Perceived poor sleep quality in the absence of polysomnographic sleep disturbance in women with severe premenstrual syndrome

Abstract

Summary Women with severe premenstrual syndrome report sleep‐related complaints in the late‐luteal phase, but few studies have characterized sleep disturbances prospectively. This study evaluated sleep quality subjectively and objectively using polysomnographic and quantitative electroencephalographic measures in women with severe premenstrual syndrome. Eighteen women with severe premenstrual syndrome (30.5 ± 7.6 years) and 18 women with minimal symptoms (controls, 29.2 ± 7.3 years) had polysomnographic recordings on one night in each of the follicular and late‐luteal phases of the menstrual cycle. Women with premenstrual syndrome reported poorer subjective sleep quality when symptomatic in the late‐luteal phase compared with the follicular phase (P < 0.05). However, there were no corresponding changes in objective sleep quality. Women with premenstrual syndrome had more slow‐wave sleep and slow‐wave activity than controls at both menstrual phases (P < 0.05). They also had higher trait‐anxiety, depression, fatigue and perceived stress levels than controls at both phases (P < 0.05) and mood worsened in the late‐luteal phase. Both groups showed similar menstrual‐phase effects on sleep, with increased spindle frequency activity and shorter rapid eye movement sleep episodes in the late‐luteal phase. In women with premenstrual syndrome, a poorer subjective sleep quality correlated with higher anxiety (r = −0.64, P = 0.005) and more perceived nighttime awakenings (r = −0.50, P = 0.03). Our findings show that women with premenstrual syndrome perceive their sleep quality to be poorer in the absence of polysomnographically defined poor sleep. Anxiety has a strong impact on sleep quality ratings, suggesting that better control of mood symptoms in women with severe premenstrual syndrome may lead to better subjective sleep quality.

Exploring Sex and Gender Differences in Sleep Health: A Society for Women's Health Research Report

“…6 Interestingly, both increases in estradiol and progesterone levels during the late luteal phase in women correlate with an increase in wakefulness and a decrease in REM sleep, thereby coinciding with the observations seen in female rats. 50 Finally, new emerging evidence suggests that estradiol consolidates circadian sleepwake rhythms in female rats lending to its novel role in interacting with both sleep and circadian regulation. 51 Evidence for the role of sex chromosomes in sleep regulation comes from two observations in mice: (1) sex differences in sleep propensity are not entirely eliminated by gonadectomy 5 (e.g., dissipation of SWA during recovery occurs more quickly in gonadectomized males compared with gonadectomized female mice); and (2) dissipation of sleep pressure after sleep loss is partially dependent on sex chromosomes.…”

“…Interestingly, severe mood-related premenstrual symptoms may be a result of serotonin deficiency. 50 In such cases, a short course over several days to a week of serotonin reuptake inhibitors (SSRIs) administered during the late luteal phase of the menstrual cycle has been shown to be effective in treating the mood symptoms; however, data on the efficacy of SSRIs in treating premenstrual sleep disturbance is lacking. 81,80 A short course of hypnotics or proactive use of CBT may also be effective in treating isolated premenstrual insomnia; once again, there is lack of data regarding these practices.…”

Sleep, Circadian Rhythms, and Fertility

“…Despite the changes in absolute temperature and amplitude of the circadian rhythm of core body temperature, the phase of the temperature rhythm appears stable over the course of the menstrual cycle [8,10,97].…”

Sex differences in sleep: impact of biological sex and sex steroids

“…In a PSG study of women with premenstrual syndrome, poorer subjective sleep quality correlates with higher anxiety and more perceived night-time awakenings in the absence of objectively defined measures of poor sleep, suggesting that sleep quality assessments are strongly impacted by anxiety, depressive symptoms and affective disorders [53]. Nevertheless, traditional measures of sleep quality such as total sleep time, sleep onset, arousal frequency and SWS/SWA, which have been historically based on male physiology, may not be sufficient to detect poor sleep in women.…”