Sleep Disorders in Women by Hrayr P. Attarian & Mari Viola-Saltzman

Author:Hrayr P. Attarian & Mari Viola-Saltzman
Language: eng
Format: epub
Publisher: Humana Press, Totowa, NJ

Note: In the previous edition of this book, the chapter on this subject was authored by Hrayr Attarian, MD

Introduction

This chapter discusses excessive daytime sleepiness (EDS) due to primary sleep disorders other than Obstructive Sleep Apnea Syndrome (OSAS) and Restless Legs Syndrome (RLS) including Narcolepsy, Recurrent Hypersomnia, Idiopathic Hypersomnia, Behaviorally Induced Insufficient Sleep Syndrome as well as Hypersomnia Due to Medical condition and Hypersomnia Due to Drug or Substance.

Several studies over the years have demonstrated that sleep complaints in general, and EDS in particular, tend to be more prevalent among women. The 2007 Sleep in America poll of women age 40–60 years old found that 20% reported sleepiness that interfered with daily life [1]. There has been some evidence to suggest that this is, at least partly, due to women being more sleep deprived [2]. A study of Japanese workers demonstrated that women with a family to care for were more likely to suffer from EDS than those without a family to care for or those living alone, while having a family was protective against sleep deprivation in men [3]. This suggests that one of the causes of more prevalent insufficient sleep in women is more extensive work and homecare responsibilities [3]. However, having children did not increase the risk of hypersomnolence in a cross-sectional population study of 5,508 women in Sweden. This study found that 16.1% reported daytime hypersomnolence, that the risk of hypersomnolence decreased with increasing age and that anxiety and depression were highly related to hypersomnolence [4]. Women also nap less during the day than men do, despite having similar total sleep time at night and similar sleep efficiency [5], thus curtailing their total sleep time. Another variable that may partially contribute to the higher prevalence of excessive sleepiness in women is the under-diagnosis of most sleep disorders in women.

One of the tools most commonly used to screen for excessive sleepiness, and therefore sleep disorders, is the Epworth Sleepiness (ESS) Scale (Table 12.1). This is a simple, self-administered questionnaire, which is shown to provide a measurement of the subject’s general level of daytime sleepiness. Patients rate the chances that they would doze off or fall asleep when in eight different situations commonly encountered in daily life [6]. One study demonstrated that using the ESS to detect subjective sleepiness is more likely to identify men with sleepiness. Since the ESS is more strongly related to other subjective measures in men, the ESS may be a more sensitive measure of subjective sleepiness in men than in women. Findings indicate that men and women answer questions on sleepiness differently [7]. A recent study of older black and white women found that the ESS was an internally consistent, valid measure of self-reported sleep problems in older women [8]. A third factor is hormonal changes and their impact on sleep in women. This gender difference in the prevalence of the EDS is not present among prepubertal children [9] and seems to be consistently reported in adults. Problems with sleep including hypersomnolence are common

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