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Presentaties ISMC - Sleep gender and age

Q: What are the key stages affecting sleep during development?

Adolescence : Anxiety and depression can impact sleep patterns. Pregnancy : Hormonal changes often disrupt sleep. Peri-menopause : Sleep disturbances are common due to hormonal fluctuations.

Q: What factors contribute to menopause transition sleep and depression?

Hormonal Instability leads to hot flashes. Hot Flashes cause sleep disturbance. Sleep Disturbance contributes to depression. Context-related Life Stressors also affect depression.

Q: How may lowered estrogen during peri-menopause contribute to depression?

Lowered estrogens contribute to depression: Directly via biochemical effects in the brain. Indirectly through climacteric vasomotor symptoms.

Q: What are the most common menopausal complaints according to Whiteley et al, J Womens Health 2013?

Hot flashes: Most common. Night sweats: Frequently reported. Insomnia: Affects many. Other complaints: Include forgetfulness, mood changes, loss of libido, joint pain, anxiety, vaginal dryness, urine leakage, depression, heart racing or pounding.

Q: What is the relationship between sleep disorders, mental disorders, and mood symptoms?

Sleep disorders are linked to: Mental disorders Mood symptoms Mental health problems are a significant factor for various sleep problems.

Q: What are the hormone level changes during reproductive years, perimenopause, and postmenopause?

Reproductive Years (Age 13-45) Follicular Phase: Rising hormones. Ovulation: Peak hormone levels. Luteal Phase: Decline in hormones. Perimenopause (Age 45-50) Early: Fluctuating hormone levels. Late: Gradual decline. Postmenopause (Age 51+) Hormones stabilize at low levels.

63 important questions on Presentaties ISMC - Sleep gender and age

What are the key stages affecting sleep during development?

Adolescence: Anxiety and depression can impact sleep patterns.
Pregnancy: Hormonal changes often disrupt sleep.
Peri-menopause: Sleep disturbances are common due to hormonal fluctuations.

What are the characteristics and risk factors of SDB during menopause?

Often underdiagnosed and interpreted as climacteric symptoms.
Increase in SDB due to:
1. Less respiratory drive
2. Increased arousals
3. Upper airway collapse
4. Weight gain
Vasomotor symptoms are an independent risk factor for OSA.
MHT is not effective for SDB.

How does MHT affect sleep disorders in menopause?

MHT improves self-reported sleep quality.
Effective regardless of dose, administration route, or duration.
Benefits vasomotor issues, mental problems, and RLS.
Possible direct effect on the central nervous system.
Treatment options: good sleep hygiene, MHT, SSRIs, melatonin.

What factors contribute to menopause transition sleep and depression?

Hormonal Instability leads to hot flashes.
Hot Flashes cause sleep disturbance.
Sleep Disturbance contributes to depression.
Context-related Life Stressors also affect depression.

How may lowered estrogen during peri-menopause contribute to depression?

Lowered estrogens contribute to depression:
- Directly via biochemical effects in the brain.
- Indirectly through climacteric vasomotor symptoms.

What are the most common menopausal complaints according to Whiteley et al, J Womens Health 2013?

Hot flashes: Most common.
Night sweats: Frequently reported.
Insomnia: Affects many.
Other complaints: Include forgetfulness, mood changes, loss of libido, joint pain, anxiety, vaginal dryness, urine leakage, depression, heart racing or pounding.

What is the relationship between sleep disorders, mental disorders, and mood symptoms?

Sleep disorders are linked to:
- Mental disorders
- Mood symptoms
Mental health problems are a significant factor for various sleep problems.

What are the hormone level changes during reproductive years, perimenopause, and postmenopause?

Reproductive Years (Age 13-45)
- Follicular Phase: Rising hormones.
- Ovulation: Peak hormone levels.
- Luteal Phase: Decline in hormones.
Perimenopause (Age 45-50)
- Early: Fluctuating hormone levels.
- Late: Gradual decline.
Postmenopause (Age 51+)
- Hormones stabilize at low levels.

What are the characteristics and treatments of nocturnal movements disorders?

RL and PLMS are more common in females and increase with age.
Symptoms: arousals, insomnia, leg cramps, daytime sleepiness.
Occurs 2-3 times more in pregnancy.
Linked to iron and folate deficiency.
Risk factors: smoking, alcohol, caffeine, medications, sleep deprivation.
Treatments:
- Iron and folate suppletion (with Vitamin C for absorption).
- Relaxation techniques, reducing caffeine, sufficient sleep.
- Dopaminergic medications, opiate, benzodiazepines (not in pregnancy).

