Women and the Importance of Sleep


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Women and the Importance of Sleep

Texas Health Resources and the Advances in Medicine Lecture Series are proud to collaborate with the Laura W. Bush Institute for Women's Health and the Texas Tech University Health Sciences Center on a lecture about women and the importance of sleep.

Clinical sleep disorder and sleep debt are often unrecognized, untreated misdiagnosed in millions of women. The amount of sleep a woman gets every night can affect her stress level, weight and overall health. Sleep loss even increases aging including memory.

This lecture presented by Dr. Emily Kirby will bring to light causes, effects and solutions. Written by Anne L. Smalligan, BSN, Med. with Kaye Renshaw, LPC

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  • A good nights sleep is one of the best things we can give ourselves and yet look at the stats on the next slide.
  • From this cycle you can see how it doesn’t take too many nights before you have a cumulative loss of multiple hours of sleep.
  • Istockphoto:Yuri_Arcurs
  • © Igor Mojzes - Fotolia.com
  • NO! Women sleep better, longer, go to sleep faster and sleep more efficiently than men.
  • The definitions follow
  • Insomnia is also linked to depression and pain.
  • Many of you have in the past or currently have these symptoms and may not have spoken with your doctor about it.
  • Insomnia is also linked to depression and pain.
  • Much of the research in OSA has been performed on men > women. Providers are taught the most “typical” presentation which is male middle aged overweightAnother reason is much like heart disease women “present” differently.Women and men report different symptoms when they experience obstructive sleep apnea. These variations have led to delayed diagnosis or misdiagnosis in women.
  • Women and men report different symptoms when they experience obstructive sleep apnea. These variations have led to delayed diagnosis or misdiagnosis in women. Men and women also respond to therapies differently - what works for men may not work for women.
  • This slide shows how too little sleep begins a cycle of abnormal hormone production that can lead to the chronic diseases and conditions.
  • Focus of talk now switches to steps women can take to improve their sleep© iQoncept - Fotolia.com
  • The stress of unpaid bills can keep our minds racing at night.Caring for a new baby or an elderly family member can greatly diminish the quantity of sleep women get each night.Conflicts or unhappiness or dissatisfaction with work robs women of sleep.
  • This is hard with busy schedules, but worth the effort. Also if you have a husband who likes to snack at night, it’s hard to pass up the chips and ice cream, but consider the cost of a sleepless night.
  • © creative soul - Fotolia.com
  • For example if you typically need 8 hours of sleep per night to feel rested and productive the next day, but for 4 days straight you only get 6 hours, you have a sleep dept of 8 hours (a full nights sleep!)
  • Sleep requirements vary from person to person. Most adults require 7-9 hours of sleep.
  • These things don’t just happen - plan them!
  • The promotion of regular sleep is known as sleep hygiene.
  • These meds do different things to promote sleep. Sometimes it might take several tries before the best medication is found. These meds should be considered as a short-term solution, and shouldn’t be prescribed until behavior modification has been tried. If depression is the under-lying problem, managing it will likely also help with sleep related problems.
