An Unfortunate Marriage: Sleep Apnea and PCOS

Nature is full of ideal pairings: peanut butter and jelly; cookies and cream; cats and laser pointers, and so on. Unfortunately, PCOS and obstructive sleep apnea (OSA), while frequently paired, are hardly ideal.

Obstructive sleep apnea is characterized by repeated episodes of partial or complete blockage of the upper airway during sleep, leading to loud snoring, gasping or choking, frequent waking, and poor sleep quality. This condition is often associated with obesity and, just like obesity itself, has reached epidemic-level prevalence in the United States, with estimates that 17% of the adult population has OSA, with that number jumping to 41-58% of overweight individuals.

Unfortunately, OSA is also much more common in women with PCOS. How much more common, you ask with a wince? Well, studies have found that OSA may be 30 times more common in women with PCOS, even after controlling for body mass, and that a whopping 70-75 percent of women with PCOS may also have OSA. Yikes!

Poor sleep quality is hardly the only downside to OSA. The condition, in conjunction with the ramifications of consistently poor or interrupted sleep, can lead to increased stress hormones circulating throughout your system, more severe mood swings, increased depression and anxiety, hypertension, stroke, coronary artery disease, insulin resistance and diabetes (as if we need any more risk of that!), and decreased mental clarity. Double yikes!

Often, conditions like PCOS, OSA, obesity, and diabetes play a kind of terrible chicken and egg game in which each condition exacerbates the others, and vice versa. Diabetes and poor sleep can lead to weight gain, which worsens OSA, which sends your stress hormones further out of whack, which keeps your androgen levels high, which causes further PCOS symptoms, etc. I’d say triple yikes but I think you get the picture.

Adding to the difficulty, because OSA is a medical condition, there is little a health psychologist such as myself can do on our own (even my powers have limits!). I can screen for OSA when I’m evaluating sleep problems, but ultimately, I’ll have to refer you to a medical doctor. So what do women with PCOS do about OSA? The first and most important step is to get tested for it and diagnosed — particularly if you find that you tend to snore, wake up frequently during the night, sleep poorly, or feel tired during the day frequently. More than likely, you will need a referral to a pulmonologist, a specialist who deals with the respiratory system.

Fortunately, OSA is often easily treated. Treatments may include bedtime additions such as nasal strips, a mouth guard, or a continuous positive airway pressure (CPAP) machine. While these devices may take some time to get used to, you will be amazed at how much better your sleep quality will be, and how much better that makes you feel overall. Research has also found that the vast majority of people with OSA do not even know they have it. If you are a woman with PCOS and you have one or more of those sleep-related symptoms I mentioned earlier, chances are, you are in this group. You deserve better. Get yourself diagnosed and treated, and you might just be amazed at how much your quality of life improves!

References:

Lee, W., Nagubadi, S., Kryger, M. H., & Mokhlesi, B. (2008). Epidemiology of obstructive sleep apnea: a population-based perspective. Expert Review of Respiratory Medicine, 2(3), 349–364. http://doi.org/10.1586/17476348.2.3.349

Tasali, E., Cauter, E. Van, & Ehrmann, D. (2008). Polycystic Ovary Syndrom and Obstructive Sleep Apnea. Sleep Medicine Clinics, 3(1), 37–46. Retrieved from http://www.sciencedirect.com/science/article/pii/S1556407X07001415

Humblebrag: I’ve joined the PCOS Challenge Health Advisory Board!

I’ve previously written about the importance of community support for women dealing with PCOS. This support can come from family and friends, as well as mental health professionals, medical professionals, and both in-person and online support groups. One of the most important organizations PCOSers (Is that even a word? It is now!) should be aware of is PCOS Challenge.

PCOS Challenge is the leading non-profit advancing the causes of those with PCOS and their loved ones. Not only does it sport a 40,000-member strong online community, but it also creates television, radio, and online programming as well as hosts numerous online and offline support groups. If you are a woman with PCOS or a person who loves one, I highly recommend you join the site and begin reaping the benefits!

