Unique Sleep Needs of Women
At the AAST 2019 Annual Meeting, Sept. 6-8 in St. Louis, Andrea Ramberg, RPSGT, CCSH, and Alex Perkins presented on a panel focused on women and sleep. What follows is an interview with Ramberg and Perkins on some of the topics of their panel. AAST members can download their session slides on the AAST website.
In what ways do women present symptoms of sleep disorders, and how does that differ from men?
Ramberg: Women complain more of unrested sleep, insomnia, headache, anxiety, depression, restless legs, nightmares, palpitations or fatigue. Women also are noted to score lower on the Epworth Sleepiness Scale (ESS) despite feeling the same levels of fatigue as men. This is possibly due to a different threshold of sleepiness and/or women complain differently than men do. Women have a greater clustering of events in REM. Women have much less severe events in NREM sleep, hence the diagnosis of overall milder OSA. REM OSA is disproportionally more common in women than men. Supine OSA is disproportionally more common in men than women. Women underreport snoring due to being embarrassed, and bed partners are less likely to notice. Women go to physician’s offices alone and do not have their partner to speak up about symptoms they aren’t even aware of. Women often fall asleep after their bed partners.
How can being pregnant affect sleep?
Perkins: Pregnancy involves huge changes in a woman’s anatomy and physiology, many of which can have an impact on sleep. Many of these normal changes such as musculoskeletal and joint pain, nocturia, gastroesophageal reflux and mood disturbances can all serve to impact on sleep quality. But on top of this, many women develop sleep disorders during pregnancy, too. Sleep-disordered breathing becomes much more common during pregnancy compared to other women of childbearing age. An elevated diaphragm and trachea makes the upper airway more crowded, and increases in blood volume tend to cause upper airway edema and further narrowing. As well as this, dynamic factors such as an increased respiratory drive as a result of increased oxygen consumption tends to cause more negative pressures within the upper airway. General sleep disturbance or sleep deprivation may also play a part in affecting respiratory loop-gain, as well as upper airway collapsibility. It’s not just sleep-disordered breathing that can be a problem for pregnant women; restless legs syndrome and insomnia are also much more common.
You can read the whole article in the Q4 issue of A2Zzz.