  • Information below + more on melatonin can be found @ http://www.nlm.nih.gov/medlineplus/druginfo/natural/940.htmlWhat is it?Melatonin is a hormone found naturally in the body. Melatonin used as medicine is usually made synthetically in a laboratory. It is most commonly available in pill form, but melatonin is also available in forms that can be placed in the cheek or under the tongue. This allows the melatonin to be absorbed directly into the body.People use melatonin to adjust the body’s internal clock. It is used for jet lag, for adjusting sleep-wake cycles in people whose daily work schedule changes (shift-work disorder), and for helping blind people establish a day and night cycle.Melatonin is also used for the inability to fall asleep (insomnia); delayed sleep phase syndrome (DSPS); insomnia associated with attention deficit-hyperactivity disorder (ADHD); insomnia due to certain high blood pressure medications called beta-blockers; and sleep problems in children with developmental disorders including autism, cerebral palsy, and mental retardation. It is also used as a sleep aid after discontinuing the use of benzodiazepine drugs and to reduce the side effects of stopping smoking.Some people use melatonin for Alzheimer’s disease, ringing in the ears, depression, chronic fatigue syndrome (CFS), fibromyalgia, migraine and other headaches, irritable bowel syndrome (IBS), bone loss (osteoporosis), a movement disorder called tardive dyskinesia (TD), epilepsy, as an anti-aging agent, for menopause, and for birth control.Other uses include breast cancer, brain cancer, lung cancer, prostate cancer, head cancer, neck cancer, and gastrointestinal cancer. Melatonin is also used for some of the side effects of cancer treatment (chemotherapy) including weight loss, nerve pain, weakness, and a lowered number of clot-forming cells (thrombocytopenia).It is also used to calm people before they are given anesthesia for surgery.The forms of melatonin that can be absorbed through the cheek or under the tongue are used for insomnia, shift-work disorder, and to calm people before receiving anesthesia for surgery.Sometimes people apply melatonin to the skin to protect against sunburn.How effective is it?Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.The effectiveness ratings for MELATONIN are as follows:Likely effective for...Sleeping problems in children with autism and mental retardation. Taking melatonin by mouth is helpful for disturbed sleep-wake cycles in children and adolescents with mental retardation, autism, and other central nervous system disorders. Melatonin also appears to shorten the time it takes for to children with developmental disabilities (cerebral palsy, autism, and mental retardation) to fall asleep.Sleep disorders in blind people.Possibly effective for...Jet lag. Most research shows that melatonin can improve certain symptoms of jet lag such as alertness and movement coordination. Melatonin also seems to improve, to a lesser extent, other jet lag symptoms such as daytime sleepiness and tiredness. But, melatonin might not be effective for shortening the time it takes for people with jet lag to fall asleep.Trouble sleeping (insomnia). Melatonin seems to be able to shorten the amount of time it takes to fall asleep, but only by about 12 minutes, according to one research study. Melatonin does not appear to significantly improve “sleep efficiency,” the percentage of time that a person actually spends sleeping during the time set aside for sleeping. Some people say melatonin makes them sleep better, even though tests don’t agree. There is some evidence that melatonin is more likely to help older people than younger people or children. This may be because older people have less melatonin in their bodies to start with.There is some interest in finding out whether melatonin might help with “secondary insomnia.” This is trouble sleeping that is related to other conditions such as Alzheimer’s disease; depression; schizophrenia; hospitalization; and “ICU syndrome,” sleep disturbances in the intensive care unit. Research to date suggests that melatonin might not help to reduce the time it takes to fall asleep in secondary insomnia, but it might improve sleep efficiency.Cluster headaches. Taking 10 mg of melatonin by mouth every evening might reduce the number of cluster headaches. However, taking 2 mg of melatonin at bedtime doesn’t seem to work.Reducing anxiety before surgery. Melatonin used under the tongue seems to be as effective in reducing anxiety before surgery as midazolam, a conventional medication. It also seems to have fewer side effects in some people.Helping elderly people sleep after they stop taking a type of drug called benzodiazepines. The controlled-release form of melatonin is the type that was shown to work for this.Helping decrease symptoms in people who are quitting smoking. A single oral dose of 0.3 mg of melatonin taken 3.5 hours after stopping cigarettes seems to reduce anxiety, restlessness, irritability, depression, and cigarette craving over the next 10 hours.Low blood platelets (thrombocytopenia).Improving the effectiveness of certain cancer medications used to fight tumors in the breast, lung, kidney, liver, pancreas, stomach, colon, prostate, and decreasing some side effects of cancer treatment.Decreasing symptoms of a movement disorder called tardive dyskinesia (TD).Decreasing sunburn when applied to the skin in a cream form before going into the sun.Possibly ineffective for...Adjusting sleep schedule in people