Category Archives for Chronic Illness

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!


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.

Tasali, E., Cauter, E. Van, & Ehrmann, D. (2008). Polycystic Ovary Syndrom and Obstructive Sleep Apnea. Sleep Medicine Clinics, 3(1), 37–46. Retrieved from

Circadian Rhythms, Insulin Resistance, and FOOD

A recent article over on CNN offers some excellent insights about one of my favorite topics. Yup, you guessed it: FOOD.

As many of you who, like me, deal with polycystic ovary syndrome (PCOS) have probably experienced, the relationship with food can become…tense. Food becomes less a source of joy and nourishment and more like a threatening opponent we must wrestle into submission in order to control our weight.

Interestingly, according to the research and interviews cited in the aforementioned article, eating in tune with our natural circadian rhythms might actually help us control our weight. So, in other words, it’s not just what you eat, but also when you eat it! The article is a great source of information and I highly recommend that you read it and come back. It’s ok, I’ll wait.

Welcome back! So, in addition to all the nuggets (mmmm, nuggets) of information in the article about weight loss, there was something else very relevant to PCOS hidden in there. Did you catch it? The article mentioned that insulin sensitivity also operates according to circadian rhythms! Why is that important?

Well, our level of insulin sensitivity controls how our body processes and stores glucose, which has a ton of important downstream effects on our health and weight. Unfortunately, more than half of women with PCOS display insulin resistance. This is bad because insulin resistance is a prime factor in developing Type II diabetes, a serious health condition that, if left unchecked, can lead to a runaway breakdown in how your body processes sugar and lead to severe health complications such as cardiovascular disease.

Insulin resistance is also a prime contributor to weight gain, as the lower our insulin sensitivity is, the more likely our food is to be stored in fat cells rather than burned for energy. Controlling weight is a huge component of proper PCOS self-care for a number of reasons. Not the least of which is that even just a 7% reduction in weight is associated with increased fertility among women with PCOS! In addition, weight gain is yet another pathway through which diabetes and cardiovascular disease can occur.

Finally, insulin resistance is also linked with sleep-disordered breathing, such as sleep apnea. This is important because sleep-disordered breathing leads to poorer metabolic function, which leads to weight gain, which worsens sleep-disordered breathing and so on, creating a negative spiral in which weight gain, insulin resistance, and poor sleep are all exacerbated, all of which then increase the risk for developing or worsening (say it with me now) diabetes and cardiovascular disease. Yikes!

So what to do about all of this? Well, as CNN’s article suggests, in order to eat according to our circadian rhythms, it’s important to eat breakfast, make a healthy balanced lunch your biggest meal of the day, and to avoid carbs at dinner. This will help synchronize your food intake when your metabolism in order to maximize energy and feelings of satiety, as well as reduce the tendency to store the food as fat. Your body will thank you for it!

Drayer, L. (May 19, 2017). Weight loss can be tied to when, not just what, you eat. CNN. Retrieved 5/25/17 from:
Dunaif, A. (1997). Insulin resistance and the polycystic ovary syndrome: Mechanism and implications for pathogenesis. Endocrine Reviews, 18(6), 774–800.
Punjabi, N. M., Shahar, E., Redline, S., Gottlieb, D. J., Givelber, R., & Resnick, H. E. (2004). Sleep-disordered breathing, glucose intolerance, and insulin resistance: The sleep heart health study. American Journal of Epidemiology, 160(6), 521–530.

PCOS and the Spoons

Are you familiar with “spoon theory?” If not, you absolutely want to do yourself a favor and read this article. Go ahead, I’ll be here.

Back? Okay, good!spoons

Spoon theory was written by a woman with lupus, Christine Miserandano, to describe what it’s like to live with a chronic disease. She imagined a person’s level of energy and ability in a given day as represented by a certain number of spoons, and then described how every task, even seemingly mundane ones, cost different amounts of spoons, causing the chronically ill person to have to make difficult decisions about how to spend their few spoons. By contrast, healthy people simply never need to worry about counting their spoons or carefully planning their expenditure.

Although spoon theory was written with lupus in mind, it can easily be applied to other chronic conditions, including polycystic ovary syndrome (PCOS), which many of my patients (as well as I) have. PCOS applies to spoon theory in terms of how we manage emotional and mental stress and anxiety. Chronic disease, of any type, is a huge life stressor that a person must contend with. This leaves that person with far fewer “spoons” to accomplish their daily tasks than those without a chronic illness.

To illustrate how this might work, let’s say a hypothetical woman with PCOS has 12 spoons. Women without PCOS or another chronic condition might have enough spoons that they don’t have to worry about even counting them most days. But for comparison’s sake, let’s say that a different hypothetical woman without PCOS also has 12 spoons.

Both women have to accomplish the same list of tasks every day, with the corresponding costs in spoons:

  • Waking up and getting herself ready for the day. (2 spoons)
  • Preparing breakfast and lunch. (1 spoon)
  • Going to work. (2 spoons)
  • Cooking and cleaning up dinner. (1 spoon)
  • Exercising. (1 spoon)
  • Quality time with partner. (1 spoon)

This leaves the woman without PCOS with four remaining spoons for the day that she can spend as she wishes. Perhaps she could grab a drink with a friend after work or make some progress on a household project. Or maybe she’ll have enough spoons left by the end of the night that she feels like having sex with her partner.

