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

Zambotti, Massimiliano de; Willoughby, Adrian R.; Sassoon, Stephanie A.; Colrain, Ian M.; Baker, Fiona C.

doi:10.1210/jc.2015-1844

Cited by 56 publications

(57 citation statements)

References 38 publications

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“…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].…”

Section: Reproductive Hormonal Milieu Influences Sleepmentioning

confidence: 64%

Sleep, Circadian Rhythms, and Fertility

Goldstein

Smith

2016

Curr Sleep Medicine Rep

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Adequate sleep is crucial for general health and wellbeing. Although the neuronal control of the reproductive axis and sleep-generating neurons share an anatomical location, little is known regarding the impact of sleep and circadian disruption on fertility in women. Animal models have established clear circadian control of the pre-ovulatory luteinizing hormone surge. Additionally, disruption of the circadian timing system by exposure to abnormal light-dark cycles or mutations of core clock genes results in diminished reproductive capacity in animals. Abnormalities in menstruation, fertility, and early pregnancy maintenance in female shift workers provide evidence for a role of circadian rhythms in the reproductive health of women. Reproductive hormones may modify sleep, and the relationship is bidirectional such that sleep disruption may alter the profile of reproductive hormone secretion. Therefore, sleep, apart from its circadian timing, may also have relevance in attaining pregnancy. Additionally, infertility is associated with psychological distress which may result in poor quality sleep. The interaction between psychological distress and disturbed sleep in reproduction has garnered minimal attention and may be a crucial factor to consider during the evaluation and treatment of infertility. This work reviews animal models and evidence in women that suggest a role for sleep and circadian rhythms in reproductive health and reveals areas that require future investigation.

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Section: Reproductive Hormonal Milieu Influences Sleepmentioning

confidence: 64%

Sleep, Circadian Rhythms, and Fertility

Goldstein

Smith

2016

Curr Sleep Medicine Rep

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“…Blood samples were collected either on arrival at the laboratory or the following morning of each visit to establish menstrual cycle phase. Nine women in the insomnia group and eight controls had both their baseline and stress nights recorded in the luteal phase of the menstrual cycle as confirmed by progesterone levels ≥ 3 ng.ml −1 (see de Zambotti et al, 2015b). Progesterone was <3 ng.ml −1 on the remaining nights.…”

Section: 2 Materials and Methodsmentioning

confidence: 99%

“…Comparisons of sleep composition between women with insomnia and controls (Baker et al, 2015) and between different menstrual cycle phases in both groups of women (de Zambotti et al, 2015b) as well as hormone-sleep relationships (de Zambotti et al, 2015a) have been previously published. The current data were drawn from an additional experimental night, for which participants were exposed to a pre-sleep anticipatory stress condition, compared to an undisturbed (baseline) night.…”

Section: 2 Materials and Methodsmentioning

confidence: 99%

Acute stress alters autonomic modulation during sleep in women approaching menopause

Zambotti

Sugarbaker

Trinder

et al. 2016

Psychoneuroendocrinology

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Hot flashes, hormones, and psychosocial factors contribute to insomnia risk in the context of the menopausal transition. Stress is a well-recognized factor implicated in the pathophysiology of insomnia; however the impact of stress on sleep and sleep-related processes in perimenopausal women remains largely unknown. We investigated the effect of an acute experimental stress (impending Trier Social Stress Task in the morning) on presleep measures of cortisol and autonomic arousal in perimenopausal women with and without insomnia that developed in the context of the menopausal transition. In addition, we assessed the macro- and micro-structure of sleep and autonomic functioning during sleep. Following adaptation to the laboratory, twenty two women with (age: 50.4 ± 3.2 y) and eighteen women without (age: 48.5±2.3 y) insomnia had two randomized in-lab overnight recordings: baseline and stress nights. Anticipation of the task resulted in higher pre-sleep salivary cortisol levels and perceived tension, faster heart rate and lower vagal activity, based on heart rate variability measures, in both groups of women. The effect of the stress manipulation on the autonomic nervous system extended into the first four hours of the night in both groups. However, vagal tone recovered four-six hours into the stress night in controls but not in the insomnia group. Sleep macrostructure was largely unaltered by the stress, apart from a delayed latency to REM sleep in both groups. Quantitative analysis of non-rapid eye movement sleep microstructure revealed greater electroencephalographic (EEG) power in the beta1 range (15-≤23Hz), reflecting greater EEG arousal during sleep, on the stress night compared to baseline, in the insomnia group. Hot flash frequency remained similar on both nights for both groups. These results show that presleep stress impacts autonomic nervous system functioning before and during sleep in perimenopausal women with and without insomnia. Findings also indicate that women with insomnia had increased EEG arousal and lacked recovery in vagal activity across the stress night suggesting a greater sensitivity to stress in this group.

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“…They were participants in a larger study of sleep quality in 72 women with and without insomnia in the MT, which involved between one and four recording nights scheduled at different phases of the menstrual cycle for cycling women or across a month for women with infrequent or skipped cycles. Data about sleep macro- and micro-structure have been published elsewhere (Baker et al, 2015), including at different menstrual cycle phases in a subsample of 20 women (de Zambotti et al, 2015). The main polysomnographic variables for the current subset of women, separately by group (insomnia and control women) and menstrual cycle phase (follicular and luteal), are shown in Supplementary Table 1.…”

Section: Methodsmentioning

confidence: 99%

Menstrual cycle-related variation in autonomic nervous system functioning in women in the early menopausal transition with and without insomnia disorder

Zambotti

Trinder

Colrain

et al. 2017

Psychoneuroendocrinology

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Insomnia is considered a hyperarousal disorder, in which several psychophysiological domains including the autonomic nervous system (ANS) are over-activated, potentially contributing to increased risk for cardiovascular (CV) disease. Here, we aimed to determine whether insomnia that develops in the context of the transition to menopause (menopausal transition insomnia, MTI) is similarly characterized by autonomic arousal. We also took into account modulation of the ANS by the hormonal changes of the menstrual cycle, a factor that has not previously been considered in studies on insomnia. Twenty one women with insomnia (49.0±3 y) and 25 controls (48.8±2.6 y), also in the menopausal transition, had overnight laboratory-based polysomnographic recordings, including electrocardiograph, during the follicular and/or luteal (progesterone ≥ 3 ng.ml−1) phases of the menstrual cycle, with 21 women having recordings in both phases. Nocturnal time and frequency-domain heart rate variability (HRV) measures were calculated. Heart rate (HR) was significantly elevated (by ~4bpm) in MTI compared to controls in both follicular and luteal phases, across hours of the night, including during undisturbed periods of NREM and REM sleep (p<0.05). A higher HR tended to be associated with lower frequency- and time-domain vagal HRV indices in MTI compared with controls. In both groups, HR was significantly higher and total and high frequency HRV measures were lower in the luteal phase compared to the follicular phase (p<0.05). In addition, REM compared to NREM sleep was characterized by increased HR coupled with decreased vagal modulation and increased sympathovagal balance (p<0.01). Insomnia in the menopausal transition is characterized by nocturnal autonomic hyperarousal during both follicular and luteal phases of the menstrual cycle, which could be a factor in the etiology of MTI as well as a potential CV risk factor.

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

Cited by 56 publications

References 38 publications

Sleep, Circadian Rhythms, and Fertility

Sleep, Circadian Rhythms, and Fertility

Acute stress alters autonomic modulation during sleep in women approaching menopause

Menstrual cycle-related variation in autonomic nervous system functioning in women in the early menopausal transition with and without insomnia disorder

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