that do shift work.Likely ineffective for...Depression. There is also some concern that melatonin might worsen symptoms in some people.Insufficient evidence to rate effectiveness for...Epilepsy. There is some evidence that melatonin at bedtime may reduce the number and length of seizures in children with epilepsy. But melatonin should be used cautiously, because melatonin may increase the number of seizures in some people.Menopausal symptoms. Limited research suggests that melatonin does not relieve menopausal symptoms. However, melatonin in combination with soy isoflavones might help psychological symptoms associated with menopause.Sleep problems associated with attention deficit-hyperactivity disorder (ADHD). Limited research suggests melatonin might improve insomnia in children with ADHD who are taking stimulants. But improved sleep does not seem to decrease symptoms of ADHD.Migraine headache. There is some evidence that taking melatonin nightly before bed can prevent episodic migraine headache. When headaches do occur, they are milder and pass more quickly. Some research suggests that melatonin production might be altered in people with migraine.Insomnia caused by medications used for high blood pressure (beta-blockers).Headache characterized by sudden sharp pain (idiopathic stabbing headache).Ringing in the ears (tinnitus).Chronic fatigue syndrome (CFS).Osteoporosis.Irritable bowel syndrome (IBS).Birth control.Fibromyalgia.Aging.Other conditions.More evidence is needed to rate melatonin for these uses.How does it work?Return to topMelatonin’s main job in the body is to regulate night and day cycles or sleep-wake cycles. Darkness causes the body to produce more melatonin, which signals the body to prepare for sleep. Light decreases melatonin production and signals the body to prepare for being awake. Some people who have trouble sleeping have low levels of melatonin. It is thought that adding melatonin from supplements might help them sleep.Are there safety concerns?Return to topMelatonin is LIKELY SAFE for most adults when taken by mouth short-term or applied to the skin. It can cause some side effects including headache, short-term feelings of depression, daytime sleepiness, dizziness, stomach cramps, and irritability. Do not drive or use machinery for four to five hours after taking melatonin. Special precautions & warnings:Pregnancy and breast-feeding: Melatonin is POSSIBLY UNSAFE in pregnancy. Don’t use it. Melatonin might also interfere with ovulation, making it more difficult to become pregnant.Not enough is known about the safety of using melatonin when breast-feeding. It’s best not to use it.Children: Melatonin should not be used in most children. It is POSSIBLY UNSAFE. Because of its effects on other hormones, melatonin might interfere with development during adolescence.High blood pressure: Melatonin can raise blood pressure in people who are taking certain medications to control blood pressure. Avoid using it.Diabetes: Melatonin might increase blood sugar in people with diabetes. Monitor your blood sugar carefully, if you have diabetes and take melatonin.Depression: Melatonin can make symptoms of depression worse.Seizure disorders: Using melatonin might increase the risk of having a seizure.Works in your brain to promote circadian rhythms. Seems to be more effective when combatting jet-lag.
  • Side effects:Sleep eating
  • It is no secret that women suffer more side effects and adverse events than men.In 40% of new drug applications (NDAs) pharmacokinetic differences by gender were submitted 40% of the drugs yet no dosing adjustments were recommended.
  • How we all wish we could sleep each night!© olesiabilkei - Fotolia.com
  • Women and the Importance of Sleep

    1. 1. Women and the Importance of Sleep “Sleep Debt” and Clinical Sleep Disorders are Often Unrecognized, Untreated, and Misdiagnosed in Millions of Women Anne L. Smalligan, BSN, Med. with Kaye Renshaw, LPC
    2. 2. Strength doesn't lie in numbers Strength doesn't lie in wealth Strength lies in nights of peaceful slumber When you wake up Wake up! It's healthy! From The Sound of Music “I Have Confidence ”
    3. 3. The Alarming Statistics • 50% of all sleep disturbances are due to stress • 63% of adults do not get enough sleep to regulate weight • 75% of Strokes have related Sleep Apnea • People who sleep five hours or less are 40% more likely to have a heart attack
    4. 4. SLEEP and the Brain/Mind • Sleep allows the brain to organize events of the day • Adequate sleep is necessary to erase and efficiently store events • Inadequate sleep leaves the task unfinished • Events pile up causing the mind to race • Concentration is interrupted • Decision making is hindered
    5. 5. The Vicious Cycle Events of the Day Depression, Anxiety, Memory loss, ILLNESS Decreased Sleep Resulting in a pressured pace coping with normal daily events Incomplete processing through inadequate sleep Events from one day to the next pile up
    6. 6. Sleep Loss ↑ Risk of Other Illnesses • • • • • • Diabetes Hypertension Obesity Heart Disease Immune Deficiency Psychological Disturbances The list is UNENDING
    7. 7. Sleep Loss Increases Effects of Aging Including Memory Loss
    8. 8. Medical vs. Mental Causes • Medical conditions should be ruled out before embarking on a stress-related diagnosis and treatment • Often a team approach, health care providers and counselors can be more effective to get you back on a normal sleep cycle
    9. 9. Her Sleep vs. His Sleep Do women and men sleep the same?
