NIH Sleep and Women’s Health

By Eugena Brooks

Growing up I couldn’t wait until I was big enough to stay up like the older girls. In my teens I couldn’t wait until I was old enough to club and bar hop until all hours of the night. By my thirties, ambition and family responsibilities never left enough time to sleep. I never gave sleep much thought because I never understood how important sleep really was for women. The quality of sleep impacts everyone’s health. Getting good (read: enough and refreshing) sleep helps boost the mind, improves mood and can help prevent major health problems. Women are more likely than men to have insomnia and other sleep disorders because changing hormones during the menstrual cycle, pregnancy, menopause and lifestyle situations affect how well women sleep.

Research Conference on Sleep and the Health of Women
The 2018 Research Conference on Sleep and the Health of Women was held October 16-17 at the National Institutes of Health (NIH) in Bethesda MD. Researchers from many venues presented their research findings on the association between sleep, health and how it impacts women during different stages of life. The information found from the NIH sponsored studies help make future medical practice for women even more useful while revealing what information is lacking and in need of further investigation. The purpose of the conference was to showcase a decade of federally funded research advances in understanding health risks, societal burden, and treatment options associated with sleep deficiency and sleep disorders in women’s health.

Women’s Sleep at Different Life Stages
A consistent revelation throughout the conference was how quality of sleep impacts women’s health in significant ways during different stages of our lives. This was first pointed out during a short but informative discussion on sleep and circadian rhythm. Often referred to as the “body clock,” the circadian rhythm is the 24-hour cycle that tells our bodies when to sleep, rise, and eat—regulating many physiological processes. This internal body clock is affected by environmental cues, like sunlight and temperature, and determines whether one feels wide-awake and energized or tired and depleted at different times of the day. Sleep quality can be influenced by changes in sleep habits including insomnia – just one of numerous ways insufficient sleep impacts the health and well-being of women.

Women as the main caregivers of the family find little time to get adequate sleep. More so if they are also the sole provider of family financial support. Very often women don’t have the support systems to be able to care for their family and take time for themselves.

When insomnia or other sleep disorders occur, women are eventually subject to a myriad of comorbidities. Also, since chronic pain impacts quality of sleep, this will also lead to other health issues. In respect to sleep-disordered breathing (SDB), of the 17% of women thought to be affected 90% remain undiagnosed. SDB may lead to coronary heart issues, diabetes, hypertension, stroke and cardiovascular disease (CVD). Insufficient sleep also may lead to: diabetes, hypertension, coronary heart issues, stroke and CVD.

Of interest, the conference highlighted how different life stages of women such as pregnancy and menopause are affected by the above-mentioned issues in significant ways as well. Pregnancy sleep-disordered breathing and cardiovascular outcomes are: Pregnancy may predispose the development of sleep-disordered breathing and lead to hypertension issues during pregnancy. Lastly, CV issues appear elevated by OSA during pregnancy. Pregnancy is an important point in a woman’s life from a sleep perspective. Sleep-disordered breathing is associated with hypertensive disorders during pregnancy and a precursor to future cardiovascular health.

Sleep and Hypertension
Another interesting section was Hypertension and Sleep Why You Should be Scared. Here it was revealed that the effect of insomnia and other sleep disorders are more prevalent upon hypertension. How epidemiological studies show that chronic shortness of sleep is more strongly associated with hypertension in women than with men and that new experimental evidence suggests a “sympathetic excitation” (fight or flight response) in women during sleep deprivation but not found in men. Some chronic models of sleep deprivation (i.e. insomnia and sleep restriction) do suggest sympathetic excitation, but sex differences yet remain unclear and finally that sleep apnea causes surges in sympathetic excitations.

My Health Journey: Indicators of What was Yet to Come
What I came away with from listening to the proceedings was a better understanding and in some instance’s validation of what my personal experiences have been as a woman. I lived my earlier years ignoring what I now know were indicators of what was yet to come. At times being told not to be concerned that nothing was wrong that I was in good condition and had nothing to be concerned about. Meanwhile experiencing symptoms that would lead to future health issues and were very real. Now in late middle age, I am suffering from the comorbidities that started long ago. I was diagnosed with osteoarthritis in my lower back at 26 but was told it was nothing of concern at that age and lived with the disease spreading to my extremities and the growing chronic pain that eventually lead to weight gain and poor health.

Enter My Sleep Apnea
I also realize now that I was living for years with sleep apnea undiagnosed until I was 42 years old. Eventually, the two finally lead to recent health issues of hypertension, congestive heart failure (CHF) and Atrial Fibrillation. All this from pushing my body way past its limits. I was also trying to make up for the losses resulting from: First, the untimely death of my parents leaving me responsible for my younger siblings; Later, followed by the untimely death of my husband leaving me alone to care for my daughter. I felt I had little choice as a single parent but had strong natural ambitions. When I finally dug in to create a decent life for myself in future years, my health gave out leading to physical disablement at the age of 45. If only this information had been available sooner how many lives like mine may have been changed or at least saved from disability.

Collaborative Efforts
The conference was the result of a collaborative partnership among the National Center on Sleep Disorders Research (NCSDR) of the National Heart, Lung, and Blood Institute (NHLBI) the NIH Office of Research on Women’s Health and the U.S. Health and Human Services (HHS) Office on Women’s Health, participating members of the trans NIH Sleep Research Coordinating Committee and other Federal agencies. Read more initiatives by the NIH and the collaborative here.