Sleep Dysfunction in Women Treatment & Management

Treatment of sleep disorders is directed at the particular problem and includes behavioral and pharmacological components and implementation of a sleep hygiene program. The treatment of choice for SDB is continuous positive airway pressure (CPAP).

Behavioral approaches for the treatment of sleep disturbances are effective and should be used as first-line treatment for chronic insomnia. Specifically, in an NIH study, cognitive behavioral therapy for insomnia (CBT-I) has produced longer lasting effects than medication. CBT-I involves the modification of certain sleep-related mal adaptive behaviors and the identification of dysfunctional perceptions and attitudes related to sleep patterns. CBT-I has also been found effective in special populations including geriatric groups and patients suffering from chronic pain conditions.

• Menstruation-related sleep disorder

  • Generally, premenstrual insomnia disappears a few days after menstruation begins.
  • For some women, the associated tension and irritability can result in lingering sleep problems and even in chronic insomnia. These women should pay attention to their sleep needs, maintain a regular sleep-wake schedule, avoid stress when possible, and eat a healthy diet.
  • Because of underlying circadian disturbances in women with premenstrual symptoms, evening bright light therapy has been reported to be effective in preventing early morning awakening in women with this complaint.
  • Women diagnosed with PMDD are more susceptible to major depressive disorder when their condition goes untreated. Studies have shown that, like patients with major depression, women with PMDD respond to treatment that incorporates sleep deprivation. Both total and partial sleep deprivations have been shown to effectively reduce depressive symptoms, although these methods still are considered experimental.
• Pregnancy-related sleep disorder

  • Relatively little is known about the health significance of sleep disturbance in pregnancy. Pregnancy can pose a risk for developing SDB, back pain, and leg cramps. It can trigger episodes of sleepwalking and PLMD.^[34]
  • Sleep disturbance during pregnancy also can be associated with frightening dreams, postpartum blues, and sometimes even major depression and postnatal psychosis.^[35]
  • Throughout their pregnancy, women need to pay extra attention to their sleep pattern by making sure that they get enough sleep, maintain a regular sleep-wake schedule, and avoid excessively stressful conditions.
  • Because sleeping pills and alcohol can harm the baby, other measures to improve sleep need to be considered.
  • The practice of muscle relaxation technique prior to bedtime may be effective in promoting better sleep and reducing the discomfort of pregnancy.
  • To avoid exacerbating heartburn, women should maintain a balanced diet and avoid eating heavy meals and spicy food for at least 2-3 hours before bedtime.
  • After delivery, getting enough rest continues to be very important, as severely disturbed sleep might place women at risk for postpartum depression and child abuse.^[36]
• Menopause-related sleep disorders

  • Women can alleviate their menopause-related sleep disturbances by paying attention to their sleep habits, controlling their bedroom temperature, adjusting the light, and using comfortable (preferably cotton) bed linen.
  • They should eliminate caffeine, sugar, and alcohol from their diet.
  • Estrogen therapy has been found to be quite effective for women with severe sleep and mood disturbances who have no history of affective illness. Hormone replacement therapy (HRT) has also been the treatment of choice for sleep interruptions related to hot flashes. However, results from recent studies have caused the safety of this treatment to be questioned.^[37]
  • The combination of antidepressant medications and supportive psychotherapy should be considered for women who have had long-standing difficulties with sleep and depression and anxiety.
• Sleep-disordered breathing

  • In the presence of SDB, nasal CPAP and/or an oral device should be offered, along with recommendation regarding weight management.
  • HRT may be useful for the treatment of OSA in menopausal women. However, results of the Women's Health Initiative study have raise concerns about the safety of HRT.
  • Finally, weight management appears to be an important factor in the management of SDB in menopausal women.
• Sleep disorders in elderly women

  • Older women should be aware of sleep disturbances and not dismiss them as part of the aging process.
  • The presence of significant daytime sleepiness should be investigated and a sleep study may be required to rule out major sleep disorders.
  • The physician should be aware of the patient's medical and psychiatric conditions and target the treatment at the cause of the disturbance rather than the symptoms.
  • General guidelines for better sleep habits should be provided.

Uvulopalatopharyngoplasty (UPPP) is a surgical procedure performed to eliminate loud snoring. It involves surgical removal of excess tissues of the soft palate (including uvula) in order to enlarge the area of the upper airways for the purpose of improvement of air exchange.

Because of the multidisciplinary nature of sleep disorders, consultation with various specialists often is needed.

• Psychiatrist: A psychiatric consultation often is needed when severe insomnia does not respond to behavioral treatment.
• Neurologist: In the differential diagnosis of parasomnias (eg, sleep terror, sleepwalking, REM sleep behavior disorder), consultation with a neurologist often is needed to rule out sleep-related seizure disorders.
• Pulmonologist: SDB is suspected in the presence of loud snoring and daytime sleepiness. Occasionally, a pulmonologist is consulted to rule out related respiratory disease such as alveolar hypoventilation syndrome.
• Dentist: For patients who are unable to tolerate nasal CPAP, oral appliances may prove effective in the treatment of SDB.

In general, women should avoid eating heavy meals within 4 hours before bedtime, as this can have a stimulating effect on sleep. Pregnant women are prone to heartburn, particularly during the last trimester of pregnancy. Therefore, they should maintain a balanced diet and avoid eating spicy food at least 2-3 hours before bedtime.

For older women, maintaining long hours of sound sleep during the night and long hours of complete alertness during the day becomes increasingly difficult. This can result in waking periods during the night and increased daytime fatigue. In addition, decreased physical activity, irregular sleep-wake schedule, and lack of outdoor light exposure may be involved in changes of the circadian rhythm. Older women should be encouraged to maintain a structured daily schedule that includes physical activity and light exposure and that allows a daily afternoon nap at a regular time.