Polycystic ovary syndrome (PCOS) is a complex condition, or group of physical symptoms, in which women experience infrequent menstruation, weight gain, acne, abnormal hair growth and fertility problems.
“Women with PCOS are at risk for other, related life-long conditions and symptoms including diabetes, high cholesterol, hypertension,” says Anuja Dokras, MD, PhD, director of the Penn Polycystic Ovary Syndrome Center. “They are also at risk for sleep apnea.”
Sleep apnea is a respiratory disorder in which a person experiences pauses in breathing. Pauses can last from a few seconds to a minute, and can occur multiple times throughout the night. “Sleep apnea presents itself as snoring, pauses in breathing followed by a gasp for breath and frequent, disturbed sleep,” says Dr. Dokras. “A partner or spouse may tell the person with sleep apnea this is occurring, or in some cases, the person with sleep apnea wakes themselves up during the night.” Snoring itself isn’t serious, but if a person is experiencing snoring with sleep apnea, the situation can have serious complications.
“For women with PCOS, sleep apnea can exacerbate other PCOS symptoms such as tiredness, difficulty losing weight, hypertension and insulin resistance,” says Dr. Dokras. “Of course, many women report feeling tired, but some also say they feel depressed and experience unexplained moodiness.”
Diagnosing Sleep Apnea
Allan Pack, MD, PhD, chief of the division of sleep medicine and director of the Center for Sleep and Circadian Neurobiology at Penn says sleep apnea often goes undiagnosed.
“There are two different ways we can diagnose sleep apnea,” he explains. “A sleep study in a sleep lab that resembles a hotel room requires patients be hooked up to wires throughout the night. An electroencephalogram, or EEG, monitors brain activity throughout the night to determine how well an individual is sleeping, while patients are watched using respiratory monitors to see if there are pauses in their breathing as they sleep”. Dr. Pack explains “at-home” sleep studies are also an option for some patients.
“For patients without a lot of other health conditions, an ‘at-home’ sleep study can monitor sleep, and pauses in breathing,” he says. “The only difference is that an EEG study is not done in the home.”
Treatments for Women with PCOS and Sleep Apnea
Treatment for PCOS includes medication, nutritional counseling and weight loss. “Weight loss can help improve sleep apnea, but treatment for sleep apnea itself can have a marked improvement on a woman’s life,” says Dr. Dokras.
Dr. Pack says most patients can use a continuous positive airway pressure machine, or CPAP machine, to help regulate breathing throughout the night.
“A CPAP machine uses a mask with pressurized air to force the airways in the mouth and neck to remain open while the person is lying down and asleep,” says Dr. Pack. “A CPAP machine is very effective. Patients who use it report having more energy throughout the day, and less drowsiness.”
There is also a small amount of evidence that suggests use of a CPAP machine can help other metabolic functions in women with PCOS such as insulin resistance, high blood pressure and high cholesterol. For those who cannot tolerate wearing a CPAP mask throughout the night, an oral device that pulls the jaw forward may be an option for treatment.
For those who cannot tolerate wearing a CPAP mask throughout the night, an oral device that pulls the jaw forward may be an option for treatment.
"We are learning more and more that restful, healthy sleep is important for every other body function," says Dr. Dokras. "That's why it's so important women with PCOS talk to their physician about their sleep, and if they are experiencing any symptoms of sleep apnea."