How are you sleeping? Do you ever feel like you can't get your breath, or just not sleeping well? Or feel unrested and tired the next day?
As we'll see in a minute, it's a PCOS problem that shouldn't be ignored.
What we're talking about here are sleeping disorders such as obstructive sleep apnea (OSA) or sleep disordered breathing (SDB). The word "apnea" means a pause in breathing, which can last for seconds or even minutes and can occur several to 30 times per hour. Mild sleep apnea may escape your notice.
Men are ten times more likely to have sleep apnea than women. But women with polycystic ovary syndrome are different. According to medical studies, they are 5 to 10 times more likely than other women to have a breathing problem during sleep or a disturbed sleeping pattern. By some estimates, as many as one-half of women with PCOS may have sleep apnea or some other sleeping abnormality.
Other than not getting a good night's sleep, should you care?
A very recent large study of women has shown a clear link between sleeping difficulties and the development of diabetes.
And studies from the University of Chicago and elsewhere suggest that sleep apnea may contribute to insulin resistance. The researchers said that obstructive sleep apnea is "a highly prevalent and important determinant of insulin resistance, glucose intolerance and type 2 diabetes in PCOS."
Insulin resistance is the poor utilization of insulin and a major cause of PCOS symptoms and possible future diabetes. Insulin resistance increases the production and availability of testosterone, leading to acne, hair problems and other issues.
The problem is "bidirectional", meaning that insufficient quality sleep disturbs your metabolism and hormones, and in turn, the disturbed metabolism and hormones make quality sleep more difficult. It's a vicious cycle. The diagram below illustrates the complex interaction between sleep and other aspects of your bodily function.
Not only is insulin resistance made worse, but other hormones are thrown out of balance, including cortisol (stress hormone), thyroid hormones, growth hormone, leptin, adiponectin, and more. Your nervous and immune systems are disturbed. Chronic inflammation is increased. You may feel sleepy during the day and find yourself eating more than you should. You may find yourself gaining weight and experiencing other symptoms of PCOS.
Now that we know what a mess this is, how do we go about cleaning it up? Here are some ideas.
1. Try to normalize your progesterone level. Lack of a normal cycle can induce a progesterone deficiency. Progesterone acts to open your airways and improve breathing. If you can breathe better, maybe you can sleep better. Get your progesterone level checked and talk to your doctor about bio-identical (natural) progesterone if needed. A nutritional supplement called "vitex" may help the body to produce progesterone.
2. Improve your diet. Women who have PCOS and sleep apnea also commonly have glucose intolerance. Glucose intolerance happens when your pancreas gland does not produce an appropriate amount of insulin, and when your circulating insulin does not perform as it should (also called insulin resistance). The result is that you cannot efficiently control your blood sugar, plus all of your hormones get screwed up.
The biggest solution to this problem is to discontinue consumption of refined carbohydrates and eat more whole foods. This is discussed in detail in the PCOS diet ebook.
3. Consider melatonin supplementation. Melatonin is a hormone that can help you get better sleep. Ask your doctor about it.
4. Go to bed at the same time every night and get up about the same time every morning.
5. Avoid stimulants like caffeine, desserts or sweets in the evening. Also avoid depressants such as alcoholic beverages.
6. Quiet your mind. Do you have unstoppable thoughts running through your mind at night? There's always something to worry about or some incident to hash over repeatedly in your mind. See if you can find a way to distract yourself from these repetitive thoughts. For example, there are a number of quick meditation techniques you could use. Do some research on this.
7. Make sure your bedroom is quiet and completely dark. If necessary, cover your windows with blackout shades or drapes.
8. Review your prescription drugs with your doctor. They may be interfering with your sleep.
9. Keep your bedroom reasonably cool, between 60 to 68 degrees Fahrenheit. A colder or warmer bedroom is not conducive to quality sleep.
10. Don't watch TV, use your computer or check your smart phone for at least two hours before bedtime. The blue spectrum of light from electronic devices disturbs your circadian rhythm.
11. Consider separate bedrooms. Sharing a bed with a partner or pet can significantly impair sleep, especially if your partner is a restless sleeper or snores.
12. Get outdoors every day in the bright sun and be physically active.
13. Get your vitamin D level checked. Women with sleep disorders often have a vitamin D insufficiency. Vitamin D is super-important for dealing with PCOS.
If you take your sleeping more seriously, you'll have yet another way to beat PCOS.
Tasali E et al, Impact of obstructive sleep apnea on insulin resistance and glucose tolerance in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2008 Oct;93(10):3878-84.
Tasali E et al, Relationships between sleep disordered breathing and glucose metabolism in polycystic ovary syndrome. J Clin Endocrinol Metab. 2006 Jan;91(1):36-42.
Lucassen EA et al, Interacting epidemics? Sleep curtailment, insulin resistance, and obesity. Ann N Y Acad Sci. 2012 Aug;1264(1):110-34.
Ehrmann DA, Metabolic dysfunction in pcos: Relationship to obstructive sleep apnea. Steroids. 2012 Mar 10;77(4):290-4.
Nitsche K et al, Obstructive sleep apnea and metabolic dysfunction in polycystic ovary syndrome. Best Pract Res Clin Endocrinol Metab. 2010 Oct;24(5):717-30.
Li Y et al. Association between sleeping difficulty and type 2 diabetes in women. Diabetologia. 2016 Jan 28. [Epub ahead of print]
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