Sleep disorders in women

Introduction
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By Antonio Culebras MD

Dr. Culebras is Professor of Neurology at SUNY Upstate Medical University and Consultant in the Sleep Center at Upstate University Hospital at Community General in Syracuse, New York. In this clinical summary, Dr. Culebras describes the idiosyncrasies of sleep in women, including changes that occur with the biological life cycles of menstruation, pregnancy, and menopause. Each phase increases the risk of sleep disturbance in unique ways that require distinct management.

New research is revealing novel aspects of sleep pathology in women (Culebras 2014). Old studies had shown that snoring women had more strokes (Hu et al 2000). In a study of 71,779 female nurses 40 through 65 years of age without previously diagnosed vascular disease followed for 8 years, the authors found that the age-adjusted relative risk of stroke was 1.60 (95% CI, 1.21 to 2.12) for occasional snorers and 1.88 (95% CI, 1.29 to 2.74) for habitual snorers. The study did not identify patients with sleep apnea, but as habitual snoring is a common marker of obstructive sleep apnea, it remains inescapable to assume that obstructive sleep apnea was the background risk factor for vascular disease. Very recent research results show that women with sleep apnea are indeed at higher risk of stroke than men, but the mechanisms of this phenomenon remain elusive (Chang et al 2014).

Key Points

  • Although women sleep better than men, 46% complain of trouble sleeping almost every night.
  • The menstrual cycle, pregnancy, and menopause are the principal modifying factors that increase the risk of sleep disturbance.
  • Sleep apnea affects 10% of pregnant women, particularly those who are obese, with the incidence reaching a peak in the third trimester of pregnancy.
  • The notion of a pathogenic link between sleep apnea and preeclampsia opens opportunities for prevention and treatment.
  • The cause of poor sleep quality in menopause is likely multifactorial.
  • Several sleep-related disorders, including restless legs syndrome, insomnia, and sleep-related eating disorder, are more prevalent and severe in women.

In This Article

Introduction
Clinical manifestations
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Management
Pregnancy
Anesthesia
Acknowledgement
References cited
Contributors