    10. 10. Her Sleep vs. His Sleep Do women and men sleep the same? Women Men • ↑Sleep quality • ↓Sleep quality • ↑Sleep times • ↓Sleep times • ↓Sleep onset/latency • ↑Sleep onset/latency • ↑Sleep efficiency • ↓Sleep efficiency Curr Opin Pulm Med. 2006 Nov; 12(6):383-9
    11. 11. That’s the Good News Despite these positive differences, women have more sleep-related complaints than men!
    12. 12. These Conditions are Clinical Disorders That Probably Require Medical Attention in Both Men and Women • Insomnia • Restless Legs Syndrome (RLS) • Obstructive Sleep Apnea
    13. 13. Insomnia An inability to fall or stay asleep that can cause a negative impact on your ability to function throughout the day.
    14. 14. Insomnia is Diagnosed by: • Difficulty falling or staying asleep or nonrestorative sleep • Sleep difficulty three times a week for at least one month • Difficulty sleeping despite opportunity and circumstances to sleep • Daytime distress or impairment caused by lack of sleep
    15. 15. Restless Legs Syndrome (RLS) An unpleasant “creeping” sensation associated with aches and pains throughout the legs that can make it difficult to fall asleep.
    16. 16. Obstructive Sleep Apnea (OSA) Interrupted sleep caused by periodic gasping or snorting noises or momentary suspension of breathing.
    17. 17. Women Report: • ↑Insomnia (especially with increased age) • ↑Restless Legs Syndrome • ↑Obstructive Sleep Apnea (OSA)
    18. 18. Why is an OSA Diagnosis Difficult to Come by in Women? The “typical” people suffering from OSA have been categorized; 1. Male 2. Middle aged 3. Overweight or obese
    19. 19. Why is an OSA Diagnosis Difficult to Come by in Women? Women and men report different symptoms when they are suffering from Obstructive Sleep Apnea.
    20. 20. Reported Symptoms of OSA Women Men • Fatigue • Snoring • Insomnia • Witnessed breathing • Morning Headache • Mood disturbances pauses • Excessive sleepiness
    21. 21. Other Female-Only Issues That Can Alter Sleep • Menstrual cycles • Pregnancy • Menopause
    22. 22. The Hormonal Picture Chronic Sleep Debt Weaken Immune System Increase cravings for Carbs Decreases production of Thyroid Stimulating Hormone Increased levels of Cortisol or stress hormones May decrease growth hormone and testosterone May decrease glucose tolerance
    23. 23. If you don’t have a clinical sleep disorder…what is keeping you awake?
    24. 24. What is Keeping us Awake? • Finances • Family | Children • Work
    25. 25. Did You Know? Eating a high calorie meal or late night snack near your bedtime is associated with lower quality of sleep -- especially in women!
    26. 26. Did You Know? The more calories consumed- the longer it took women to fall asleep. So, don’t eat after 7 pm – it is also a good idea to help you maintain or lose weight!
    27. 27. Mood Disorders are Increased with Inadequate Sleep • Adjustment Disorders • Depression • Anxiety
    28. 28. Symptoms of Mood Disorders Signs and symptoms of adjustment disorder may affect how you feel and think about yourself or life, including: • • • • • • • • Sadness & hopelessness Lack of enjoyment or crying spells Nervousness or worry Thoughts of suicide Desperation Trouble sleeping Difficulty concentrating Feeling overwhelmed
    29. 29. Behavioral Symptoms of Mood Disorders Signs and symptoms of adjustment disorder may affect your actions or behavior, such as: • • • • • • Fighting Ignoring bills Avoiding family or friends Poor school or work performance Absenteeism Forgetting important events/appointments
    30. 30. And…Reckless Driving
    31. 31. Symptoms Over Time • Symptoms persisting less than a few weeks may go away on their own with self care • Symptoms persisting over several weeks may not go away on their own….SEEK HELP  Make an appointment with your health practitioner  Medication may be necessary to resolve the issue
    32. 32. How Much Sleep Do You Need? • Sleep requirements vary from person to person • Most adults need seven to nine hours of sleep per night • If you don’t get your required amount of sleep, you begin to accumulate “Sleep Debt”
    33. 33. Pay Down Your “Sleep Debt” • You must pay yourself with an increase in sleep: If you need eight hours of sleep and you have a “debt” – sleep 9-10 hours per night until you no longer feel tired during the day. After “paying the debt” you can return to sleeping your required amount.
