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. http://doi.org/10.1586/174763126.96.36.1999
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
As a health psychologist, I know that our brains excel at making associations between things. As a person with common sense, I know that people tend to really like sleeping and having sex. One of the problems of chronic sleep issues is that the bedroom becomes associated with lots of different activities: watching TV, checking FaceBook, working on a laptop, or laying awake wishing you could sleep.
Clean the slate! Move the TV out of the bedroom and move all non-sleeping or sexing (is that even a word?) activities to other rooms or, if you’re tight on space, at least not on the bed. When getting into bed is only associated with sleepy time (or sexy time), it helps our minds relax and our brains send signals that it’s time to fall asleep.
In order for us to fall asleep, we all need to accrue a “sleep debt,” which lets us feel tired and ready for bed. Napping cuts into that sleep debt and leads to difficulties falling asleep, or sleeping in increasingly disjointed chunks. To keep your sleep schedule more regular, and your sleep more restful, it’s better to avoid napping at all and instead let yourself be a little more tired going into the evening. Worst case, if you simply must take a nap, try to keep it brief and before the early evening. A better alternative might be taking a brief walk outside, doing some stretching, or spending a few minutes on an enjoyable task (like playing a game) before returning to your to-do list.
As a health psychologist, I’m big on exercise! It helps regulate your mood, keeps your body in shape, and improves health. But regular exercise can also really improve your sleep! The key is to exercise at the right times, namely in the mornings, afternoons, or early evenings. Regular exercise helps regulate and deepen our sleep overall. However, exercising tends to amp us up for a few hours afterwards because of the hormones it tells our brain to release. So if you’re one of those people who like to hit the gym or go for a run late at night, this may be contributing to your sleep difficulties. Instead, make sure that you exercise at least three hours before bed or earlier.