• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
WOMEN IN MIND: Women's sleep: Much more than beauty sleep
 

WOMEN IN MIND: Women's sleep: Much more than beauty sleep

on

  • 264 views

Presented by The Royal's Dr. Elliott Lee at our annual Women in Mind Conference. ...

Presented by The Royal's Dr. Elliott Lee at our annual Women in Mind Conference.
Dr. Elliott Lee is an Assistant Professor and Sleep
Specialist at The Royal, where he works in both the
Sleep Disorders Clinic and the Anxiety Disorders Clinic.

Statistics

Views

Total Views
264
Views on SlideShare
264
Embed Views
0

Actions

Likes
0
Downloads
0
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    WOMEN IN MIND: Women's sleep: Much more than beauty sleep WOMEN IN MIND: Women's sleep: Much more than beauty sleep Presentation Transcript

    • Womens’ Sleep: Much More Than Just Beauty Sleep Women in Mind|Body and Mind November 15, 2013 Elliott Lee MD, FRCP(C), D. ABPN D. ABPN Sleep medicine, Addiction Psychiatry D. Amer Board of Sleep Medicine Assistant Professor, Sleep Specialist, Royal Ottawa Mental Health Center
    • Journey CASE
    • Case Study
    • More about Zoe… • MedHx – Asthma • Meds: alesse, quetiapine (for sleep) • FHx - sister “anger issues” - mother – trauma • SocHx Some conflicts with parents (rel issues) • Psych Hx - Mood Sx X 2-3 yrs - suicide attempt (2011- CHEO) - Med trials: sertraline citalopram venlafaxine mirtazapine trazodone - Hx of cutting - No drug use
    • Normal sleep
    • STAGES OF SLEEP • • NREM & REM NREM=N1, N2 (light stages of sleep) N3 (Slow wave sleep (SWS)) • • • Sleep cycles across the night REM increases as the night progresses Changes across the lifespan
    • SLEEP HYPNOGRAM W N2 1 N1 N3 REM 1 2 3 4 Hours 5 6 7
    • Sleep Stage % by Age
    • Functions of Sleep (?) • REM sleep functions: - Dreaming - Mood regulatory role? - Memory? - Modulate emotional memories? • Slow Wave Sleep (SWS) - Declarative memory? - Cerebral restoration? • Clear waste?
    • Womens’ sleep
    • Womens’ Sleep Architecture EEG Power vs. Sleep Cycle Women Men Dijk DJ et al. Sleep 1989; 12(6):500-7
    • Women vs Men: Changes with Age  Young women have short sleep latency and higher sleep efficiency compared to young men  A trend was found for older women to have a higher sleep efficiency, but elderly males spend more time in bed
    • Sleep in the Menstrual Cycle Lee KA et al. Sleep 1990;13(5):403-9.
    • Women are more likely to work rotating shifts or evening shifts Men Women Other 13% Other 12% Irregular 25% Evening 14% Evening 10% Irregular 35% Night 8% Night 8% Rotating 41% Rotating 34% Source: Williams C. Worklife Balance of Shift Workers, Stats Canada General Social Survey, 2005
    • Shift Work • International Agency on Research and Cancer (IRAC) classified shift work as a probable carcinogen in 2007. • 40-50% increase in breast cancer risk with >20-30 years of shift work exposure. • Melatonin thought to play a key role; reduces estrogen levels and shown to have anticancer properties. Megdal et al. Eur J Cancer. 2005; 41: 2023-32 Grundy A et al. Occup Environ Med. 2013; 70: 831-8 Shernhammer ES and Hankinson SE. Cancer Epidemiol Biomarkers Prev 2009; 18: 74-9
    • Pregnancy
    • Pregnancy • Pregnancy and postpartum period physiologically and psychologically affect sleep • Sleep disturbance very common: - Hormonal alterations - Fetal enlargement - Newborn sleep schedule
    • Duration and Efficiency of Sleep in Pregnancy 1Lee KA T et al. Obstet Gynaecol. 2000; 95(1): 14-8
    • What Affects Sleep in Pregnant Women? 2007 Sleep in America Poll National Sleep Foundation, 2007
    • Post Partum Depression (PPD) • Sleep compromised - infant care - physiologic changes • 20% of women report PPD • 50% in outpt treatment for PPD report insomnia • Poor subjective sleep quality is associated with PPD Park EM et al. Arch Womens Ment Health. 2013; 4 jun
    • Tips for Sleep in Pregnancy: • Obtain sufficient sleep (w/o excess time in bed) • Regular sleep/wake times • Take naps if needed • Avoid caffeine • Report symptoms of sleep disorders • Get help at home, particularly for post partum period
    • Menopause
    • Menopause (Climacteric) • Ovarian follicle store is exhausted • Estrogen and progesterone decline • 90% experience symptoms1 • 25-50% describe sleep disturbances2 1Ameratunga 2Guidozzi D et al. Intern Med J. 2012; 42(7): 742-7 F. Climacteric. 2013; 16(2): 214-9
