eMedicine Specialties > Neurology > Sleep-Related Diseases
Sleep Dysfunction in Women: Treatment & Medication
Updated: Dec 15, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
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.
- Sleep disturbance during pregnancy also can be associated with frightening dreams, postpartum blues, and sometimes even major depression and postnatal psychosis.
- 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.
- 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.
- 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.
Surgical Care
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.
Consultations
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.
Diet
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.
Activity
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.
Medication
Treat underlying disease by HRT, hypnotics, antidepressants, and behavioral therapy.
Hypnotics
These agents are used for treatment of acute and short-term insomnia.
Zolpidem (Ambien, Ambien CR)
DOC for treatment of primary insomnia (ie, sleep-onset insomnia). Indicated for acute short-term insomnia for duration that does not exceed a few weeks. The extended-release product (Ambien CR) consists of a coated 2-layer tablet and is useful for insomnia characterized by difficulties with sleep onset and/or sleep maintenance. The first layer releases drug content immediately to induce sleep; the second layer gradually releases additional drug to provide continuous sleep.
Adult
10 mg PO hs
Extended-release: 12.5 mg PO hs
Extended-release in elderly patients: 6.25 mg PO hs
Pediatric
Not established
Increases toxicity of alcohol and CNS depressants; effect may be delayed if taken with food or shortly after a meal
Documented hypersensitivity; lactation
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Monitor elderly for impaired cognitive or motor performance; extended-release dosage form must be swallowed whole (do not divide, chew, or crush)
Zaleplon (Sonata)
A pyrazolopyrimidine, indicated for short-term treatment of difficulties in falling asleep. Should be used for 7-10 d. Has been shown to cause minimal daytime grogginess.
Adult
5-10 mg PO hs
Pediatric
Not established
Cimetidine significantly increases levels
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Failure of insomnia to remit after 7-10 d of treatment may indicate need for evaluation of primary psychiatric or medical illness; limit treatment to 7-10 d of use, and reevaluate patient if to be taken for >2-3 wk (do not prescribe in quantities exceeding 1-mo supply); in hepatic function impairment, reduce dose to 5 mg PO hs; caution in patients exhibiting signs or symptoms of depression
Eszopiclone (Lunesta)
Nonbenzodiazepine hypnotic pyrrolopyrazine derivative of the cyclopyrrolone class. The precise mechanism of action is unknown but is believed to interact with GABA-receptor at binding domains close to or allosterically coupled to benzodiazepine receptors. Indicated for insomnia to decrease sleep latency and improve sleep maintenance. Short half-life of 6 h. Higher doses (ie, 2 mg for elderly adults and 3 mg for nonelderly adults) are more effective for sleep maintenance, whereas lower doses (ie, 1 mg for elderly adults and 2 mg for nonelderly adults) are suitable for difficulty in falling asleep.
Adult
Nonelderly adults: 2 mg PO hs; may increase to 3 mg PO hs prn
Elderly adults: 1 mg PO hs initially; not to exceed 2 mg PO hs
Severe hepatic impairment: Do not exceed 2 mg PO hs
Pediatric
<18 years: Not established
>18 years: Administer as in adults
CYP3A4 and CYP2E1 substrate; potent CYP3A4 inhibitors (eg, ketoconazole, itraconazole, clarithromycin, nefazodone, ritonavir, nelfinavir) increases AUC, Cmax, and t1/2 and therefore potential toxicity (decrease dose); potent CYP3A4 inducers (eg, rifampicin) increase clearance; coadministration with alcohol or other CNS depressants may increase effect and toxicity (decrease dose); coadministration with olanzapine may decrease DSST scores; sleep onset may be delayed if taken with or immediately after a high-fat or heavy meal
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May cause dysgeusia, headache, or coldlike symptoms; rare adverse effects associated with hypnotics include short-term amnesia, confusion, agitation, hallucinations, worsened depression, or suicidal thoughts; high doses (ie, 6-12 mg) produce euphoric effects similar to those of diazepam 20 mg; anxiety, abnormal dreams, nausea, and upset stomach may occur within 48 h after discontinuing; alertness may be affected the following day, use caution while operating machinery or driving a car
Hormone replacement therapy
Estrogen replacement has been shown to improve sleep in menopausal women, primarily by reducing vasomotor symptoms that disturb sleep. In addition, may improve sleep-related breathing disorders. Studies have shown that estrogen, either alone or combined with progestin (but not progestin alone), markedly reduced OSA in menopausal women. Oral Premarin is an example of an oral estrogen replacement. The choice of HRT should be made on an individual basis in consultation with a gynecologist.
