Women and the Importance of Sleep
Texas Health Resources and the Advances in Medicine Lecture Series are proud to collaborate with the Laura W. Bush Institute for Women's Health and the Texas Tech University Health Sciences Center on a lecture about women and the importance of sleep.
Clinical sleep disorder and sleep debt are often unrecognized, untreated misdiagnosed in millions of women. The amount of sleep a woman gets every night can affect her stress level, weight and overall health. Sleep loss even increases aging including memory.
This lecture presented by Dr. Emily Kirby will bring to light causes, effects and solutions. Written by Anne L. Smalligan, BSN, Med. with Kaye Renshaw, LPC
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Women and the Importance of Sleep
1. Women and the
Importance of Sleep
“Sleep Debt” and Clinical Sleep Disorders are
Often Unrecognized, Untreated,
and Misdiagnosed in Millions of Women
Anne L. Smalligan, BSN, Med.
with Kaye Renshaw, LPC
2. Strength doesn't lie in numbers
Strength doesn't lie in wealth
Strength lies in nights of
peaceful slumber
When you wake up
Wake up! It's healthy!
From The Sound of Music “I Have Confidence ”
3. The Alarming Statistics
• 50% of all sleep disturbances are due to
stress
• 63% of adults do not get enough sleep to
regulate weight
• 75% of Strokes have related Sleep Apnea
• People who sleep five hours or less are 40%
more likely to have a heart attack
4. SLEEP and the Brain/Mind
• Sleep allows the brain to organize events of
the day
• Adequate sleep is necessary to erase and
efficiently store events
• Inadequate sleep leaves the task unfinished
• Events pile up causing the mind to race
• Concentration is interrupted
• Decision making is hindered
5. The Vicious Cycle
Events of the Day
Depression,
Anxiety, Memory
loss, ILLNESS
Decreased Sleep
Resulting in a
pressured pace
coping with
normal daily
events
Incomplete
processing
through
inadequate
sleep
Events from one
day to the next
pile up
6. Sleep Loss ↑ Risk of
Other Illnesses
•
•
•
•
•
•
Diabetes
Hypertension
Obesity
Heart Disease
Immune Deficiency
Psychological Disturbances
The list is UNENDING
8. Medical vs. Mental
Causes
• Medical conditions should be ruled out
before embarking on a stress-related
diagnosis and treatment
• Often a team approach, health care
providers and counselors can be more
effective to get you back on a normal
sleep cycle
9. Her Sleep vs. His Sleep
Do women and men sleep the same?
10. Her Sleep vs. His Sleep
Do women and men sleep the same?
Women
Men
• ↑Sleep quality
• ↓Sleep quality
• ↑Sleep times
• ↓Sleep times
• ↓Sleep onset/latency
• ↑Sleep onset/latency
• ↑Sleep efficiency
• ↓Sleep efficiency
Curr Opin Pulm Med. 2006 Nov; 12(6):383-9
11. That’s the Good News
Despite these positive
differences, women have
more sleep-related
complaints than men!
12. These Conditions are Clinical
Disorders That Probably Require
Medical Attention in Both Men
and Women
• Insomnia
• Restless Legs Syndrome (RLS)
• Obstructive Sleep Apnea
13. Insomnia
An inability to fall or stay asleep that can
cause a negative impact on your ability
to function throughout the day.
14. Insomnia is Diagnosed by:
• Difficulty falling or staying asleep or nonrestorative sleep
• Sleep difficulty three times a week for at
least one month
• Difficulty sleeping despite opportunity and
circumstances to sleep
• Daytime distress or impairment caused by
lack of sleep
15. Restless Legs Syndrome
(RLS)
An unpleasant “creeping”
sensation associated with aches
and pains throughout the legs
that can make it difficult to fall
asleep.
17. Women Report:
• ↑Insomnia (especially with
increased age)
• ↑Restless Legs Syndrome
• ↑Obstructive Sleep Apnea (OSA)
18. Why is an OSA Diagnosis
Difficult to Come by in
Women?
