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Sleep Dysfunction in Women Workup

  • Author: Gila Hertz, PhD, ABSM; Chief Editor: Selim R Benbadis, MD  more...
Updated: May 13, 2014

Approach Considerations


Overnight sleep studies or polysomnograms may be done in sleep-disorder centers, at home, or as inpatient procedures. Indications include risk factors, symptoms or cardiovascular manifestations arising from sleep apnea, disorders of respiratory control, and chronic obstructive or restrictive lung disease.

Multiple Sleep Latency Test

The Multiple Sleep Latency Test (MSLT) is indicated in the assessment of excessive daytime sleepiness. It is performed following a supervised overnight polysomnogram. The presence of 2 or more sleep-onset REMs (SOREMs) in an MSLT following a normal polysomnographic study the night before supports a diagnosis of narcolepsy.

Sleep logs

While not technically a laboratory test, sleep logs are sleep-wake cycle diaries, generally kept for a 2-week period and correlated with the patient's subjective assessments of daytime alertness. These diaries can be particularly helpful in diagnosing circadian rhythm disorders.

Imaging studies

Imaging studies may be required in the case of patients with OSA and craniofacial dysmorphologies to evaluate potential surgical strategies (eg, jaw advancement). They also may be utilized in the workup of neurodegenerative disorders.

Contributor Information and Disclosures

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, American Psychological Association

Disclosure: Nothing to disclose.


Mary E Cataletto, MD Professor of Clinical Pediatrics, State University of New York at Stony Brook

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians

Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida Morsani College of Medicine

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, American Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cyberonics; Eisai; Lundbeck; Sunovion; UCB; Upsher-Smith<br/>Serve(d) as a speaker or a member of a speakers bureau for: Cyberonics (Livanova); Eisai; Lundbeck; Sunovion; UCB<br/>Received research grant from: Cyberonics (Livanova); GW, Lundbeck; Sunovion; UCB; Upsher-Smith.


Norberto Alvarez, MD Assistant Professor, Department of Neurology, Harvard Medical School; Consulting Staff, Department of Neurology, Boston Children's Hospital; Medical Director, Wrentham Developmental Center

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.

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: Avanir Pharmaceuticals Consulting fee Consulting

Gabriele M Barthlen, MD Assistant Professor, Department of Neurology, Cornell University; Director of Sleep-Wake Disorders Center, Department of Neurology, New York Presbyterian Hospital

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

  1. Lyytikäinen P, Rahkonen O, Lahelma E, Lallukka T. Association of sleep duration with weight and weight gain: a prospective follow-up study. J Sleep Res. 2011 Jun. 20(2):298-302. [Medline].

  2. Mork PJ, Nilsen TI. Sleep problems and risk of fibromyalgia: longitudinal data on an adult female population in Norway. Arthritis Rheum. 2012 Jan. 64(1):281-4. [Medline].

  3. Suarez EC. Self-reported symptoms of sleep disturbance and inflammation, coagulation, insulin resistance and psychosocial distress: evidence for gender disparity. Brain Behav Immun. 2008 Aug. 22(6):960-8. [Medline]. [Full Text].

  4. Moe KE. Reproductive hormones, aging, and sleep. Semin Reprod Endocrinol. 1999. 17(4):339-48. [Medline].

  5. Driver HS, McLean H, Kumar DV, et al. The influence of the menstrual cycle on upper airway resistance and breathing during sleep. Sleep. 2005 Apr 1. 28(4):449-56. [Medline].

  6. Owens JF, Matthews KA. Sleep disturbance in healthy middle-aged women. Maturitas. 1998 Sep 20. 30(1):41-50. [Medline].

  7. 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. 1993 Aug. 16(5):484-6. [Medline].

  8. Ancoli-Israel S, Kripke DF, Klauber MR, et al. Periodic limb movements in sleep in community-dwelling elderly. Sleep. 1991 Dec. 14(6):496-500. [Medline].

  9. Ekbom KA. Restless legs syndrome. Neurology. 1960 Sep. 10:868-73. [Medline].

  10. Arnulf I. REM sleep behavior disorder: Motor manifestations and pathophysiology. Mov Disord. 2012 May. 27(6):677-89. [Medline].

  11. Bodkin CL, Schenck CH. Rapid eye movement sleep behavior disorder in women: relevance to general and specialty medical practice. J Womens Health (Larchmt). 2009 Dec. 18(12):1955-63. [Medline].

  12. Boeve BF. REM sleep behavior disorder: Updated review of the core features, the REM sleep behavior disorder-neurodegenerative disease association, evolving concepts, controversies, and future directions. Ann N Y Acad Sci. 2010 Jan. 1184:15-54. [Medline]. [Full Text].

  13. Koo BB, Dostal J, Ioachimescu O, Budur K. The effects of gender and age on REM-related sleep-disordered breathing. Sleep Breath. 2008 Aug. 12(3):259-64. [Medline].

  14. Manber R, Armitage R. Sex, steroids, and sleep: a review. Sleep. 1999 Aug 1. 22(5):540-55. [Medline].

  15. 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. 1997 Feb. 12(1):34-46. [Medline].

  16. Kronenberg F. Hot flashes: epidemiology and physiology. Ann N Y Acad Sci. 1990. 592:52-86; discussion 123-33. [Medline].

