By A/Prof Lisa Moran and Dr Lin Mo        

Polycystic Ovary Syndrome (PCOS) is a common condition affecting up to 13% of reproductive-aged women.

It is diagnosed based on ovulatory problems, hormonal imbalances or ultrasound imaging of the ovaries. The effects of this can be wide-ranging, including weight gain and increased risk of infertility, diabetes, depression, anxiety and cardiovascular disease 1-3.

One often overlooked feature of PCOS is its association with sleep disturbances.

Symptoms of sleep disturbances may include feeling excessively tired during the day, having difficulty falling asleep, and/or having restless or disturbed sleep.

An association between PCOS and sleep disturbances has been shown before in two research studies. While these studies provided useful information, they weren’t country-wide based studies and didn’t assess sleep disturbances in detail or didn’t account for the effect of potential contributing factors such as body mass index (BMI), depression or demographic factors.

This led us to examine the relationship between PCOS and sleep problems in a large, national cohort of Australian women who are participants in the Australian Longitudinal Study on Women’s Health (ALSWH).

In our study published in the journal Clinical Endocrinology 4, we looked at questionnaire responses from over 6,500 Australian women with and without PCOS. We compared sleep duration and sleep disturbances while considering other factors that might also contribute to poor sleep patterns, such as BMI and depression. This allowed us to see whether any differences in sleep patterns were due to PCOS or were because women with PCOS are more likely to have a higher BMI and depression – both of which can affect sleep quality on their own.

We found women with PCOS were around 1.5 times more likely to experience sleep disturbances compared to women without PCOS.

In particular, women with PCOS were more likely to experience difficulty getting to sleep and severe tiredness throughout the day.  This was true, even when accounting for other factors that can cause sleep disturbances.

 

Why could PCOS cause sleep problems?

There are several possible reasons why PCOS might cause sleep disturbances.

Women with PCOS are at higher risk of Obstructive Sleep Apnoea (OSA), a condition where the airway becomes blocked many times during sleep.

PCOS can also lead to weight gain, with women more often being overweight or obese.

Being overweight or obese is associated with sleep disorders such as insomnia as well as OSA in the general population.

There are other features of PCOS that may also lead to sleep disturbances, even in women without OSA.

Hormonal imbalances in women with PCOS can lead to decreased production of the hormone progesterone. Progesterone has been shown to have an important sleep stabilizing effect 5.

Conditions that occur more often with PCOS, such as diabetes 6 and depression 7, can also make daytime sleepiness worse.

 

Sleep is important for your overall health and well-being

Sleep disturbances can have significant social and health implications.

Poor sleep can lead to increased stress, decreased productivity and contribute to depressed mood states 8.

Short sleep duration has also been associated with increased cholesterol levels, high blood pressure and weight gain 9.

 

What to do if you have PCOS and experience poor sleep

Having a good night’s sleep can make an immense difference in how you feel and your overall health and wellbeing.

If you wake feeling unrefreshed from sleep, the best place to start is to practice good sleep hygiene – see tips below.

If this doesn’t work, we recommend speaking to your doctor (GP) or other health specialist (endocrinologist, obstetrician, gynaecologist). They can help find the solution that suits your individual needs. This may result in a referral to a sleep specialist to be screened for obstructive sleep apnoea, or, for severe insomnia, being referred to a qualified specialist for treatments such as cognitive behavioural therapy.

 

Tips for improving sleep hygiene

  1. Try to go to sleep and wake up at a regular time – this gets your body into a rhythm. Avoid disrupting the rhythm by sleeping in on the weekends.
  2. The bedroom is only for sleep or sex. Avoid watching TV or reading in bed, otherwise your brain will associate being in bed with not sleeping.
  3. Being active, exercising and going outdoors can improve quality of sleep.
  4. People can differ in how much sleep they require, but most people need between 7-9 hours every night to function normally.
  5. Avoid screens e.g. computer, phone late at night that emit blue light. This can make it harder to fall asleep. Glasses are available to block blue light, and some phones have a mode that turns off the blue light parts of the screen.
  6. Avoid caffeinated beverages after early afternoon. The effects of some caffeinated beverages can last for many hours.

 

About the Authors

A/Prof Lisa Moran PhD is a dietitian and researcher in the field of lifestyle and women’s health. She is passionate about finding ways to work with women to help them prioritise their health and lifestyle. Lisa works with women at various stages of their lives or with conditions when focusing on lifestyle is particularly important, such as PCOS, gestational diabetes, infertility or during or following pregnancy. Lisa works at the Monash Centre for Health Research and Implementation at Monash University.

 

 

Dr Lin Mo is a Respiratory and Sleep Physician currently employed as a Research Fellow at Sir Charles Gairdner and Fiona Stanley Hospitals. He previously worked as a registrar at Monash Health. He has a special interest in data collection and analysis and is currently undertaking a Graduate Diploma in Data Science through Monash University.

 

 

References

  1. Azziz R. Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: the Rotterdam criteria are premature. J Clin Endocrinol Metab 2006;91:781-5.
  2. Barry JA, Kuczmierczyk AR, Hardiman PJ. Anxiety and depression in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 2011;26:2442-51.
  3. Moran LJ, Misso ML, Wild RA, Norman RJ. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2010;16:347-63.
  4. Mo L, Mansfield DR, Joham A, et al. Sleep disturbances in women with and without polycystic ovary syndrome in an Australian National Cohort. Clin Endocrinol (Oxf) 2019;90:570-8. https://doi.org/10.1111/cen.13922
  5. Caufriez A, Leproult R, L’Hermite-Baleriaux M, Kerkhofs M, Copinschi G. Progesterone prevents sleep disturbances and modulates GH, TSH, and melatonin secretion in postmenopausal women. J Clin Endocrinol Metab 2011;96:E614-23.
  6. Bixler EO, Vgontzas AN, Lin HM, Calhoun SL, Vela-Bueno A, Kales A. Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endocrinol Metab 2005;90:4510-5.
  7. Damone AL, Joham AE, Loxton D, Earnest A, Teede HJ, Moran LJ. Depression, anxiety and perceived stress in women with and without PCOS: a community-based study. Psychol Med 2019;49:1510-20.
  8. Pemberton R, Fuller Tyszkiewicz MD. Factors contributing to depressive mood states in everyday life: A systematic review. J Affect Disord 2016;200:103-10.
  9. Cappuccio FP, Miller MA. Sleep and Cardio-Metabolic Disease. Curr Cardiol Rep 2017;19:110.