The “typical” people suffering from OSA
have been categorized;
1. Male
2. Middle aged
3. Overweight or obese
19. Why is an OSA Diagnosis
Difficult to Come by in
Women?
Women and men report
different symptoms when
they are suffering from
Obstructive Sleep Apnea.
20. Reported Symptoms of OSA
Women
Men
• Fatigue
• Snoring
• Insomnia
• Witnessed breathing
• Morning Headache
• Mood disturbances
pauses
• Excessive sleepiness
22. The Hormonal Picture
Chronic Sleep
Debt
Weaken
Immune
System
Increase
cravings for
Carbs
Decreases
production of
Thyroid
Stimulating
Hormone
Increased levels of
Cortisol or stress
hormones
May decrease
growth
hormone and
testosterone
May decrease glucose
tolerance
23. If you don’t have a
clinical sleep
disorder…what is
keeping you awake?
24. What is Keeping us Awake?
• Finances
• Family | Children
• Work
25. Did You Know?
Eating a high calorie meal or late night
snack near your bedtime is associated
with lower quality of sleep -- especially in
women!
26. Did You Know?
The more calories consumed- the longer
it took women to fall asleep.
So, don’t eat after 7 pm – it is also a
good idea to help you maintain or lose
weight!
28. Symptoms of Mood Disorders
Signs and symptoms of adjustment disorder may
affect how
you feel and think about yourself or life, including:
•
•
•
•
•
•
•
•
Sadness & hopelessness
Lack of enjoyment or crying spells
Nervousness or worry
Thoughts of suicide
Desperation
Trouble sleeping
Difficulty concentrating
Feeling overwhelmed
29. Behavioral Symptoms of
Mood Disorders
Signs and symptoms of adjustment disorder may affect
your actions or behavior, such as:
•
•
•
•
•
•
Fighting
Ignoring bills
Avoiding family or friends
Poor school or work performance
Absenteeism
Forgetting important events/appointments
31. Symptoms Over Time
• Symptoms persisting less than a few
weeks may go away on their own
with self care
• Symptoms persisting over several
weeks may not go away on their
own….SEEK HELP
Make an appointment with your health
practitioner
Medication may be necessary to resolve
the issue
32. How Much Sleep
Do You Need?
• Sleep requirements vary from person to
person
• Most adults need seven to nine hours of
sleep per night
• If you don’t get your required amount of
sleep, you begin to accumulate “Sleep
Debt”
33. Pay Down Your “Sleep Debt”
• You must pay yourself with an increase in
sleep:
If you need eight hours of sleep and you
have a “debt” – sleep 9-10 hours per
night until you no longer feel tired
during the day.
After “paying the debt” you can return
to sleeping your required amount.
34. Coping with Stress →
Improving Sleep
Be Intentional;
• Set routines
• Go to bed earlier
• Eliminate stimuli
35. Coping with Stress →
Improving Sleep
Plan Stress Relief;
• Walk instead of running
• Take a bubble bath
• Order take out
• Get a massage
36. Coping with Stress →
Improving Sleep
Demand the opportunity for self
care;
• Practice assuming permission
• Be vulnerable with a:
Friend
Counselor
Minister
37. Improve Sleep by:
• Avoiding caffeine
• Journaling thoughts and close the
book
• Getting into bed
• Turning all lights off
• Turning all sound off
• Doing relaxation exercises
39. Sleep Hygiene
• Go to bed and get up at the same time
each day
• Sleep in a quiet, dark and relaxing
environment
• Have a comfortable temperature in your
room
• Your bed is for sleeping and sex only!
• Remove TVs, computers and other
gadgets from your bedroom
• Avoid large meals and snacks before
bedtime
CDC Features- Sleep and Sleep Disorders
40. What about Sleep Aids
and Medications?