What are the effects of very low AHI in pregnancy?

Very low AHI negatively impacts foetal outcomes.
Increases pregnancy complications.

What factors are protective against SDB during pregnancy?

Increased ventilation.
Lateral sleeping position.
Decreased REM sleep.

What are the treatment recommendations during pregnancy and postpartum?

During pregnancy and postpartum, consider the following:

Avoid risks for complications and preterm delivery.
Practice sleep hygiene and lifestyle advice.
Limit evening drinks to reduce nocturia.
Use dietary interventions for heartburn.
Consider CBTi (Cognitive Behavioral Therapy for insomnia).
Safely use antihistamines and certain antidepressants (amitriptyline or mirtazapine).
Avoid benzodiazepines and melatonin due to risks like floppy infant syndrome and respiratory problems.

What are the risk factors for SDB in pregnancy?

Gestational weight gain.
Decreased lung reserve capacity.
Increased arousals during sleep.

What is the prevalence and most common type of sleep disorder in pregnancy and postpartum?

Prevalence is 10-15%.
Insomnia is the most common disorder.
Nocturia causes more awakenings.
Other causes: nausea, leg cramps, joint pain, anxiety, snoring.

How does progesterone affect airway collapse in pregnancy?

Progesterone has a sedative effect.
More airway collapse occurs.

What are the characteristics of postpartum sleep patterns?

Lower sleep efficiency
Decreased total sleep time
Lengthened WASO (Wake After Sleep Onset)
Breastfeeding not often controlled in studies
Breastfeeding increases SWS and lowers NREM sleep

What factors contribute to sleep disturbances later in pregnancy?

Gastro-oesophageal reflux and fetal movements.
Onset of snoring.
Restless legs syndrome.

What role do estrogens play in SDB during pregnancy?

Upregulate progesterone receptors.
Increase mucus secretion.
Heighten upper airway resistance.

What are the implications of sleep disorders in pregnancy?

Often underdiagnosed.
Risk to mother's health and prenatal outcomes.
Chronic sleep problems.
Hormonal changes: 100x estrogen, 10x progesterone.
Major life situation changes.

How do sleep problems differ in first-time mothers and after a C-section?

More common in first-time mothers.
More after a C-section.
Problems continue up to 3 months postpartum.

What does the graph in "Oral contraception" illustrate about hormone levels?

Graph A shows fluctuating hormone levels over 28 days.
Graph B illustrates consistent hormone levels with oral contraception over 28 days.

How does pregnancy affect sleep architecture?

Decreased sleep efficiency from the 1st trimester.
U-shaped pattern, improving in the 3rd trimester.
Longer sleep latency.
Increased WASO.
Reduced REM sleep, increased stage 1 sleep.

What are the recommended treatments for SDB in pregnancy?

Nasal CPAP is safe and effective.
Positional lateral sleep posture.
Nasal corticosteroids reduce nasal mucosal oedema.

Which interventions are not recommended for SDB treatment during pregnancy?

Weight loss is not advised.
Surgery is not recommended.

What are the characteristics and risks associated with Polycystic Ovary Syndrome?

Prevalence: 4-21%
Elevated androgen levels
Low progesterone levels
Insulin resistance
Sleep issues: insomnia, restless sleep, daytime tiredness
SDB risk: 5-10x higher
Prevention: early lifestyle interventions

How does primary dysmenorrhea affect sleep in menstruating women, and what is a potential treatment?

Primary dysmenorrhea causes pain, affecting sleep and leading to more pain.
Treatment involves anti-inflammatory drugs to alleviate symptoms.

What happens during the follicular phase of the menstrual cycle?

Days: 1 to 14
Hormones: FSH and estrogen rise
Basal Body Temperature: Low
Ovarian Cycle: Follicle development
Uterine Cycle: Menses and proliferative phases

What are the sleep-related effects and treatment options for premenstrual syndrome in menstruating women?

Affects 18% of women; PMDD is less common.
Increased sensitivity to sex hormonal changes.
Reports of insomnia, hypersomnia, and unpleasant dreams.
Hormones involved: serotonin, allopregnanolone, and melatonine.
Treatment includes low-dose SSRI for 14 days/continuous, contraceptives, and light therapy.

What are some mechanisms that make sleep-disordered breathing (SDB) different in women?