One of those benefits is the FREE bi-monthly online PCOS Challenge Magazine! In the current May-June issue, yours truly has a featured article all about dating with PCOS, as well as quick tips on fighting anxiety and depression.

• Have you felt either too intimidated or too jaded to date?
• Are you feeling unsure when, or how, to disclose to a potential partner that you have PCOS?
• Trying to figure out how to handle personal grooming in dating and partnership?
• Looking for quick, easy solutions to manage your mood swings, depression, or anxiety?

Behold, the answers lie within!

Also in this issue, you will find a very special announcement. I am extremely pleased and honored to share that I have joined PCOS Challenge’s Health Advisory Board (HAB)! The HAB consists of researchers and healthcare leaders who help ensure the accuracy of the information that PCOS Challenge shares, as well as helps guide PCOS Challenge’s content, funding, and advocacy efforts.

This is a huge honor for me and I am excited and grateful to get to utilize my expertise as a health psychologist specializing in PCOS and other endocrine disorders to contribute to such an important organization!

Gretchen Kubacky, Psy.D., “The PCOS Psychologist,” is a health psychologist in private practice in Los Angeles, California. She a Certified PCOS Educator, and the founder of PCOSwellness.com. You can contact Dr. Kubacky at AskDrGretchen@gmail.com.

The Gift of Self-Forgiveness

You’ve fallen off the diet wagon. Again.

Six months later and you’re still not pregnant.

Two weeks have passed since you’ve set foot in that gym.

If this were you, what would your reaction be? Inevitably, we all end up failing to reach our goals sometimes, and sooner or later even the most disciplined person is going to have a lapse. What happens then?

Odds are, you will react to this by treating yourself harshly. You might call yourself lazy, unmotivated, a failure, or other epithets unsuitable for a family blog. This might be a typical reaction for many people, but alas it is an extremely unhelpful one. Treating yourself harshly in face of setbacks, such as by becoming self-critical, can backfire by making you even less likely to succeed in the long-run. The reason for this has to do with shame.

When we do something wrong, it is normal (and often healthy) to feel some amount of guilt. Guilt is when we feel bad for what we did. However, often we instead shame ourselves. Shame is when we feel bad for who we are. So instead of saying to yourself, “I shouldn’t have eaten that piece of chocolate,” you instead might say, “I’m a pig!” This self-shaming then lowers morale, worsens feelings of anxiety or depression, and can create a downward cycle.

So how to stop this cycle of self-shaming in the face of mistakes? With self-forgiveness! Self-forgiveness, also often referred to as self-compassion, involves cutting out the self-shaming and instead actively working to bring peaceful, calming feelings to the perceived failure. Not only does this improve your self-esteem and mental health, but it can also increase your motivation to self-improve!

Here’s one way to practice self-forgiveness:

1. Identify the mistake (e.g., “I cheated on my diet.”)
2. Take responsibility for what happened (e.g., “Nobody forced me to do it, I made the choice.”)
3. Take a few moments to think about the incident, and pay attention to what comes up for you. Listen closely for any messages of self-condemnation (e.g., “I’m a failure; I’m fat; I’m weak.”)
4. Remind yourself that those messages of self-condemnation are not true. They are simply negative messages you have received from the past and from the outside world. They are not you.
5. Close your eyes, take a few deep breaths, and give yourself some positive affirmations, such as reminding yourself that mistakes and setbacks are a normal part of growth, and that you are worthy as a person.
6. Tell yourself, out loud if possible, that you forgive yourself and that you will continue to do your best.

 
There are many ways we can practice self-compassion and self-forgiveness. Can you think of others? They can be quick and easy, such as simply giving ourselves a big hug, or laughing at our own mistakes instead of shaming ourselves for them.
The key is that, because many of us are used to treating ourselves so harshly for most of our lives, self-forgiveness takes some active effort on our part as well as repetition for it to sink in. It’s ok if forgiving yourself does not immediately make you feel better. This is a practice that plants seeds for the future, and the more you practice it the better you will get at it. Treat yourself as well as you deserve!

