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PCOS and sleep: insomnia, sleep apnea and sleeping too much

For many people with Polycystic Ovary Syndrome (PCOS), the day-to-day challenges go beyond reproductive health concerns. A frequently overlooked aspect is the link between PCOS and sleep.

This article pulls back the curtains on how PCOS affects sleep, how insomnia, sleep apnea and sleeping too much may be linked to PCOS, and we even offer solutions to those night-time troubles. Keep reading to learn more about PCOS and sleep.

What is PCOS?

PCOS is a hormonal disorder that affects 1 in 10 people assigned female at birth. With a combination of genetic and environmental factors at play, PCOS has become increasingly prevalent in recent decades, affecting millions worldwide.

PCOS has many symptoms associated with it including acne, oily skin, hirsutism, alopecia, irregular periods, challenges getting pregnant and sleep disturbances.

Why is sleep important?

Everyone loves a good night’s sleep. But beyond the immediate feelings of refreshment, sleep plays a pivotal role in our overall health. Sleep is characterised by a restful state of both mind and body. Given that the typical individual spends 26 years of their life asleep, it’s crucial we understand its importance. Ensuring adequate and restorative sleep is as vital to our well-being as food and water.

It’s the time when our body heals, rejuvenates, and consolidates memories. Moreover, adequate sleep helps in hormonal balance, metabolic functions, and emotional well-being. In a nutshell, we don’t just enjoy sleep, we fundamentally need it.

There are 3 stages of sleep:

  1. Non-Rapid Eye Movement (non-REM) sleep: this is the first stage we enter, which is classed as ‘light sleep’ and can last for around 25 minutes.
  2. Deep sleep: the next stage, is critical as this is when the body repairs itself, restores energy and releases hormones.
  3. REM sleep: as our sleep cycles repeat (around 90-minute cycles) we enter REM sleep several times. The first stage lasts around 10 minutes, getting longer each time following this.

Does PCOS make you tired?

We cannot say for certain that PCOS makes you tired but there are various components of PCOS that may contribute to PCOS fatigue including insulin resistance, irregular periods, mood disorders like depression, sleep disorders, thyroid problems, vitamin B12 deficiency, iron deficiency anaemia and not eating enough.

PCOS sleep issues and disorders

It is unclear whether PCOS exacerbates sleep disorders, or whether sleep disorders exacerbate PCOS. The most likely explanation is it works both ways.

Insomnia

People with PCOS may suffer from insomnia. Insomnia is a sleep disorder characterised by persistent issues falling asleep, staying asleep, or waking up too early and not being able to get back to sleep. Individuals with insomnia often experience fatigue, low energy, difficulty concentrating, mood disturbances, and decreased performance at work or at school.

Insomnia is diagnosed by a combination of medical history, sleep diaries, physical examination and sleep studies.

Sleep apnea

Sleep apnea is a serious sleep disorder where a person’s breathing repeatedly stops and starts during sleep. There are three types of sleep apnea: Obstructive Sleep Apnea (OSA), Central Sleep Apnea (CSA) and Complex Sleep Apnea Syndrome (Treatment-emergent Central Sleep Apnea).

Obstructive sleep apnea is the most prevalent form of sleep apnea. It occurs when the muscles in the back of the throat can’t keep the airway open. 35% of people with PCOS suffer from sleep apnea, compared to around 20% of the general population.

Sleeping too much

Alternatively, some people with PCOS find it challenging to stay awake, often oversleeping. This could be the body’s attempt to counterbalance PCOS fatigue from poor sleep quality. Although there is no clear definition of what sleeping too much means if you are sleeping more than 9-10 hours and don’t feel well rested, then further investigation may be required.

Chronic oversleeping or feeling persistently tired despite long hours of sleep should be discussed with a healthcare professional.

PCOS fatigue

Many people with PCOS note fatigue as a symptom. While further studies are needed, a connection between PCOS and fatigue seems evident. A study indicated that individuals with PCOS are more prone to experiencing fatigue as a symptom compared to those without PCOS.

>> Read more | PCOS fatigue: does PCOS make you tired?

What is the link between PCOS and sleep?

Although more research is required, there does appear to be a correlation between PCOS and sleep. There are many different potential theories hypothesised for why PCOS impacts sleep, including insulin resistance, high cortisol levels, raised androgen levels and mood disorders like depression and anxiety.

Insulin resistance

It is estimated that up to 80% of people with PCOS have insulin resistance. Insulin resistance occurs when the body’s tissues don’t respond as effectively to insulin, preventing glucose from entering cells as it normally would. As a result, glucose remains in the bloodstream for extended periods, potentially leading to hyperglycemia symptoms. These may include excessive thirst or hunger, hunger pangs shortly after eating, increased urination, tingling in the hands or feet, unusual fatigue, and recurring infections.