Non-pharmacy sleep aids -- use
them if they are helpful to you;
• Sound machines
• Eye masks
41. Sleep Aids and Medications
Prescription Medications;
• Benzodiazepine Sleep Aids
• Non-Benzodiazepine Sleep Aids
• Melatonin Receptor Agonists (Rozerem) for Falling
Asleep
• Antidepressants as Sleep Aid
All of these medications have side effects and most lose effectiveness over
time. Discuss their use with your health care provider.
42. Sleep Aids and Medications
Over-the-counter medications;
• Melatonin -- A naturally occurring hormone that is sold as
a health supplement. The research on it’s effectiveness
as a sleep aid is limited to specific cases and it’s use
should be discussed with your health care provider.
43. Gender Differences
and Medications
• March 2013 FDA Label Change
FDA recommended a dosing change for Ambien, a
common sleep drug
The maximum dose recommended for women was
reduced from 10mg to 5mg
Women metabolized (used) this medicine at a slower
rate
More active drug was left in the system the next day
causing increased risk for side effects: sleep eating,
sleep driving, headaches, and daytime grogginess
44. Ambien
Approved 20-plus Years Ago
We are now recognizing this significant
difference because during the
application for a new sleep aid
Intermezzo (zolpidem) a team’s
evaluation data looked at gender.
This resulted in a dosing change
for women.
45. A recent publication revealed
that 8 out of 10 drugs pulled
from the market between
1997-2000 had more
adverse events
(side effects and death)
in women
46.
47. Take Home Tips
1. Not sleeping enough is harmful
2. Pay your sleep debt
3. Talk with your doctor if you are not
sleeping
4. Sleep hygiene works
5. Medical illnesses can cause insomnia
and can lead to serious health outcomes
6. Medications can be useful: start low and
go slow to avoid side effects
48. Remember
“… Sufficient sleep is not a luxury- it is
a necessity- and should be thought of as
a vital sign of good health.”
Wayne H. Giles, MD, MS
NO! Women sleep better, longer, go to sleep faster and sleep more efficiently than men.
The definitions follow
Insomnia is also linked to depression and pain.
Many of you have in the past or currently have these symptoms and may not have spoken with your doctor about it.
Insomnia is also linked to depression and pain.
Much of the research in OSA has been performed on men > women. Providers are taught the most “typical” presentation which is male middle aged overweightAnother reason is much like heart disease women “present” differently.Women and men report different symptoms when they experience obstructive sleep apnea. These variations have led to delayed diagnosis or misdiagnosis in women.
Women and men report different symptoms when they experience obstructive sleep apnea. These variations have led to delayed diagnosis or misdiagnosis in women. Men and women also respond to therapies differently - what works for men may not work for women.
This slide shows how too little sleep begins a cycle of abnormal hormone production that can lead to the chronic diseases and conditions.
The stress of unpaid bills can keep our minds racing at night.Caring for a new baby or an elderly family member can greatly diminish the quantity of sleep women get each night.Conflicts or unhappiness or dissatisfaction with work robs women of sleep.
This is hard with busy schedules, but worth the effort. Also if you have a husband who likes to snack at night, it’s hard to pass up the chips and ice cream, but consider the cost of a sleepless night.
For example if you typically need 8 hours of sleep per night to feel rested and productive the next day, but for 4 days straight you only get 6 hours, you have a sleep dept of 8 hours (a full nights sleep!)
Sleep requirements vary from person to person. Most adults require 7-9 hours of sleep.
These things don’t just happen - plan them!
The promotion of regular sleep is known as sleep hygiene.
These meds do different things to promote sleep. Sometimes it might take several tries before the best medication is found. These meds should be considered as a short-term solution, and shouldn’t be prescribed until behavior modification has been tried. If depression is the under-lying problem, managing it will likely also help with sleep related problems.