Conjugated estrogens (Premarin)
Multiple aspects of menopause respond to estrogen replacement therapy, including vasomotor symptoms and atrophic vaginitis. However, has not been shown effective in treating depression associated with menopause. Decisions for HRT should be made on individual basis in consultation with gynecologist. Dosing may need to be titrated individually, and each patient monitored for risks and adverse effects. Premarin available in tablet form for oral administration in strengths of 0.3 mg, 0.625 mg, 0.9 mg, 1.25 mg, and 2.5 mg.
Adult
0.3-1.25 mg PO; use lowest possible effective dose
Pediatric
Not established
May reduce hypoprothrombinemic effect of anticoagulants; barbiturates, rifampin, and other agents that induce hepatic microsomal enzymes may reduce levels; pharmacologic and toxicologic effects of corticosteroids may occur as result of estrogen-induced inactivation of hepatic P-450 enzyme; hydantoins may result in loss of seizure control
Documented hypersensitivity; known or suspected pregnancy; breast cancer; undiagnosed abnormal genital bleeding; active thrombophlebitis or thromboembolic disorders; history of thrombophlebitis, thrombosis; or thromboembolic disorders associated with previous estrogen use (except when used in treatment of breast or prostatic malignancy)
Pregnancy
X - Contraindicated; benefit does not outweigh risk
Precautions
While weight gain, peripheral edema, and breast tenderness are among more frequent adverse effects, patients should be advised to notify their gynecologist of any breast masses, depression, or changes in vaginal bleeding and their internist if they have any chest pain, tingling, or shortness of breath; advise patient to avoid exposure to prolonged or direct sunlight and not to skip doses or alter regimen without consulting physician
Antidepressants
Selective serotonin reuptake inhibitors (SSRIs) are generally well tolerated and are currently the most frequently prescribed drugs for treatment of depression. Pharmacologic treatment with antidepressants is indicated for PMDD, postpartum depression, and clinical depression in patients of any age.
Serotonin noradrenaline reuptake inhibitors (SNRIs) are also used. These agents exhibit both noradrenergic and serotonergic effects in patients with depression.
Sertraline (Zoloft)
Effective for treatment of clinical depression in women. Also indicated for panic disorders and obsessive-compulsive disorders.
Adult
50 mg/d PO
Pediatric
Not established
Increases toxicity of MAOIs, diazepam, tolbutamide, and warfarin; serotonin syndrome (ie, myoclonus, rigidity, confusion, nausea, hyperthermia, autonomic instability, coma, eventual death) occurs with simultaneous use of other serotonergic agents (eg, anorectic agents, tramadol, buspirone, trazodone, clomipramine, nefazodone, tryptophan), discontinue other serotonergic agents at least 2 wk prior to SSRIs
Documented hypersensitivity; concurrent MAOIs
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in preexisting seizure disorders, recent myocardial infarction, unstable heart disease, or hepatic or renal impairment
Escitalopram oxalate (Lexapro)
Insomnia associated with depression. Selective serotonin reuptake inhibitor (SSRI) and S-enantiomer of citalopram. Used for the treatment of depression. Mechanism of action is thought to be potentiation of serotonergic activity in central nervous system resulting from inhibition of CNS neuronal reuptake of serotonin. Onset of depression relief may be obtained after 1-2 wk, which is sooner than other antidepressants.
Adult
10 mg PO daily without regard to meal; may titrate up to 20 mg qd
Pediatric
<18 years: Not established
>18 years: Administer as in adults
Primarily metabolized by CYP450 3A4 and 2C19; coadministration with alcohol or other centrally acting drugs increases CNS depression; cimetidine increases AUC and maximum serum concentration; coadministration with sumatriptan and SSRIs has caused weakness and hyperreflexia
Documented hypersensitivity; administration within 14 d of receiving MAOI
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Elderly persons have decreased clearance; cognitive and motor function (use caution operating motor vehicles and heavy materials); depression may worsen; suicides have been reported; seizures; activation of mania/hypomania; lactation; physician must be consulted before other medications are added or used
Fluoxetine hydrochloride (Sarafem)
Approved recently for treatment of PMDD. Indicated for treatment of premenstrual insomnia associated with PMDD.
