Sleep is Underrated for PCOS

In past years, by Christmas Day I would be typically exhausted and often sick.  Six weeks of planning, cooking, traveling, shopping, parties, while neglecting my diet, exercise and lifestyle would take its toll.  But this year I feel great. I credit my well-being to sticking with my eating plan and getting plenty of sleep. Most nights since before Thanksgiving, I have been in bed as soon as the kids were tucked in, often by 8:30 PM. This quality sleep has helped my immunity, and I would venture to say stress and hormone levels too.  It is so refreshing to enter the New Year feeling good.

After working with thousands of women with PCOS, I find that most are not getting enough sleep.  Sleep is so vital to our hormone health and is a key way to manage PCOS.

A Few Benefits of Sleep for PCOS

1.  Sleep makes a big difference in the results of diet change.  Getting adequate sleep may enhance the beneficial effects of a diet. Not getting enough sleep could defeat the desired effects. According to a study published in the Annals of Internal Medicine, “the amount of sleep makes a big difference on the results of dietary interventions. One should not ignore the way one sleeps when going on a diet. Obtaining adequate sleep may enhance the beneficial effects of a diet. Not getting enough sleep could defeat the desired effects.”  Getting adequate sleep also helped control the dieters’ hunger. Average levels of ghrelin (a hunger hormone) did not change when dieters spent 8.5 hours in bed. When they spent 5.5 hours in bed, their ghrelin levels rose over two weeks from 75 ng/L to 84 ng/L.  I think insufficient sleep will keep you from your weight loss goals

2. Too little sleep increases the risk of impaired glucose tolerance. People who get either less than 6 hours of sleep a night have a higher risk of developing Impaired Glucose Tolerance, which is defined as a fasting plasma glucose level of more than 5.3 mmol/L or 95 mg/dL and is particularly prevalent amongst women who have PCOS or Diabetes Mellitus, another disease for which women with PCOS have a significantly increased risk of developing.

3. Sleep deprivation causes an increase in the early evening levels of the stress hormone cortisol. Normally in the evening, cortisol decreases to minimal levels shortly before regular bedtime. The rate of decrease of cortisol concentrations in the early evening was approximately 6-fold slower in subjects who had undergone 6 days of sleep restriction than in subjects who were fully rested. Elevations of evening cortisol levels in chronic sleep loss are likely to promote the development of insulin resistance, a symptom of PCOS and risk factor for obesity and diabetes.

4. Sleep deprivation suppresses immune system function. The more all-nighters you pull, the more likely you are to decrease your body’s ability to respond to colds or bacterial infections. Prolonged sleep deprivation and the accompanying stress response results in chronic low-grade inflammation, and also produce immunodeficiency, which both have detrimental effects on our health.

5. Get help for Sleep Apnea:   Women with PCOS are 30 fold higher risk for Obstructive Sleep Apnea than women without PCOS.  David Ehrmann, M.D., of the University of Chicago found that women with PCOS and OSA are at least three times more likely to have prediabetes, compared to women without PCOS.

“In the last few years, sleep apnea has been found to be a frequent comorbidity [coexisting condition] with PCOS, and our study shows that women who have both conditions are at greatest risk of metabolic disturbances such as prediabetes,” says Dr. Ehrmann. “Patients who have one or both of these conditions should be screened early for type 2 diabetes and should be monitored regularly.”

The study also showed that blood sugar levels increased as women’s levels of the hormone progesterone decreased. Women with PCOS often have low progesterone levels and Dr. Ehrmann says that low progesterone may play a role in obstructive sleep apnea.

Continuous positive airway pressure (CPAP) is now the first-line therapy for OSA. CPAP is delivered by a machine with a tight-fitting face mask. The good news is that a study recently showed that when using a CPAP women with PCOS can see an improvement in blood pressure, metabolic function, and insulin resistance.

If you suspect you have Sleep Apnea please advocate for yourself and talk to your doctor.  Positive airway pressure (PAP) treatment has been shown to improve insulin sensitivity, daytime and nighttime norepinephrine levels, and daytime diastolic blood pressure in women with PCOS and OSA, with greater magnitude of improvement with longer hours of PAP use.

References:

1. http://pcosdiva.com/2012/07/pcos-is-a-snore/

2. http://medicine.yale.edu/intmed/pulmonary/clinical/wsh-program/Conditions_Treatments/WSHP_Sleep_disorders_in_PCOS.aspx

3. http://www.uchospitals.edu/news/2010/20101004-sleep-dieting.html

4. http://archinte.jamanetwork.com/article.aspx?articleid=486518

5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1991337/

6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256323/

7. Endocrine Society, “Sleep Apnea With Polycystic Ovary Syndrome Raises Risk of Prediabetes,” 6/26/2012

8. Tasali E, Chapotot F, Leproult R, Whitmore H, Ehrmann DA. Treatment of obstructive sleep apnea improves cardiometabolic function in young obese women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2011 Feb;96(2):365-74. Epub 2010 Dec 1.

9. Nitsche K, Ehrmann DA. Obstructive sleep apnea and metabolic dysfunction in polycystic ovary syndrome. Best Pract Res Clin Endocrinol Metab. 2010 Oct;24(5):717-30.

10. Tasali E, Van Cauter E, Ehrmann DA. Polycystic Ovary Syndrome and Obstructive Sleep Apnea. Sleep Med Clin. 2008 Mar;3(1):37-46.