Information below + more on melatonin can be found @ http://www.nlm.nih.gov/medlineplus/druginfo/natural/940.htmlWhat is it?Melatonin is a hormone found naturally in the body. Melatonin used as medicine is usually made synthetically in a laboratory. It is most commonly available in pill form, but melatonin is also available in forms that can be placed in the cheek or under the tongue. This allows the melatonin to be absorbed directly into the body.People use melatonin to adjust the body’s internal clock. It is used for jet lag, for adjusting sleep-wake cycles in people whose daily work schedule changes (shift-work disorder), and for helping blind people establish a day and night cycle.Melatonin is also used for the inability to fall asleep (insomnia); delayed sleep phase syndrome (DSPS); insomnia associated with attention deficit-hyperactivity disorder (ADHD); insomnia due to certain high blood pressure medications called beta-blockers; and sleep problems in children with developmental disorders including autism, cerebral palsy, and mental retardation. It is also used as a sleep aid after discontinuing the use of benzodiazepine drugs and to reduce the side effects of stopping smoking.Some people use melatonin for Alzheimer’s disease, ringing in the ears, depression, chronic fatigue syndrome (CFS), fibromyalgia, migraine and other headaches, irritable bowel syndrome (IBS), bone loss (osteoporosis), a movement disorder called tardive dyskinesia (TD), epilepsy, as an anti-aging agent, for menopause, and for birth control.Other uses include breast cancer, brain cancer, lung cancer, prostate cancer, head cancer, neck cancer, and gastrointestinal cancer. Melatonin is also used for some of the side effects of cancer treatment (chemotherapy) including weight loss, nerve pain, weakness, and a lowered number of clot-forming cells (thrombocytopenia).It is also used to calm people before they are given anesthesia for surgery.The forms of melatonin that can be absorbed through the cheek or under the tongue are used for insomnia, shift-work disorder, and to calm people before receiving anesthesia for surgery.Sometimes people apply melatonin to the skin to protect against sunburn.How effective is it?Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.The effectiveness ratings for MELATONIN are as follows:Likely effective for...Sleeping problems in children with autism and mental retardation. Taking melatonin by mouth is helpful for disturbed sleep-wake cycles in children and adolescents with mental retardation, autism, and other central nervous system disorders. Melatonin also appears to shorten the time it takes for to children with developmental disabilities (cerebral palsy, autism, and mental retardation) to fall asleep.Sleep disorders in blind people.Possibly effective for...Jet lag. Most research shows that melatonin can improve certain symptoms of jet lag such as alertness and movement coordination. Melatonin also seems to improve, to a lesser extent, other jet lag symptoms such as daytime sleepiness and tiredness. But, melatonin might not be effective for shortening the time it takes for people with jet lag to fall asleep.Trouble sleeping (insomnia). Melatonin seems to be able to shorten the amount of time it takes to fall asleep, but only by about 12 minutes, according to one research study. Melatonin does not appear to significantly improve “sleep efficiency,” the percentage of time that a person actually spends sleeping during the time set aside for sleeping. Some people say melatonin makes them sleep better, even though tests don’t agree. There is some evidence that melatonin is more likely to help older people than younger people or children. This may be because older people have less melatonin in their bodies to start with.There is some interest in finding out whether melatonin might help with “secondary insomnia.” This is trouble sleeping that is related to other conditions such as Alzheimer’s disease; depression; schizophrenia; hospitalization; and “ICU syndrome,” sleep disturbances in the intensive care unit. Research to date suggests that melatonin might not help to reduce the time it takes to fall asleep in secondary insomnia, but it might improve sleep efficiency.Cluster headaches. Taking 10 mg of melatonin by mouth every evening might reduce the number of cluster headaches. However, taking 2 mg of melatonin at bedtime doesn’t seem to work.Reducing anxiety before surgery. Melatonin used under the tongue seems to be as effective in reducing anxiety before surgery as midazolam, a conventional