    34. 34. Coping with Stress → Improving Sleep Be Intentional; • Set routines • Go to bed earlier • Eliminate stimuli
    35. 35. Coping with Stress → Improving Sleep Plan Stress Relief; • Walk instead of running • Take a bubble bath • Order take out • Get a massage
    36. 36. Coping with Stress → Improving Sleep Demand the opportunity for self care; • Practice assuming permission • Be vulnerable with a: Friend Counselor Minister
    37. 37. Improve Sleep by: • Avoiding caffeine • Journaling thoughts and close the book • Getting into bed • Turning all lights off • Turning all sound off • Doing relaxation exercises
    38. 38. Tips to Reduce Stress and Reduce Sleep Debt • • • • Breathe Effectively Eat Healthy Stretch | YOGA Massage Therapy
    39. 39. Sleep Hygiene • Go to bed and get up at the same time each day • Sleep in a quiet, dark and relaxing environment • Have a comfortable temperature in your room • Your bed is for sleeping and sex only! • Remove TVs, computers and other gadgets from your bedroom • Avoid large meals and snacks before bedtime CDC Features- Sleep and Sleep Disorders
    40. 40. What about Sleep Aids and Medications? Non-pharmacy sleep aids -- use them if they are helpful to you; • Sound machines • Eye masks
    41. 41. Sleep Aids and Medications Prescription Medications; • Benzodiazepine Sleep Aids • Non-Benzodiazepine Sleep Aids • Melatonin Receptor Agonists (Rozerem) for Falling Asleep • Antidepressants as Sleep Aid All of these medications have side effects and most lose effectiveness over time. Discuss their use with your health care provider.
    42. 42. Sleep Aids and Medications Over-the-counter medications; • Melatonin -- A naturally occurring hormone that is sold as a health supplement. The research on it’s effectiveness as a sleep aid is limited to specific cases and it’s use should be discussed with your health care provider.
    43. 43. Gender Differences and Medications • March 2013 FDA Label Change  FDA recommended a dosing change for Ambien, a common sleep drug  The maximum dose recommended for women was reduced from 10mg to 5mg  Women metabolized (used) this medicine at a slower rate  More active drug was left in the system the next day causing increased risk for side effects: sleep eating, sleep driving, headaches, and daytime grogginess
    44. 44. Ambien Approved 20-plus Years Ago We are now recognizing this significant difference because during the application for a new sleep aid Intermezzo (zolpidem) a team’s evaluation data looked at gender. This resulted in a dosing change for women.
    45. 45. A recent publication revealed that 8 out of 10 drugs pulled from the market between 1997-2000 had more adverse events (side effects and death) in women
    46. 46. Take Home Tips 1. Not sleeping enough is harmful 2. Pay your sleep debt 3. Talk with your doctor if you are not sleeping 4. Sleep hygiene works 5. Medical illnesses can cause insomnia and can lead to serious health outcomes 6. Medications can be useful: start low and go slow to avoid side effects
    47. 47. Remember “… Sufficient sleep is not a luxury- it is a necessity- and should be thought of as a vital sign of good health.” Wayne H. Giles, MD, MS
    48. 48. References • http://www.sleepdex.org/deficit.htm • J Women’s Health (Larchmt). 2008 Sep;17(7):1191-9. doi: 10.1089/jwh.2007.0561. • Rev Neurol. 2009 Oct 1-15;49(7):376-82. • Curr Opin Pulm Med. 2006 Nov; 12(6):383-9. • J Clin Sleep Med. 2011 Dec 15;7(6):659-64. doi: 10.5664/jcsm.1476. • http://www.webmd.com/sleepdisorders/news/20100115/sleep-debt-hard-to-repay • http://www.nhlbi.nih.gov/health/dci/Diseases/rls/rls_WhatIs.ht ml