Adult
20 mg PO qd
Pediatric
Not established
Increases toxicity of diazepam and trazodone by decreasing clearance; increases toxicity of MAOIs and highly protein-bound drugs; serotonin syndrome (ie, myoclonus, rigidity, confusion, nausea, hyperthermia, autonomic instability, coma, eventual death) occurs with simultaneous use of other serotonergic agents (eg, anorectic agents, tramadol, buspirone, trazodone, clomipramine, nefazodone, tryptophan), discontinue other serotonergic agents at least 2 wk prior to SSRIs
Documented hypersensitivity; MAOIs within last 2 wk
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in hepatic impairment and history of seizures; MAOIs should be discontinued at least 14 d before initiating fluoxetine therapy
Mirtazapine (Remeron)
Relatively new antidepressant, not as widely used as sertraline. Exhibits both noradrenergic and serotonergic activity. In cases of depression associated with severe insomnia and anxiety, has been shown superior to other SSRI drugs.
Adult
15 mg (range 15-30 mg) PO hs initially; increase if necessary
Pediatric
Not established
May increase effect of CNS depressants; concurrent MAOIs may trigger hypertensive crisis
Documented hypersensitivity; MAOIs within past 14 d
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May cause drowsiness; discontinue use if patient develops sore throat, fever, or other signs of infection; suicide ideation inherent in depression and may persist until significant remission occurs; severe neutropenia reported in clinical trials
Stimulants
These agents may be effective in narcolepsy.
Modafinil (Provigil)
Mechanism(s) of action in wakefulness unknown. Has wake-promoting actions like sympathomimetic agents.
Adult
200 mg PO qd
Pediatric
<16 years: Not established
>16 years: Administer as in adults
May decrease levels of cyclosporine or steroidal contraceptives, and to lesser degree, theophylline; may increase concentrations of diazepam, propranolol, and phenytoin
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Monitor patients closely for signs of misuse or abuse, especially those with history of abuse of drugs or stimulants such as methylphenidate, amphetamine, and cocaine
Armodafinil (Nuvigil)
R-enantiomer of modafinil (mixture of R- and S-enantiomers). Elicits wake-promoting actions similar to sympathomimetic agents, although pharmacologic profile is not identical to sympathomimetic amines. In vitro, binds dopamine transporter and inhibits dopamine reuptake. Not a direct- or indirect-acting dopamine receptor agonist. Indicated to improve wakefulness in individuals with excessive sleepiness associated with narcolepsy, obstructive sleep apnea-hypopnea syndrome (OSAHS), or shift-work sleep disorder.
Adult
Narcolepsy: 150-250 mg PO qam
OSAHS: 150 mg PO qam; may increase dose, not to exceed 250 mg/d
Shift work: 150 mg PO administered 1 h before start of work shift
Pediatric
<17 years: Not established
>17 years: Administer as in adults
Weakly induces CYP1A2 and CYP3A; may decrease levels of drugs metabolized by CYP1A2 (eg, theophylline) and CYP3A (eg, cyclosporine, midazolam, triazolam, steroidal contraceptives); may inhibit CYP2C19 activity, thereby increasing serum levels of CYP2C19 substrates (eg, omeprazole, phenytoin, propranolol)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in hepatic impairment and decrease dose with severe hepatic impairment; serious rash, including Stevens-Johnson syndrome, has been reported; other serious hypersensitivity reactions include angioedema, anaphylactoid reactions, and multiorgan hypersensitivity reactions; psychiatric adverse events (eg, mania, delusions, hallucinations, suicidal ideation) have been reported with modafinil; may increase blood pressure; monitor patients closely for signs of misuse or abuse, especially those with a history of drug or stimulant abuse (eg, methylphenidate, amphetamine, or cocaine)
Dopamine agonists
Dopamine agonists may be effective for treatment of restless legs syndrome.
Pramipexole (Mirapex)
Nonergot dopamine agonist with specificity of D2 dopamine receptor, but also has been shown to bind to D3 and D4 receptors and may stimulate dopamine activity on nerves of striatum and substantia nigra.