Interestingly, insulin resistance can directly influence sleep patterns. There is a plethora of evidence linking insulin resistance and sleep disturbances. Elevated nighttime insulin levels can lead to more wakeful nights and less REM sleep, studies find. Insulin resistance has been found to be the strongest risk factor for sleep apnea in people with PCOS.

High cortisol levels

Often termed the ‘stress hormone’, cortisol peaks in the early morning to help us wake up. However, elevated cortisol levels, especially at night, can disrupt this natural rhythm, making it harder to sleep. Cortisol appears to be higher in people with PCOS. Interestingly, sleep deprivation is a stressor itself and is associated with elevated cortisol levels – creating a perpetual cycle.

Raised androgen levels

Higher levels of androgens, typical in PCOS, may interfere with the sleep-wake cycle, contributing to conditions like sleep apnea. More research is required as there are mixed results about increased androgens and sleep disturbances.

Depression and anxiety

People with PCOS are more likely to suffer from mood disorders like depression and anxiety than people without PCOS. One of the most common symptoms of depression and anxiety is insomnia and trouble sleeping.

Inforgraphic for 6 ways to improve sleep for PCOS

6 ways to improve your sleep with PCOS

Improving your sleep quality and quantity is possible if you have PCOS, with medical and lifestyle interventions.

1. Speak to a medical professional

This is the most important place to start, especially if you think you have a sleep disorder like insomnia or sleep apnea. Speak to your doctor or healthcare professional and begin the process of diagnosis. You may need blood tests, sleep studies or complete sleep diaries for a diagnosis.

2. Avoid caffeine after lunchtime

Did you know caffeine has a half-life (the time it takes for your body to remove half of the caffeine from your system) of six hours? So, say you have a cup around 3 pm, it will still be in your system at around 9 pm.

While some people think an evening cup may not affect them, a study found an evening dose of caffeine reduced deep sleep by 20%. So, while you may not be aware of it at the time, it can leave you feeling exhausted the next day.

If you enjoy an afternoon or evening tea or coffee, try swapping to decaf after lunch.

3. Avoid screen time before bed

We have an internal body ‘clock’ that regulates our circadian rhythm which determines when we stay awake and when we sleep. As this isn’t 100% accurate, it requires signals from our external environment to adjust itself. The most important of these signals for sleep are daylight and darkness.

When we’re exposed to blue light (e.g. from smartphones, TVs or computers) in the evening it can trick our brain into thinking it’s light outside, thus impacting our circadian rhythm.

To help avoid this you can:

  • Avoid screens for at least 2 hours before sleep.
  • Reduce the brightness of lights throughout your house in the evening
  • Try blue-light-blocking glasses

4. Calm your racing mind

Going to bed with a never-ending list of things on your mind can make it difficult to fall asleep. A recent study found that writing a to-do list for the next day before going to bed helped people fall to bed faster.

Try leaving a notebook and pen by your bed as a reminder and give it a go!

5. Supplement with Vitamin D

Vitamin D is an important nutrient for bone and immune health as well as increased cognition. As we absorb most of it from direct sunlight, it is recommended we supplement with vitamin D during the winter months.

Research has suggested that vitamin D deficiency is linked with sleep disorders. Furthermore, another study found that vitamin D supplementation in individuals who suffered from sleep disorders helped to improve their sleep quality. Although more studies are required, the research so far in this area is promising.

6. Regulate bedroom temperature

Our body’s core temperature decreases when we sleep and increases when we wake. If your sleep environment is too hot or too cold, it can affect your quality of sleep.

A study found that individuals who slept in cooler better ventilated rooms had better sleep. To help reduce your room temperature and increase ventilation throughout spring and summer try sleeping with your window open or using a fan to cool down your room.

Key takeaways: PCOS insomnia – the link between PCOS and sleep

The connection between PCOS and sleep is undeniable. From insomnia to sleep apnea, the implications of PCOS on sleep are vast. Recognising and understanding these challenges is the first step. The good news? With awareness and proactive steps, better sleep is achievable whether you have insomnia, sleep apnea or feel like you’re sleeping too much.

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Alex Okell ANutr Founder and Editor

Founder and Editor | Registered Associate Nutritionist

 

Founder of Be The Collective LTD [The PCOS Collective & The Endo Collective] Alex Okell ANutr is a London-based reproductive health nutritionist with experience in research, private practice and digital media. She holds a Master’s degree in Nutrition from King’s College London and has co-authored papers with the University of Cambridge, King’s College London, The Food Foundation and the Food Standards Agency. Alex offers 1:1 PCOS support in our virtual PCOS clinic.

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