Sleep Disturbances Across a Woman's Lifespan: What Is the Role of Reproductive Hormones?

Abstract

Fluctuations of reproductive hormones are associated with various forms of sleep disturbances and specific sleep disorders, e.g. insomnia or sleep-disordered breathing, across different stages of reproductive ageing. During the menstrual cycle, sleep is particularly disrupted during the late luteal phase as demonstrated by both objective and subjective measurements of sleep. Progesterone and its metabolites generally have sleep promoting effects. A steep decline in progesterone, e.g. during the late luteal phase, is associated with sleep disruption. Endogenous estrogen shows no clear correlation with sleep alterations in relation to the menstrual cycle. During pregnancy, sleep disruption is not associated with changes in estrogen or progesterone but rather with changing physiological factors, e.g. nocturnal micturition, gastroesophageal reflux or musculoskeletal discomfort, all substantial factors that most likely mask any effect of hormones. Both endogenous and exogenous estrogen, as well as progesterone, are positively associated with sleep during the menopausal transition. A marked improvement of sleep disturbances is observed with perimenopausal hormone therapy. As this effect is not seen in younger women receiving contraceptive therapy, other causes of sleep disturbances, e.g. ageing and related changes in metabolism of stress hormones, secondary effects of vasomotor symptoms or depression, must be considered. Gonadotropins are less associated with sleep disturbances than ovarian hormones, except for during the menopausal transition where follicle-stimulating hormone (FSH) is related to sleep disruption. Further, hyperandrogenism, as seen in women with polycystic ovary syndrome (PCOS), is associated with sleep disturbances and specific sleep disorders, e.g. obstructive sleep apnea (OSA).