  17. Brownell LG, West P, Kryger MH. Breathing during sleep in normal pregnant women. Am Rev Respir Dis. 1986 Jan. 133(1):38-41. [Medline].

  18. Popovic RM, White DP. Upper airway muscle activity in normal women: influence of hormonal status. J Appl Physiol. 1998 Mar. 84(3):1055-62. [Medline].

  19. 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. 1979 Mar 8. 300(10):513-7. [Medline].

  20. Feinsilver SH, Hertz G. Respiration during sleep in pregnancy. Clin Chest Med. 1992 Dec. 13(4):637-44. [Medline].

  21. Kripke DF, Jean-Louis G, Elliott JA, et al. Ethnicity, sleep, mood, and illumination in postmenopausal women. BMC Psychiatry. 2004 Apr 7. 4(1):8. [Medline].

  22. Paul KN, Turek FW, Kryger MH. Influence of sex on sleep regulatory mechanisms. J Womens Health (Larchmt). 2008 Sep. 17(7):1201-8. [Medline].

  23. 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). 2008 Sep. 17(7):1191-9. [Medline].

  24. Manconi M, Ulfberg J, Berger K, Ghorayeb I, Wesström J, Fulda S, et al. When gender matters: Restless legs syndrome. Report of the "RLS and woman" workshop endorsed by the European RLS Study Group. Sleep Med Rev. 2011 Nov 8. [Medline].

  25. Beaudreau SA, Spira AP, Stewart A, Kezirian EJ, Lui LY, Ensrud K, et al. Validation of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale in older black and white women. Sleep Med. 2011 Oct 25. [Medline].

  26. Ameratunga D, Goldin J, Hickey M. Sleep disturbance in menopause. Intern Med J. 2012 Jan 31. [Medline].

  27. Moline ML, Broch L, Zak R. Sleep in women across the life cycle from adulthood through menopause. Med Clin North Am. 2004 May. 88(3):705-36, ix. [Medline].

  28. Ekholm EM, Polo O, Rauhala ER, Ekblad UU. Sleep quality in preeclampsia. Am J Obstet Gynecol. 1992 Nov. 167(5):1262-6. [Medline].

  29. 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. 1997 Jan. 45(1):1-7. [Medline].

  30. Suarez EC. Self-reported symptoms of sleep disturbance and inflammation, coagulation, insulin resistance and psychosocial distress: evidence for gender disparity. Brain Behav Immun. 2008 Aug. 22(6):960-8. [Medline].

  31. 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. 2008 Dec. 39(12):3185-92. [Medline].

  32. Diagnostic Classification Steering Committee. International Classification of Sleep Disorders: Diagnostic and Coding Manual of Sleep Disorders. American Sleep Disorders Association. 1990.

  33. Miró E, Martínez MP, Sánchez AI, Prados G, Medina A. When is pain related to emotional distress and daily functioning in fibromyalgia syndrome? The mediating roles of self-efficacy and sleep quality. Br J Health Psychol. 2011 Nov. 16(4):799-814. [Medline].

  34. Lee KA, Shaver JF, Giblin EC, Woods NF. Sleep patterns related to menstrual cycle phase and premenstrual affective symptoms. Sleep. 1990 Oct. 13(5):403-9. [Medline].

  35. Manber R, Bootzin RR. Sleep and the menstrual cycle. Health Psychol. 1997 May. 16(3):209-14. [Medline].

  36. Patkai P, Johannson G, Post B. Mood, alertness and sympathetic-adrenal medullary activity during the menstrual cycle. Psychosom Med. 1974 Nov-Dec. 36(6):503-12. [Medline].

  37. Fast A, Hertz G. Nocturnal low back pain in pregnancy: polysomnographic correlates. Am J Reprod Immunol. 1992 Oct-Dec. 28(3-4):251-3. [Medline].

  38. Hertz G, Fast A, Feinsilver SH, et al. Sleep in normal late pregnancy. Sleep. 1992 Jun. 15(3):246-51. [Medline].

  39. Schweiger MS. Sleep disturbance in pregnancy. A subjective survey. Am J Obstet Gynecol. 1972 Dec 1. 114(7):879-82. [Medline].

  40. Woodward S, Freedman RR. The thermoregulatory effects of menopausal hot flashes on sleep. Sleep. 1994 Sep. 17(6):497-501. [Medline].

  41. Lee KA. Self-reported sleep disturbances in employed women. Sleep. 1992 Dec. 15(6):493-8. [Medline].

  42. Bourjeily G, Ankner G, Mohsenin V. Sleep-disordered breathing in pregnancy. Clin Chest Med. 2011 Mar. 32(1):175-89, x. [Medline].

  43. Santiago JR, Nolledo MS, Kinzler W, Santiago TV. Sleep and sleep disorders in pregnancy. Ann Intern Med. 2001 Mar 6. 134(5):396-408. [Medline].

  44. Frank E, Kupfer DJ, Jacob M, et al. Pregnancy-related affective episodes among women with recurrent depression. Am J Psychiatry. 1987 Mar. 144(3):288-93. [Medline].

  45. Driver HS, Shapiro CM. A longitudinal study of sleep stages in young women during pregnancy and postpartum. Sleep. 1992 Oct. 15(5):449-53. [Medline].

  46. 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].

  47. 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. 2002 Jul 17. 288(3):321-33. [Medline].

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