medication. It also seems to have fewer side effects in some people.Helping elderly people sleep after they stop taking a type of drug called benzodiazepines. The controlled-release form of melatonin is the type that was shown to work for this.Helping decrease symptoms in people who are quitting smoking. A single oral dose of 0.3 mg of melatonin taken 3.5 hours after stopping cigarettes seems to reduce anxiety, restlessness, irritability, depression, and cigarette craving over the next 10 hours.Low blood platelets (thrombocytopenia).Improving the effectiveness of certain cancer medications used to fight tumors in the breast, lung, kidney, liver, pancreas, stomach, colon, prostate, and decreasing some side effects of cancer treatment.Decreasing symptoms of a movement disorder called tardive dyskinesia (TD).Decreasing sunburn when applied to the skin in a cream form before going into the sun.Possibly ineffective for...Adjusting sleep schedule in people that do shift work.Likely ineffective for...Depression. There is also some concern that melatonin might worsen symptoms in some people.Insufficient evidence to rate effectiveness for...Epilepsy. There is some evidence that melatonin at bedtime may reduce the number and length of seizures in children with epilepsy. But melatonin should be used cautiously, because melatonin may increase the number of seizures in some people.Menopausal symptoms. Limited research suggests that melatonin does not relieve menopausal symptoms. However, melatonin in combination with soy isoflavones might help psychological symptoms associated with menopause.Sleep problems associated with attention deficit-hyperactivity disorder (ADHD). Limited research suggests melatonin might improve insomnia in children with ADHD who are taking stimulants. But improved sleep does not seem to decrease symptoms of ADHD.Migraine headache. There is some evidence that taking melatonin nightly before bed can prevent episodic migraine headache. When headaches do occur, they are milder and pass more quickly. Some research suggests that melatonin production might be altered in people with migraine.Insomnia caused by medications used for high blood pressure (beta-blockers).Headache characterized by sudden sharp pain (idiopathic stabbing headache).Ringing in the ears (tinnitus).Chronic fatigue syndrome (CFS).Osteoporosis.Irritable bowel syndrome (IBS).Birth control.Fibromyalgia.Aging.Other conditions.More evidence is needed to rate melatonin for these uses.How does it work?Return to topMelatonin’s main job in the body is to regulate night and day cycles or sleep-wake cycles. Darkness causes the body to produce more melatonin, which signals the body to prepare for sleep. Light decreases melatonin production and signals the body to prepare for being awake. Some people who have trouble sleeping have low levels of melatonin. It is thought that adding melatonin from supplements might help them sleep.Are there safety concerns?Return to topMelatonin is LIKELY SAFE for most adults when taken by mouth short-term or applied to the skin. It can cause some side effects including headache, short-term feelings of depression, daytime sleepiness, dizziness, stomach cramps, and irritability. Do not drive or use machinery for four to five hours after taking melatonin. Special precautions & warnings:Pregnancy and breast-feeding: Melatonin is POSSIBLY UNSAFE in pregnancy. Don’t use it. Melatonin might also interfere with ovulation, making it more difficult to become pregnant.Not enough is known about the safety of using melatonin when breast-feeding. It’s best not to use it.Children: Melatonin should not be used in most children. It is POSSIBLY UNSAFE. Because of its effects on other hormones, melatonin might interfere with development during adolescence.High blood pressure: Melatonin can raise blood pressure in people who are taking certain medications to control blood pressure. Avoid using it.Diabetes: Melatonin might increase blood sugar in people with diabetes. Monitor your blood sugar carefully, if you have diabetes and take melatonin.Depression: Melatonin can make symptoms of depression worse.Seizure disorders: Using melatonin might increase the risk of having a seizure.Works in your brain to promote circadian rhythms. Seems to be more effective when combatting jet-lag.
Side effects:Sleep eating
It is no secret that women suffer more side effects and adverse events than men.In 40% of new drug applications (NDAs) pharmacokinetic differences by gender were submitted 40% of the drugs yet no dosing adjustments were recommended.