Insomnia-like symptoms and cardiovascular comorbidity link to nocturnal hypoxaemia.
Higher proportion of REM-related AHI affects hypertension and glucose metabolism.
Body fat distribution is more favorable in women.
Upper airways are stable during sleep but influenced by luteal phase progesterone.

What are the characteristics of the luteal phase in the menstrual cycle?

Days: 14 to 28
Hormones: LH and progesterone peak
Basal Body Temperature: High
Ovarian Cycle: Ovulation occurs
Uterine Cycle: Secretory phase

What are the differences in OSAS symptoms between men and women?

Men:
- Loud snoring
- Breathing pauses
- Gasping and choking during sleep
- Excessive daytime sleepiness
Women:
- Less snoring, nocturnal apneas
- Insomnia, nocturia, night sweats
- Fatigue, morning headache
- Mood disturbance, restless legs

Describe the hormone levels throughout the menstrual cycle.

FSH: Rises in follicular phase
LH: Peaks at ovulation
Estrogen: Increases before ovulation
Progesterone: Peaks after ovulation

What factors influence sleep-disordered breathing (SDB) in men and women?

SDB occurs twice as often in men than women.
Women typically receive diagnosis later, often linked to high BMI.
PCOS, gestational diabetes, and pre-eclampsia are SDB risk factors in women.

How does upper airway obstruction affect women with OSAS?

Leads to increased CO2 during sleep
Causes EEG slowing
Women have lower AHI but more systemic inflammation
CPAP treatment for symptomatic women with low AHI corrects EEG slowing

How does the uterine lining change during the menstrual cycle?

Menses: Shedding of lining
Proliferative Phase: Lining thickens
Secretory Phase: Thickened, enriched lining ready for potential pregnancy

What concepts are shown in the illustration regarding gender differences in brain functioning?

Male Brain:
- Fishing and snails
- Sport
- Analytic
- Visual
- Aggression
- Ego
- Nature
Female Brain:
- Sugar and spice
- Selfless
- Compassion
- Attention
- Ego
- Nurture

What are the AHI ratings for sleep apnea severity?

Normal: AHI < 5
Mild Sleep Apnea: AHI 5-15
Moderate Sleep Apnea: AHI 15-30
Severe Sleep Apnea: AHI > 30

Where are estrogen receptors predominantly found in the brain?

Estrogen receptors are prevalent in regions like:
- Cerebellum
- Ventral tegmental area (VTA)
- Hippocampus
- Amygdala
- Frontal cortex
- Raphe nuclei of the midbrain

What factors are involved in sleep and gender differences according to Chapter 9?

Insomnia is nearly twice as high in women than men.
Mood disorders play a role.
Sex hormones influence sleep differences.
Early programming affects sleep.
Other hormones also contribute.

How do estrogen-alpha and estrogen-beta receptors differ in distribution?

Greater concentration of estrogen-alpha receptors in:
- Amygdala
- Hypothalamus
Estrogen-beta receptors dominate in the:
- Hippocampus

What is the title of the presentation?

Title: Sleep and Gender

Where is there more equal representation of estrogen receptors?

Equal representation occurs in:
- Thalamus
- Cerebellum

What hormones are involved in the male Hypothalamic-Pituitary-Gonadal (HPG) axis?

Hypothalamus: Releases GnRH (Gonadotropin-releasing hormone)
Pituitary Gland: Secretes LH (Luteinizing hormone) and FSH (Follicle-stimulating hormone)
Testes: Produces testosterone

What are the gender differences in sleep during the reproductive age?

Women experience:
- More SWS (Slow Wave Sleep)
- Higher spindle density and amplitude of fast spindles
- Higher melatonin rhythm
- Delayed biological time of sleep, leading to more insomnia
Men experience:
- More sleep stage 1
- Lower spindle density and amplitude
- Lower melatonin rhythm
- Less insomnia

How does the Hypothalamic-Pituitary-Gonadal (HPG) axis function in relation to catecholamines and endorphins?

Catecholamines: Influence GnRH release
Endorphins: Modulate pituitary gland response
Prolactin, Estrogen, Progesterone, Inhibin: Involved in feedback regulation

What are the changes in sleep regulation from neonates to infancy?

Light exposure influences the supraciasmatic nucleus.
Circadian timing becomes stable from 6 months of age.
These developments occur as infants grow from neonates to infants.

What are the differences in stress related to disorders shown?