    • Causes of Disturbed Sleep in Menopause Depression Caregiver responsibilities Lifestyle changes Circadian influences on aging Career changes SLEEP Hormone influences on sleep Insomnia Restless legs syndrome Sleep Apnea Figure courtesy of Sleep in women : Normal sleep and sleep disorders slide presn, prepared by AASM, 2008
    • Hot flashes • Most common symptom of climacteric (up to 87% of women) • Intense warmth with sweating, chills or flushes • Lasts 1-5 min, sometimes 1 hour • Persists 4-5 years Ameratunga D et al. Intern Med J. 2012; 42(7): 742-7 Freedman R. J Steroid Biochem Mol Biol. 2013; Sept
    • Treatment of hot flashes • Non pharmacologic - Reduce core body temp - cool drinks - avoid stimulants: caffeine nicotine - Relaxation therapies - Paced breathing • Pharmacologic - Hormone therapy - Clonidine - Serotonergic drugs - Paroxetine - Fluoxetine - Venlafaxine - Gabapentin • General reduction in frequency by 50-80% Freedman R. J Steroid Biochem Mol Biol. 2013; Sept
    • Menopause and Insomnia Treatment • Womens Health Initiative study - 16 500 women evaluated - Improved sleep with HRT - Risks: - Breast cancer - Stroke - Heart disease - Thrombembolic disease Nelson HD et al. JAMA. 2002: 288(7); 872-81
    • Sleep Disorders: - Obstructive Sleep Apnea (OSA) - Upper Airway Resistance syndrome (uars) - Restless legs Syndrome (RLS) - Insomnia
    • Obstructive sleep apnea (osa) Upper airway resistance syndrome (uars)
    • Obstructive Sleep Apnea (OSA) • • • • Pauses in breathing > 10 seconds in length Respiratory Disturbance Index (RDI): >5 hr = significant Prevalence – up to 25% of men, and 9% of women Key diagnostic questions: - Do you feel satisfied with the quality of your sleep? - Does your partner complain that you snore? Young T et al. N Engl J Med. 1993; 328: 1230-5
    • OSA Clinical Symptoms
    • Upper Airway Resistance Syndrome (UARS) • • Subtle sleep disordered breathing Sleep disordered breathing events with arousals, but not hypoxemia • More common in women (UARS - ♂/♀=1:1 vs OSA - ♂/♀ 2:1) • Symptoms: fatigue, depression, insomnia, headaches, irritability Guilleminault C et al. Chest. 1993; 104: 781-7 Bao G and Guilleminault C. Curr Opin Pulm Med. 2004; 10:461-7
    • Treatments for OSA/UARS • • • • **Weight loss - ↓ BMI = ↓ RDI Avoid alcohol consumption and sedative medications “Snoreball” technique / positional therapy Upper airway surgery o o Uvulopalatopharyngoplasty (UPPP) o Maxillomandibular Advancement (MMA) o • • Tonsillectomy (pediatrics) Tracheostomy Provent Oral Appliances - Mandibular Repositioning Devices (MRDs), Tongue Retention Devices (TRDs) • **CPAP – Continuous Positive Airway Pressure
    • GERD Hypertension Motor vehicle accidents OSA Consequences Impaired glucose control Heart attack and stroke Amenorrhea (!) Irritability, mental illness e.g. depression Memory problems
    • OSA and Mental Illness • OSA can exacerbate mental illness: - Aggression /cognition in schizophrenia - Mood disorders - Nightmares in PTSD - Cognitive dysfunction in dementias - Relapse to substance abuse Lee EK and Douglass AB. Can J Psychiatry, 2010; 55(7): 403-12
    • OSA and Attractiveness? • Treatment of OSA with CPAP has been shown to improve attractiveness • Perceived to be - More alert - More youthful - Less forehead creases Chervin R et al. J Clin Sleep Med, 2013; 9(9): 845-52
    • OSA and Pregnancy • • Sleep complaints are common in pregnancy 14-45% of women may snore in pregnancy (vs. 4% non pregnant women) • Even snoring has been linked with adverse pregnancy outcomes - Intrauterine Growth Retardation - Hypertension
    • OSA and Pregnancy • OSA in pregnancy – linked to: - Preclampsia/hypertension - Gestational diabetes - Intrauterine growth retardation • • Prevalence - ? Increased risk: - Fluid retention - Nasal congestion/upper airway edema
    • Mechanism of OSA Affecting Pregnancy Iczi-Balserak B and Pien GW. Curr Opin Pulm Med, 2010; 16(6): 574-82
    • OSA and Menopause • OSA is twice as prevalent in postmenopausal vs premenopausal women • • Up to 4-44% of post menopausal women may be affected Several factors may play a role: - Reduced respiratory stability - Loss of protective effect of progesterone - Age/increased soft tissue collapsibility - Increasing weight
