet. Increase vitamin E intake in your diet or take a vitamin E supplement.
  • A light snack at bedtime may help, a good snack is milk and honey with crackers.
  • Consider hormone replacement therapy, which can be helpful in relieving severe hot flashes and resultant significant sleep loss. Your healthcare professional can offer advice about this mode of treatment.
  • Avoid hot baths or showers within 1-2 hours of bedtime.
  • A variety of medications and over the counter supplements may help, but some over the counter supplements may be harmful. Your healthcare professional can advise you on the safety of these products and prescribe medications that are safe and effective.

What sleep changes will develop in the postmenopausal years?

In the years following menopause, women’s sleep grows lighter and more fragmented. It becomes more difficult to maintain consistent uninterrupted sleep and to maintain long hours of wakefulness during the day. An increase in daytime fatigue can be one result.

Other physical factors can also disturb sleep:

  • arthritis and other painful conditions
  • chronic lung disease
  • certain medications
  • heartburn
  • increased frequency of urination

Some sleep disorders occur more frequently in the postmenopausal years. For example, sleep disordered breathing – uncommon in young women – is more common in postmenopausal women. This may be related to falling progesterone levels, since younger women who experience surgical menopause are also at increased risk of developing sleep disordered breathing.

Higher body weight and lower levels of physical activity are also risk factors for this syndrome. Signs of sleep disordered breathing include loud snoring during sleep and excessive daytime sleepiness.

Other factors also influence the quality of sleep in post menopausal women:

  • psychosocial environment
  • physical health
  • emotional state
  • Depression, anxiety and insomnia are closely linked
  • Subtle worries and tensions can also disturb sleep

Guidelines for Better Sleep Post-Menopause

  • Maintain a comfortable, sleep environment in your bedroom:  reduce disturbing noises, reduce obtrusive lighting and extreme temperatures.
  • Go to bed and get up at the same time every day.
  • Avoid staying in bed late in the morning to make up for sleep loss.
  • Get up early in the morning and maintain structured daily activity.
  • Consider an early afternoon nap (less than one hour and at least 5 hours before bed) at a regular time.
  • Stay away from fatty, spicy foods that are likely to cause indigestion or heartburn.
  • Seek medical advice if following these measures does not alleviate your excessive daytime sleepiness.
  • Exercise regularly. (Consult a healthcare provider before beginning an exercise programme).

Other factors that can affect women’s sleep

Emotional issues continue to affect women’s sleep at any age. Two conditions worthy of mention are depression and nocturnal eating syndrome.

Depression

Insomnia is one of the most common symptoms of depression at any age. If you are a woman who suffers from depression you may tend to fall asleep fairly quickly but awaken in the middle of the night, unable to go back to sleep. This kind of insomnia may be interpreted as the cause of the depression – “If I could just get more sleep I would not feel depressed” – but getting professional help and treatment for the depression can often solve the insomnia problem.

Nocturnal Eating Syndrome

Some women wake up in the middle of the night and feel that they are unable to go back to sleep until they eat.  Unless there is a medical cause (such as an ulcer) this type of problem is typically associated with dieting during the day.

When should I see a healthcare professional?

Occasional disturbances in sleep can happen to anyone and generally do not require medical intervention. Serious sleep problems can affect your daily functioning, relationships and sense of well being. When a sleep problem results in disruption in one of these areas, it may be time for you to consult with a healthcare professional.

Women are particularly sensitive to sleep difficulties because they are affected by hormonal changes, family stresses and role conflicts, any of which can affect sleep quality.

Your healthcare professional will be able to refer you to a sleep disorders specialist for a comprehensive evaluation of your sleep difficulties.  You may be asked to have your sleep monitored for a more detailed evaluation.  At the sleep centre, accurate diagnosis will allow your healthcare professional to develop the right treatment plan for you.

Tips on How to Sleep Well...

There are some general guidelines that help promote good sleep.

  1. Go to bed only when you are sleepy.
  2. Get out of bed if you are unable to fall asleep after about 20 minute. Leave your bedroom and do something relaxing. Come back to bed only when you are sleepy.
  3. Use your bed only sleep, sex and to recover from illness.
  4. Wake up at the same time every day, including weekends and holidays.
  5. If you have trouble sleeping at night then avoid naps during the daytime. If you need to take a nap, keep it to less than one hour and take it before 3pm.
  6. Begin rituals to help you relax before bedtime, such as taking a warm bath or reading for a few minutes.
  7. Exercise on a regular basis, but do it earlier in the day.
  8. Maintain a regular daily schedule to keep your brain’s internal clock running smoothly.
  9. Eat a light snack before bedtime, but avoid a big meal.
  10. Avoid caffeine, alcohol and cigarettes late in the day.
  11. Set aside time during the day to get all of your worries out of your system.
  12. Avoid sleeping pills or use them cautiously under the supervision of a doctor.
  13. Never drink alcohol while taking sleeping pills or other medications.
  14. Talk to your doctor or a sleep specialist if you have an ongoing problem related to your sleep.
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