Adult
0.125-1 mg PO hs initially, increase prn
Pediatric
Not established
Cimetidine may increase toxicity; increases levodopa levels
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in renal insufficiency and preexisting dyskinesias
Melatonin agonists
Indicated for insomnia characterized by difficulty with sleep onset.
Ramelteon (Rozerem)
Melatonin receptor agonist with high selectivity for human melatonin MT1 and MT2 receptors. MT1 and MT2 are thought to promote sleep and be involved in maintenance of circadian rhythm and normal sleep-wake cycle.
Adult
8 mg PO 30 min before bedtime on empty stomach
Pediatric
Not established
Major substrate of cytochrome P450 CYP1A2 and minor substrate of CYP2C and CYP3A4; strong CYP1A2 inhibitors (eg, fluvoxamine) increase AUC up to 190-fold and Cmax 70-fold; strong CYP inducers (eg, rifampin) decrease total exposure by mean of 80%; strong CYP3A4 inhibitors (eg, ketoconazole) and strong CYP2C9 inhibitors (eg, fluconazole) may increase serum levels
Documented hypersensitivity; strong cytochrome P450 CYP1A2 inhibitors (eg, fluvoxamine); severe hepatic impairment
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution with mild hepatic impairment; adverse effects leading to discontinuation in clinical trials included dizziness, nausea, fatigue, headache, and worsening insomnia
Benzodiazepines
These agents have been the hypnotics of choice for many years because of their relative safety compared to barbiturates. By binding to specific receptor sites, these agents appear to potentiate the effects of GABA and facilitate inhibitory GABA neurotransmission and other inhibitory transmitters.
Benzodiazepines are used when additional anxiolytic effects are desired in addition to hypnotic effects. Intermediate and long-acting benzodiazepines are used for sleep-maintenance insomnia.
Triazolam (Halcion)
Short acting; good agent for sleep-onset insomnia; has no significant residual effects in morning.
Adult
0.125-0.25 mg PO hs; 0.125 mg PO hs in elderly persons
Pediatric
Not established
Phenothiazines, barbiturates, alcohols, and MAOIs increase CNS toxicity
Documented hypersensitivity; narrow-angle glaucoma; untreated obstructive sleep apnea; history of substance abuse
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
High incidence of rebound insomnia; adverse effects include dizziness, drowsiness, and headache, all of which are dose related; use cautiously in depressed patients; caution and close monitoring needed in hepatic dysfunction, low albumin levels, renal or pulmonary disease; may cause residual daytime sedation, impair cognition, and increase risk of falls, especially in older people
Estazolam (ProSom)
Intermediate acting with slow onset of action and long duration; good agent for sleep-maintenance insomnia.
Adult
1-2 mg PO hs; 0.5-1 mg PO hs in elderly persons
Pediatric
Not established
Phenothiazines, barbiturates, alcohols, and MAOIs increase CNS toxicity
Documented hypersensitivity; narrow-angle glaucoma; untreated obstructive sleep apnea; history of substance abuse
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in depressed patients; most common adverse effects include drowsiness, hypokinesia, dizziness, and abnormal coordination; may have more significant respiratory depressive effects than other agents in its class; caution and close monitoring needed in hepatic dysfunction, low albumin levels, renal or pulmonary disease; may cause residual daytime sedation, impair cognition, and increase risk of falls, especially in older people
Temazepam (Restoril)
Indicated for both sleep-onset and maintenance insomnia. Should be taken at bedtime to prevent daytime aftereffects.
Adult
<60 years: 15-30 mg/d PO qhs
>60 years: Use lower doses
Pediatric
Not recommended
Phenothiazines, barbiturates, alcohols, and MAOIs increase toxicity
Documented hypersensitivity; narrow-angle glaucoma; untreated OSA; history of substance abuse; severe uncontrolled pain
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution with other CNS depressants, low albumin levels, or hepatic disease (may increase toxicity)
Nonergoline dopamine agonist
These agents may be effective for moderate-to-severe primary RLS. Neuropharmacological evidence suggests primary dopaminergic system involvement in RLS.
Ropinirole hydrochloride (Requip)
Second-generation, nonergoline dopamine agonist that directly stimulates dopamine receptors in brain. Has high specificity for D3 receptor subtype. Indicated for moderate-to-severe RLS. Take at bedtime.
