Actigraphy-defined measures of sleep and movement across the menstrual cycle in midlife menstruating women

Abstract

Objective To evaluate patterns in actigraphy-defined sleep measures across the menstrual cycle, testing the hypothesis that sleep would be more disrupted in the premenstrual period, i.e. in the 14 days prior to menses. Methods A community-based, longitudinal study of wrist actigraphy-derived sleep measures was conducted with 163 women (58 African-American, 78 White, and 27 Chinese) of late reproductive age (mean=51.5, SD=2.0 years) from the Study of Women's Health Across the Nation (SWAN) Sleep Study. Daily measures of sleep [sleep efficiency (%) and total sleep time (minutes)] and movement during sleep [mean activity score (counts)] were characterized using wrist actigraphy across a menstrual cycle or 35 days, whichever was shorter. Data were standardized to 28 days to account for the variation of unequal cycle lengths and divided into four weekly segments for analyses. Results Sleep efficiency percentage declined gradually across the menstrual cycle, but the decline became pronounced in fourth week, the premenstrual period. Compared with third week, sleep efficiency declined by 5% (p<0.0001) and mean total sleep time was 25 minutes less (p=0.0002) in fourth week. No significant mean differences were found when comparing the means of second week versus third week. The association of weekly segments with sleep efficiency or minutes of total sleep time was modified by sociodemographic and lifestyle factors, including body mass index (BMI), race, study site, financial strain, marital status, and smoking. Conclusions Sleep varied systematically across the menstrual cycle in women of late reproductive age, including a gradual decline in sleep efficiency across all weeks, with a more marked change premenstrually during the last week of the menstrual cycle. These sleep changes may be modifiable by altering lifestyle factors.

Sleep, Circadian Rhythms, and Fertility

“…These findings have also been seen in women of later reproductive age [32,131]. Interestingly, the predominant hormone during the luteal phase, progesterone, is a known GABA A receptor agonist [81] and exogenous administration increases sleep in post-menopausal women [25,94] and women in the early follicular phase [106].…”

Sleep and Women’s Health

“…These corresponding changes, however, were not found in PSG sleep 22–24 . Recently, actigraphic sleep was examined in participants from the Study of Women’s Health Across the Nations (SWAN) and investigators found that among later reproductive-age women, sleep efficiency declines across the menstrual cycle with the most pronounced decline in the last week of the menstrual cycle 25 . Another recent study demonstrated that a steeper rate of rise in progesterone levels from follicular phase through mid-luteal phase was associated with greater PSG wake after sleep onset and sleep fragmentation in the late luteal phase 26 .…”

Menstrual Cycle-Related Variation in Physiological Sleep in Women in the Early Menopausal Transition

“…In addition, more women, both pre-and early perimenopausal, reported trouble sleeping in the late luteal and early follicular phases compared with other phases of the menstrual cycle (11). Recently additional SWAN data showed that actigraphy-derived sleep measures varied with menstrual phase in midlife women, with total sleep time and sleep efficiency declining gradually across the menstrual cycle, being lowest in the premenstrual (late-luteal) phase (12). It remains unknown how the polysomnogram (PSG) and sleep EEG are impacted by menstrual cycle phase in perimenopausal women.…”

“…Most studies also show that sleep efficiency, wakefulness after sleep onset (WASO), and number of awakenings are similar across the menstrual cycle in young women. The most prominent effect of the menstrual cycle in young women is a marked increase in -electroencephalographic (EEG) activity (12)(13)(14)(15), presumed to reflect an increase in sleep spindles (brief bursts of ϳ12-15 Hz synchronous activity), in the luteal compared with the follicular phase (7)(8)(9), although only one small study has assessed menstrual cycle modulation of sleep spindle characteristics (10).…”