    • Restless Legs Syndrome (RLS) (Ekbom’s Disease)
    • Restless Legs Syndrome • Uncomfortable sensations in the legs (usually) that bother patients at night WHILE AWAKE “URGE” U – urge to move legs R – rest – worsened at rest G – gets better with movement E – evening – worse in evening
    • Patient Descriptions • • • • • • “Creepy crawly” Tingling “Heebee Jeebees” Electricity in veins Aching Burning • • • • • Coca cola Itching Restless “Like I have to move” “Nervous”
    • Epidemiology/Pathology - RLS • • • 5-10% of the population affected (♀/♂=2/1) The leading hypothesis is brain dopamine dysfunction May involve a circadian mechanism - circadian fluctuations in dopamine? • Deficiencies in other substances, especially iron, likely play a role. • Key diagnostic question: Do your legs ever bother you at night?
    • RLS prevalence by Age and Gender (symptoms > 1x/wk associated with distress) Prevalence (%) 8 RLS sufferers (n=116) All Men Women 6 4 2 0 20-29 30-39 40-49 50-59 60-69 70-79 80+ Age group (years) Allen RP et al. Arch Intern Med. 2005;165:1286-1292.
    • Treatment Non Pharmacologic: • Check ferritin, vitaminB12 • Avoid caffeine, nicotine, alcohol • Rule out other sleep/medical disorders • Cold/warm compresses • Massage Pharmacologic: • Dopamine agonists (Pramipexole, Ropinirole, Sinemet) • Gabapentin - anticonvulsant • Benzodiazepines (sedative hypnotics) - Clonazepam - Lorazepam - Diazepam • Opioids - Codeine - Hydrocodone - Methadone Silber MH et al. Mayo Clin Procs. (2004) 79 (7): 916-22
    • RLS and Pregnancy Extremely common in pregnancy – 11-56% • Especially 3rd trimester (highest estrogen levels) - Estrogen may interfere with dopamine transmission - Anemia/shared iron supply 25 20 15 10 5 0 >9 s th s s th hs on on th on t on m m m m 8 6 4 Treatment options limited 7- 5- 3- • Prevalence by Months of Pregnacy Prevalence (%) • Suzuki K et al. Sleep 2003; 26(6): 673-7.
    • Insomnia
    • Risk Factors for Insomnia: Specific to Women Menstrual phase worsens sleep in 31% of menstruating women • Pregnant women frequently describe difficulty sleeping • Self-reported insomnia increases with menopause Manber R, Bootzin RR. Health Psychol 1997;16(3):209-14. Shaver JL, Paulsen VM. Fam Pract Res J 1993;13(4):373-84. . % Affected •
    • Co-morbid Conditions  Co-morbid conditions more common in women  Pain syndromes and fibromyalgia  Depressive disorders, anxiety disorders  Restless Legs Syndrome  Nocturnal sleep-related eating disorder
    • Insomnia and Major Depressive Disorder • Insomnia often predates the onset of mood symptoms - Metaanalysis by Baglioni et al showed pts with insomnia have a 2-fold increased risk of developing depressive disorder, especially ♀ • 1 Insomnia symptoms may persist even after mood symptoms abate2 1 Baglioni C et al. J Affect Disord. 2011; 135: 10-9 2 Manber R and Chambers AS. Curr Psychiatr Rep. 2009; 11: 437-42
    • Insomnia predating mood (Adapted from Benca RM, 2004)
    • What about Zoe…
    • Zoe’s Sleep Study Respiratory Events Apnea C Apnea O Apnea M Hypopnea RERA CSR 11:07 PM 12:09 AM 1:11 AM 2:14 AM 3:16 AM 4:18 AM 5:20 AM 6:22 AM 12:09 AM 1:11 AM 2:14 AM 3:16 AM 4:18 AM 5:20 AM 6:22 AM SpO2% 100 90 80 70 60 50 11:07 PM
    • Zoe’s Sleep Study with CPAP Respiratory Events Apnea C Apnea O Apnea M Hypopnea RERA CSR 11:29 PM 12:29 AM 1:29 AM 2:30 AM 3:30 AM 4:30 AM 5:30 AM 6:30 AM
    • Zoe after treatment…
    • Summary • Womens’ sleep is different from men - Different biological, psychosocial underpinnings - Menstruation - Pregnancy - Menopause • Women suffer from sleep disorders, but the presentation may be different, and often overlooked - OSA/UARS - Restless Legs Syndrome - Insomnia • Failure to recognize/address sleep issues can lead to a myriad of consequences: daytime fatigue, cardiovascular disease, psychiatric illness, cancer, death
    • Tips for Optimizing Sleep • • • • • Have regular sleep times /wake times Have a relaxing pre bedtime routine Avoid caffeine/alcohol late at night Make sleep an appropriate priority Bed – only for sleep or intimacy - No backlit screens. - Bedroom – dark and comfortable* • • • Avoid clock watching Exercise in the day, and minimize stress Seek help/referral if problems persist
    • Questions?