The woman with PCOS, however, has other hidden costs that she must spend spoons on throughout her day, in addition to the above, such as:

  • Pushing through feelings of self-loathing at her body, due to the excess mid-section weight she can’t seem to lose, in order to get ready for work. (1 spoon)
  • Checking herself for excess facial hair growth and treating her acne. (1 spoon)
  • Spending her lunch break trying to make appointments with the fertility specialist and endocrinologist. (1 spoon)
  • Resisting the strong cravings to eat food she misses, and instead eating PCOS-healthy meals. (1 spoon)
  • Getting into yet another argument with her partner about her excessively low (or excessively high) libido. (1 spoon)

As you can see, this leaves the woman with PCOS with one spoon too few to accomplish her daily tasks, forcing her to make difficult choices. Even worse, all of this happens invisibly, under the surface, and it might be very difficult to explain to partners and friends. This can lead to chronic stress as well as feelings of shame or inadequacy, costing further spoons.

Does this describe your life? If so, there is some good news.

PCOS may cost you a lot of spoons, but there IS a way to gain more spoons on the average day. A qualified health psychologist with expertise in PCOS can help you deal with the physical and emotional struggles of your chronic condition. In addition, reaching out to other women with PCOS to find support and community can help tremendously.

Always remember that you are not alone, and that PCOS can be effectively managed in order to live a full and happy life.


de Ridder, D., Geenen, R., Kuijer, R., & van Middendorp, H. (2008). Psychological adjustment to chronic disease. Lancet (London, England), 372(9634), 246–55.

Resolving to Make Effective Resolutions

Well, it’s almost New Years! I’m sure I’m not alone when I say that I am FULLY READY to say goodbye (perhaps along with some choice expletives) to 2016, which has been such a difficult year for many people, myself included.

resolutions2Along with the New Year comes a time-honored tradition among many Americans: making, and then almost immediately breaking, New Year’s resolutions! The dawn of a new year has traditionally been an ideal time to take stock of one’s life and make bold new plans for how to improve it. We survey our situations, determine the necessary next-steps to become happier and healthier, and we resolve to do what must be done!

Unfortunately, it rarely works out that smoothly. In fact, Forbes reports that only 8% of people actually achieve their New Year’s resolutions! And what type of resolutions are we regularly failing to fulfill? You probably guessed it. Nielsen found that staying fit and losing weight are the two most common types of New Year’s resolutions. Not only is it a shame that so many people struggle to accomplish these goals, but also failing to meet a New Year’s resolution can lead to feelings of failure, lower self-esteem, and can worsen the spirals of depression and anxiety. No bueno!

Those with chronic health conditions, such as PCOS, as well as people who struggle with mental health conditions like depression, know how important staying healthy and active is to their physical and emotional well-being. Simply put, the stakes are higher. But what if you’ve fallen off the wagon recently? Or perhaps you never got on the wagon at all? Maybe you are so far from the wagon you aren’t even sure what a wagon looks like?

In those cases, making a New Year’s resolution can be a great motivating tool to help you take charge of your health, as long as you can stick to it. But how?

Here are my tips for making, and keeping, effective health-related New Year’s resolutions:

1. Keep it realistic. This is the biggest way people stumble in making resolutions. Resolving to lose weight is fine, but resolving to lose 50 pounds is going to raise the likelihood that you are setting yourself up for disappointment.

2. One resolution at a time. Remember that self-control is like a muscle. That means it both grows stronger the more we exercise it, BUT that it also sometimes needs to be given a break to rest. If we make multiple challenging resolutions at once, we may not be giving our self-control muscle adequate recharge time, and it will raise the likelihood that it (and we) will fail. So go ahead and resolve to quit smoking, or to go to the gym regularly, but don’t try to accomplish both at once. Instead, focus on one goal at a time.

3. Create a series of small, progressive goals. Large, impressive goals can help us feel motivated and excited because we imagine what things will be like if we accomplish them. The problem is, impressive goals often tend to become imposing, increasing avoidance, procrastination, and low motivation when results come in slowly. When setting a New Years resolution, chart out a series of small, progressive goals for yourself over the course of the year. Weekly or monthly goals work well for this. And remember that sometimes, progress looks like two steps forward, one step back. So if you stumble in your journey, don’t beat yourself up! Just take the next step forward.

4. Start (too) easy. In concert with tip #3, it’s crucial to start VERY small. Want to set a New Year’s resolution that you will meditate for 20 minutes every day? Great! Perhaps a good first goal would be that you will meditate once, for five minutes, every week. Once you’ve hit that goal for several weeks in a row, progress to five minutes twice per week for a few weeks, and continue increasing in that fashion. Too easy, you say? Good! The goal is to get yourself on a roll of successfully meeting your goals. This will increase motivation and what we psychologists call self-efficacy, or your belief that you can do something. We often sabotage ourselves by setting the bar too high, too fast.

And here are some bonus tips: Don’t forget to keep yourself accountable! Keeping a calendar or log of your progress will help you stay motivated and focused, and sharing your goals with your family and friends, as well as asking them to periodically check on you about them and provide encouragement, can be really important.

Finally, remember to practice self-kindness and self-compassion no matter what. So if things feel difficult or if progress seems slow, don’t forget to give yourself some love. Making positive changes in our lives is hard. If it was easy, New Year’s resolutions wouldn’t be a thing! However, if you follow these tips, you are much more likely to set yourself up success. Join the 8% club!

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