Neuro-endocrine responses are related to stress.
Health risks include:
1. Depression
2. Hypertension
3. Diabetes
4. Obesity
Additional factor: Sleep disordered breathing

How does adolescence affect sleep patterns according to the diagram?

Later Circadian Melatonin Phase: Shift occurs during adolescence.
Evening Alertness: Increases, causing sleep onset insomnia if sleeping early.
Morning Sleepiness: Greater difficulty waking in the morning.
Delayed Sleep Time: Reduces sleep duration during school/work weeks.

What factors contribute to more reported sleep problems in females than males?

Menstrual cycle effects.
Higher prevalence of depression and anxiety in women.
Lower socio-economic status can impact sleep issues.

What is the difference between continuous and discontinuous EEG in neonates to infants?

Continuous EEG:
- Steady amplitude
Discontinuous EEG:
- Alternates between "on" periods (BURSTS) and "off" periods (INTERBURSTS)
- Interburst interval (IBI): discontinuous portion of the EEG

What changes occur in sleep patterns later in adult life?

Further decrease in TST (Total Sleep Time)
Increase in sleep latency
Decreased sleep efficiency
More fragmented sleep
Shift to superficial sleep (N1, N2) from deep sleep (N3)

What are some key aspects of sleep in childhood?

Napping decreases.
Total Sleep Time (TST) decreases to 10 hours at ages 6-10.
Sleep efficiency increases.
nonREM/REM cycle duration increases from 40 min (age 2) to 60 min (age 5), reaching 90-110 min in adults.
Night awakenings in toddlers/preschoolers are due to circadian rhythm development.
Maximal power in faster frequency bands (theta, alpha, beta).
Power in SWA frequency increases between ages 8-11.

How does sleep architecture change in older adults?

Increase in superficial sleep (N1 and N2)
Decrease in deep sleep (N3)
Spindles and K-complexes become less numerous
Slowed spindle frequency

What are the additional factors affecting sleep in aging?

Retirement: Alters daily routine.
Increased daytime naps: Reduces night sleep need.
Reduced physical and mental activities: Decreases sleep need at night.

What circadian changes occur in sleep later in life?

Altered circadian regulation
Earlier wake-up and sleep times
Phase advance of +1 hour
Reduced melatonin secretion
REM shifts to earlier night-time sleep

What are the changes in adult sleep and EEG power with aging?

Decreased quantity and quality of sleep.
Increased sleep disorders: insomnia, sleep apnea, periodic leg movements, depression.
Associations: reduced SWA, cortical atrophy, impaired memory.

How does poorer eyesight affect sleep in the elderly?

Reduces exposure to the light-dark cycle.
Cataracts: Lead to less blue light exposure, affecting circadian rhythms and sleep patterns.

What are the circadian and homeostatic changes of sleep during adolescence?

SWS decreases; REM and NonREM reach adult levels.
SWA shows a 65% reduction, reflecting brain maturation.
Processes include synaptic pruning and refinement.
SWA shifts posterior-anterior.

How do neurodegenerative disorders relate to sleep disturbances?

Neurodegenerative disorders can lead to disturbance in sleep patterns.
Disturbed sleep further exacerbates neurodegenerative disorders, creating a cycle.

What changes occur in sleep regulation from neonates to infancy?

Homeostatic process undergoes developmental changes.
In neonates, sleep deprivation increases NREM duration; SWS starts at 2 months.
In adults, sleep pressure shows as intensified or "recovery sleep."
In infants, sleep pressure accumulates faster, leading to irritability.

What are the key changes in sleep regulation from neonates to infancy regarding circadian rhythm and sleep processes?

Newborns lack a circadian rhythm related to day-night cycles.
Sleep timing/intensity is regulated by:
1. Process S: Homeostatic process; increases during wakefulness, declines during sleep.
2. Process C: Endogenously driven circadian rhythm of 24 hours.

What are the types of sleep observed in infancy and what are their characteristics?

Quiet sleep (QS): nonREM sleep
Active sleep (AS): REM sleep
Intermittent sleep (IS): Transitions between QS and AS, disappears at 6 months

How does total sleep time change from neonatal to infancy sleep, and what sequences develop?

Total sleep time decreases from 16 to 13 hours
Alternation of NREM and REM establishes ultradian rhythm: 40-50 min in infancy
Sleep spindles and K-complexes appear in N2

The question on the page originate from the summary of the following study material:

Sleep Medicine Textbook | 9781119789017 | Claudio Basseti, et al

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