References:
Breines, J. G., & Chen, S. (2012). Self-Compassion Increases Self-Improvement Motivation. Personality and Social Psychology Bulletin, 38(9), 1133–1143. http://doi.org/10.1177/0146167212445599

Dealing with the Diagnosis of PCOS

A diagnosis of Polycystic Ovary Syndrome (PCOS), or any other chronic illness, changes your life. The formal diagnosis might have been preceded by years of battling with mysterious symptoms, feelings of inadequacy or shame, the trials of judgmental or unsupportive family members or friends, and a deep feeling of anxiety about just what the heck was going on with you. How does getting such a diagnosis affect you? How do you cope and move forward?

Different people will react to being diagnosed with PCOS or another chronic illness in a myriad of ways. For some, receiving a diagnosis might feel like a relief after a long and exhausting search for an answer. For others, a diagnosis might feel more like a life sentence.

Many negative reactions to receiving a serious diagnosis are common. Fear, for example, might be the most common of all. Receiving a serious diagnosis can feel terrifying for the patient, as they struggle to wrap their heads around what it might mean for them, their family, and their future. Another common negative reaction is anger. Even for those whose diagnosis feels like an answer to a mystery, they might feel angry at the time and energy they have lost searching for answers. Anger might be sparked by thinking about the delays in getting diagnosed and treated. Often, such anger may co-exist with, or even be covering up, deep feelings of loss and grief. People who receive a serious diagnosis like PCOS must give themselves the time and space to grieve and heal. Being diagnosed with PCOS can mean needing to face a restructuring of one’s identity and expectations for the future.

On the other hand, many women experience positive reactions to finally being diagnosed with PCOS. For example, often there is a feeling of gratification at finally having an answer. Without a diagnosis, a woman might have been struggling in the dark for years with mysterious symptoms and dismissive doctors. A formal diagnosis can have a tremendously validating impact on a woman by proving to herself and others that she is not crazy, and that there really is something wrong. Furthermore, getting diagnosed can give the years of preceding pain and confusion a sense of meaning. Rather than struggling against a strange and nameless foe, a diagnosis allows the person to marshal their resources against a specific and well-defined enemy. Finally, a diagnosis provides a label for one’s health problems that can be easily communicated to others. It provides a common language with which to communicate your health concerns and needs.

One other benefit of receiving a formal diagnosis is that it is a necessary and important step in the road to long-term adjustment to chronic disease. Researchers recommend that patients with a chronic disease, like PCOS, should take several concrete steps to begin adjusting to their diagnosis. One is maintaining an active lifestyle, with regular exercise, as this not only boosts your physical health but also improves your mood. Another recommendation is to express one’s emotions fully and constructively, be it to partners, friends, or helping professionals. This is where a qualified health psychologist (like me!) can really come in handy, by helping you learn how to effectively communicate your needs and feelings in order to reduce stress and build supportive alliances with others around you. In addition, researchers recommend that patients actively engage in self-management of their condition, such as mobilizing personal resources, balancing, pacing, and prioritizing your lifestyle, and recognizing and monitoring your own personal boundaries, such as your energy levels and work hours.

Finally, healthy adjustment to a chronic disease involves trying to find the hidden positive outcomes of the disease. While a disease like PCOS can cause numerous unwanted and even traumatic outcomes, such as infertility, there is the possibility that adjusting to the condition may result in improved appreciation of life, an enhanced sense of purpose, better attention to self-care, and improved communication and/or relationships. The road of having PCOS or some other chronic condition is certainly not easy, but it also has the potential for hidden upsides.

References:
de Ridder, D., Geenen, R., Kuijer, R., & van Middendorp, H. (2008). Psychological adjustment to chronic disease. Lancet (London, England), 372(9634), 246–55. http://doi.org/10.1016/S0140-6736(08)61078-8