Adult
Administer once daily, 1-3 h before bedtime; after 2 d, may gradually titrate dose upward to desired effect according the following schedule:
Days 1-2: 0.25 mg PO hs
Days 3-7: 0.5 mg PO hs
Week 2: 1 mg PO hs
Week 3: 1.5 mg PO hs
Week 4: 2 mg PO hs
Week 5: 2.5 mg PO hs
Week 6: 3 mg PO hs
Week 7: 4 mg PO hs
Pediatric
Not established
Estrogens may reduce clearance by 36%; dose adjustment may be required if estrogen therapy stopped or started during treatment; potential exists for substrates or inhibitors of CYP1A2 to alter clearance; if therapy with potent CYP1A2 inhibitor stopped or started during treatment, dose adjustments may be necessary; dopamine antagonists (eg, phenothiazines, butyrophenones, thioxanthenes, metoclopramide) may diminish effectiveness; coadministration with sedatives and other CNS depressants may cause additive sedation
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Monitor for signs and symptoms of orthostatic hypotension; dopamine receptor agonists may potentiate adverse dopaminergic effects of levodopa and may cause or exacerbate preexisting dyskinesia (decreasing levodopa dose may ameliorate this adverse effect); retroperitoneal fibrosis, pulmonary infiltrates, pleural effusion, and pleural thickening have occurred in some patients treated with ergot-derived dopaminergic agents; complete resolution of these complications does not always occur when drug is discontinued; may cause patients to fall asleep or feel very sleepy while doing normal activities (eg, driving); common adverse effects while treating RLS include nausea, somnolence, vomiting, dizziness, and fatigue
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 |
| « Previous Page | Next Page » |
References
Ancoli-Israel S, Kripke DF, Klauber MR, et al. Periodic limb movements in sleep in community-dwelling elderly. Sleep. Dec 1991;14(6):496-500. [Medline].
Bamford CR. Menstrual-associated sleep disorder: an unusual hypersomniac variant associated with both menstruation and amenorrhea with a possible link to prolactin and metoclopramide. Sleep. Aug 1993;16(5):484-6. [Medline].
Block AJ, Boysen PG, Wynne JW, Hunt LA. Sleep apnea, hypopnea and oxygen desaturation in normal subjects. A strong male predominance. N Engl J Med. Mar 8 1979;300(10):513-7. [Medline].
Brownell LG, West P, Kryger MH. Breathing during sleep in normal pregnant women. Am Rev Respir Dis. Jan 1986;133(1):38-41. [Medline].
Diagnostic Classification Steering Committee. International Classification of Sleep Disorders: Diagnostic and Coding Manual of Sleep Disorders. American Sleep Disorders Association;1990.
Driver HS, Shapiro CM. A longitudinal study of sleep stages in young women during pregnancy and postpartum. Sleep. Oct 1992;15(5):449-53. [Medline].
Driver HS, McLean H, Kumar DV, et al. The influence of the menstrual cycle on upper airway resistance and breathing during sleep. Sleep. Apr 1 2005;28(4):449-56. [Medline].
Ekbom KA. Restless legs syndrome. Neurology. Sep 1960;10:868-73. [Medline].
Ekholm EM, Polo O, Rauhala ER, Ekblad UU. Sleep quality in preeclampsia. Am J Obstet Gynecol. Nov 1992;167(5):1262-6. [Medline].
Fast A, Hertz G. Nocturnal low back pain in pregnancy: polysomnographic correlates. Am J Reprod Immunol. Oct-Dec 1992;28(3-4):251-3. [Medline].
Feinsilver SH, Hertz G. Respiration during sleep in pregnancy. Clin Chest Med. Dec 1992;13(4):637-44. [Medline].
Frank E, Kupfer DJ, Jacob M, et al. Pregnancy-related affective episodes among women with recurrent depression. Am J Psychiatry. Mar 1987;144(3):288-93. [Medline].
Hertz G, Fast A, Feinsilver SH, et al. Sleep in normal late pregnancy. Sleep. Jun 1992;15(3):246-51. [Medline].
Keefe DL, Watson R, Naftolin F. Hormone replacement therapy may alleviate sleep apnea in menopausal women: a pilot study. Menopause. 1999;6(3):196-200. [Medline].
Kripke DF, Jean-Louis G, Elliott JA, et al. Ethnicity, sleep, mood, and illumination in postmenopausal women. BMC Psychiatry. Apr 7 2004;4(1):8. [Medline].
