eMedicine Specialties > Neurology > Sleep-Related Diseases

Sleep Dysfunction in Women: Follow-up

Author: Gila Hertz, PhD, ABSM, Director, Center for Insomnia and Sleep Disorders, Clinical Associate Professor of Psychiatry and Behavioral Sciences, State University of New York at Stony Brook
Coauthor(s): Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Contributor Information and Disclosures

Updated: Dec 15, 2008

Follow-up

Further Outpatient Care

  • Compliance with nasal CPAP treatment has been estimated to be 50-73% in the first 6 months of treatment. It decreases sharply to less than 60% by 18 months of treatment; therefore, long-term follow-up is essential to maintain efficacy of this treatment.
  • Treatment of primary insomnia typically consists of a short-term cognitive-behavioral treatment with follow-up visits at 3 and 12 months. In the presence of comorbid psychiatric conditions, psychological treatment typically is combined with medication, and long-term follow-up treatment is needed.

Deterrence/Prevention

  • Good sleep hygiene: Maintaining good sleep hygiene improves the sleep of most women. Detailed guidelines for better sleep hygiene are listed in Patient Education.
  • Stress management: Stress associated with daily life often contributes to sleep problems. Learning stress management skills can help women sleep better and prevent more serious sleep problems.
  • Body weight maintenance: Regular exercise and healthy diet promote good sleep. In addition, maintaining normal weight may prevent development of SDB associated with obesity.

Complications

  • Persistent insomnia may lead to daytime fatigue, decreased daytime function, memory and concentration problems, higher incidents of automobile accidents, and depression. Patients with persistent insomnia tend to have more psychological and medical problems including those of the respiratory, gastrointestinal, and musculoskeletal systems.
  • Untreated or undertreated sleep apnea may lead to cardiac arrhythmias, hypertension, and congestive cardiac failure. In addition, daytime fatigue has been associated with increased neuropsychological impairment. Patients with sleep apnea are at higher risk for traffic accidents and increased mortality rates related to cardiovascular complications.

Prognosis

  • When treated, sleep apnea has an excellent prognosis. Shortly after treatment with nasal CPAP, patients report increased alertness, decreased nocturnal awakenings, and improved sense of well-being.
  • The prognosis of persistent insomnia is good when the treatment plan involves resolution of the underlying problem. Because of the large number of contributing factors, effective treatment relies on an understanding of the differential diagnosis and available treatment options.

Patient Education

  • Promoting good sleep hygiene: Physicians should educate women about habits and behaviors that help promote good sleep. These behaviors help most women sleep better, regardless of the type of sleep problem. The following sleep hygiene instructions should be emphasized:
    • Get up about the same time every day.
    • Go to bed only when sleepy.
    • Establish a relaxing presleep routine such as reading or listening to relaxing music.
    • Avoid heavy meals or consuming caffeinated beverages within 5-6 hours before bedtime.
    • Avoid smoking close to bedtime. Avoid sleeping pills for periods longer than few weeks. Be careful not to drink alcohol while taking sleeping pills.
    • Maintain a regular daily schedule that includes exercise, down time, and regular meal times. Avoid strenuous exercises within 6 hours before bedtime.
    • Older women should try to take a daily afternoon nap at a regular time to prevent early evening dozing.
  • For excellent patient education resources, visit eMedicine's Mental Health and Behavior Center, Sleep Disorders Center, and Women's Health Center. Also, see eMedicine's patient education articles Sleep Disorders in Women, Disorders That Disrupt Sleep (Parasomnias), Insomnia, Narcolepsy, REM Sleep Behavior Disorder, Periodic Limb Movement Disorder, and Menopause.

Miscellaneous

Medicolegal Pitfalls

Women who present with excessive daytime sleepiness should be warned about the dangers of driving and operating heavy machinery. This warning should be documented in the patient's chart. This is particularly important because in most sleep labs the time interval between initial evaluation, ordering of a sleep study, and initiation of treatment can be as long as weeks and even months.

Special Concerns

  • Pregnancy-related sleep disorder
    • Emotional disturbances are common during childbearing and the early postpartum period. Severely disturbed sleep might place women at higher risk for postpartum depression, postnatal psychosis, and child abuse, even in the absence of a premorbid psychiatric history. Because sleeping pills and other psychoactive medications can harm the fetus, other measures to improve sleep need to be considered.
    • Most patients with narcolepsy rely on stimulant and antidepressant medication to maintain daytime alertness and to control cataplexy; therefore, cessation of medication during pregnancy can cause excessive sleepiness or cataplexy, which may result in injury. In addition, withdrawal from medications also may affect sleep patterns. No adverse fetal outcome has been described in 2 case reports in women with narcolepsy who continued to take amphetamine throughout pregnancy and during nursing. Despite these findings, caution must be used in administration of these medications during pregnancy, because the long-term sequelae have not been assessed fully.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Gabriele M Barthlen, MD to the development and writing of this article.



More on Sleep Dysfunction in Women

Overview: Sleep Dysfunction in Women
Differential Diagnoses & Workup: Sleep Dysfunction in Women
Treatment & Medication: Sleep Dysfunction in Women
Follow-up: Sleep Dysfunction in Women
References
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Further Reading

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Keywords

insomnia, sleep disorders, sleep-onset insomnia, sleep-maintenance insomnia, circadian rhythm, sleep-disordered breathing, upper airway resistance syndrome, UARS, obstructive sleep apnea, OSA, restless legs syndrome, RLS, periodic limb movement disorder, PLMD, narcolepsy, parasomnias, premenstrual syndrome, PMS, sleep deprivation, sleep hygiene, snoring, fatigue, pregnancy-related sleep disorder, menstrual cycle and sleep

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Contributor Information and Disclosures

Author

Gila Hertz, PhD, ABSM, Director, Center for Insomnia and Sleep Disorders, Clinical Associate Professor of Psychiatry and Behavioral Sciences, State University of New York at Stony Brook
Gila Hertz, PhD, ABSM is a member of the following medical societies: American Academy of Sleep Medicine and American Psychological Association
Disclosure: Nothing to disclose.

Coauthor(s)

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians
Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Medical Editor

Carmel Armon, MD, MSc, MHS, Professor of Neurology, Tufts University School of Medicine; Chief, Division of Neurology, Baystate Medical Center
Carmel Armon, MD, MSc, MHS is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Association of Neuromuscular and Electrodiagnostic Medicine, American Clinical Neurophysiology Society, American College of Physicians, American Epilepsy Society, American Medical Association, American Neurological Association, American Stroke Association, Massachusetts Medical Society, Movement Disorders Society, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Norberto Alvarez, MD, Assistant Professor, Department of Neurology, Harvard Medical School; Consulting Staff, Department of Neurology, Boston Children's Hospital
Norberto Alvarez, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, and Child Neurology Society
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

 
 
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