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Sleep and the Menstrual Cycle

Progesterone levels rise significantly after ovulation on days 13-14 of the menstrual cycle, and peak on days 19-21. As levels fall precipitously during the premenstrual phase of days 22-28, women frequently experience insomnia. Poorer quality sleep can also occur during the menstrual period itself.

Sleep and Pregnancy

High progesterone levels in the first trimester may lend to hypersomnia or excessive sleepiness. During the third trimester, sleep problems are almost universal due to leg crams, reflux, or regurgitation at night, and nocturia or the need to go to the bathroom frequently, and nasal congestion. Approximately one-third of women who have never snored will begin to snore during pregnancy. Some of these women will actually develop sleep apnea. Severe sleep apnea can decrease oxygen levels and affect fetal growth. As many as 15% of women will develop the creepy-crawling sensations of restless legs in their calves and thighs during pregnancy. The majority of cases improve after delivery. Hypertension at night may occur in 50% of women during pregnancy, but is much more common in women with pre-eclampsia who spill protein in their urine.

Pregnant women with sleep disorders need to be aware of the potential risks to the fetus from drug therapies that they may be receiving for sleep disorders

Sleep and Menopause

Hot flashes can frequently occur at night, resulting either in insomnia or poor quality sleep due to frequent awakenings. If symptoms are severe enough, hormone replacement therapy is warranted as long as the patient isn't already at risk for breast cancer or coronary heart disease.

Estrogen (Premarin 0.625 mg) with micronized progesterone (Prometrium 200 mg) seems to best improve the quality of sleep in post menopausal women taking estrogen.

The incidence of sleep apnea in women increases significantly in women after menopause, and with it, brings increased risks for hypertension, heart attacks, strokes and excessive daytime sleepiness.

Sleep and Old Age

As we age, the overall quality and quantity of sleep deteriorates. It is inappropriate to expect eight hours of quality sleep.

Difficulty initiating and maintaining sleep becomes a greater problem with aging. Early awakenings are common. Chronic illnesses and the medications used to threat them can affect the quality or quantity of sleep. Both sleep apnea and restless leg syndrome also increase in occurrence with age.

Specific Problems

Nocturia is the waking two or more times at night to void, due to a combination of a low bladder capacity and a relative increase in night time urine production compared to day time production. Nocturia occurs in 9% of women ages 19-39 years and in 63% of women 50-90 years in age. Increased mortality rates due to falls and fractures are associated with progressive nocturia. Nocturia in postmenopausal women can be relieved in 50% of cases with hormonal replacement therapy. Nocturia in black females is more often associated with obstructive sleep apnea.

Sleep Deprivation due to poor quality sleep can be associated with both fibromyalgia and interstitial cystitis. In both situations the maintenance of strict sleep hygiene and a mild hypnotic can improve sleep continuity.

Sleep Disorders Center at Regional Medical Center

Madisonville, Kentucky
(270) 825-5730 or 1-800-635-6506

Medical Director James Davis, MD
Clinical Coordinator Penny Hardison, RRT, RPSGT