Kronenberg F. Hot flashes: epidemiology and physiology. Ann N Y Acad Sci. 1990;592:52-86; discussion 123-33. [Medline].
Landis CA, Lentz MJ, Tsuji J, et al. Pain, psychological variables, sleep quality, and natural killer cell activity in midlife women with and without fibromyalgia. Brain Behav Immun. Jul 2004;18(4):304-13. [Medline].
Lee KA, Shaver JF, Giblin EC, Woods NF. Sleep patterns related to menstrual cycle phase and premenstrual affective symptoms. Sleep. Oct 1990;13(5):403-9. [Medline].
Lee KA. Self-reported sleep disturbances in employed women. Sleep. Dec 1992;15(6):493-8. [Medline].
Manber R, Bootzin RR. Sleep and the menstrual cycle. Health Psychol. May 1997;16(3):209-14. [Medline].
Manber R, Armitage R. Sex, steroids, and sleep: a review. Sleep. Aug 1 1999;22(5):540-55. [Medline].
Moe KE. Reproductive hormones, aging, and sleep. Semin Reprod Endocrinol. 1999;17(4):339-48. [Medline].
Moline ML, Broch L, Zak R. Sleep in women across the life cycle from adulthood through menopause. Med Clin North Am. May 2004;88(3):705-36, ix. [Medline].
Newman AB, Enright PL, Manolio TA, et al. Sleep disturbance, psychosocial correlates, and cardiovascular disease in 5201 older adults: the Cardiovascular Health Study. J Am Geriatr Soc. Jan 1997;45(1):1-7. [Medline].
Owens JF, Matthews KA. Sleep disturbance in healthy middle-aged women. Maturitas. Sep 20 1998;30(1):41-50. [Medline].
Parry BL, LeVeau B, Mostofi N, et al. Temperature circadian rhythms during the menstrual cycle and sleep deprivation in premenstrual dysphoric disorder and normal comparison subjects. J Biol Rhythms. Feb 1997;12(1):34-46. [Medline].
Patkai P, Johannson G, Post B. Mood, alertness and sympathetic-adrenal medullary activity during the menstrual cycle. Psychosom Med. Nov-Dec 1974;36(6):503-12. [Medline].
Phillipson EA, Remmers JE. American Thoracic Society Consensus Conference on indications and standards for cardiopulmonary sleep studies. Am Rev Respir Dis. 1992;145:141-152.
Popovic RM, White DP. Upper airway muscle activity in normal women: influence of hormonal status. J Appl Physiol. Mar 1998;84(3):1055-62. [Medline].
Prinz PN. Sleep patterns in the healthy aged: Relationship with intellectual function. J Gerontol. 1979;32:179-186.
Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. Jul 17 2002;288(3):321-33. [Medline].
Santiago JR, Nolledo MS, Kinzler W, Santiago TV. Sleep and sleep disorders in pregnancy. Ann Intern Med. Mar 6 2001;134(5):396-408. [Medline].
Schweiger MS. Sleep disturbance in pregnancy. A subjective survey. Am J Obstet Gynecol. Dec 1 1972;114(7):879-82. [Medline].
Woodward S, Freedman RR. The thermoregulatory effects of menopausal hot flashes on sleep. Sleep. Sep 1994;17(6):497-501. [Medline].
Phillips BA, Collop NA, Drake C, Consens F, Vgontzas AN, Weaver TE. Sleep disorders and medical conditions in women. Proceedings of the Women & Sleep Workshop, National Sleep Foundation, Washington, DC, March 5-6, 2007. J Womens Health (Larchmt). Sep 2008;17(7):1191-9. [Medline].
Paul KN, Turek FW, Kryger MH. Influence of sex on sleep regulatory mechanisms. J Womens Health (Larchmt). Sep 2008;17(7):1201-8. [Medline].
Suarez EC. Self-reported symptoms of sleep disturbance and inflammation, coagulation, insulin resistance and psychosocial distress: evidence for gender disparity. Brain Behav Immun. Aug 2008;22(6):960-8. [Medline].
Chen JC, Brunner RL, Ren H, Wassertheil-Smoller S, Larson JC, Levine DW, et al. Sleep duration and risk of ischemic stroke in postmenopausal women. Stroke. Dec 2008;39(12):3185-92. [Medline].
Further Reading
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
