Menstrual factors in sleep.
The changing endocrine profile in premenopausal women alters aspects of sleep and circadian rhythms. Subjectively women appear to feel a greater need for sleep and report poor and insufficient sleep more often than men. This greater sleep requirement may manifest with a higher amplitude of slow-wave sleep in the EEG in women. Healthy young women, with biphasic body temperature rhythms of ovulatory menstrual cycles, have more stage 2 sleep, higher spindle frequency activity and less rapid-eye movement (REM) sleep when progesterone predominates in the luteal phase. These sleep-EEG changes may largely be caused by neurosteroids acting on the brain. Sleep regulatory mechanisms, indicated by the onset to sleep, slow-wave sleep (SWS) and slow-wave activity, appear to be unaffected by menstrual phase in women with normal cycles. Women with premenstrual mood symptoms have more stage 2 sleep and seemingly less SWS and REM sleep, a blunted circadian rhythm of melatonin and an earlier minimum body temperature than asymptomatic women. Subjective repercussions include increased daytime sleepiness, lethargy and fatigue. Treatment strategies for menstrual-associated complaints include using oral contraceptives and sleep deprivation but the physiology and pharmacology of normal menstrual changes, the disorders and their treatment need to be better understood.
Department of Psychiatry and Playfair Neuroscience Unit, University of Toronto, The Toronto Hospital Western Division, Ontario, Canada. hdriver@playfair.utoronto.ca
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