Sleep dysfunction in women and its management

Sleep Quality and Health-Related Quality of Life in Pregnancy

The aim of this study was to investigate sleep quality and health-related quality of life in pregnancy. In a cross-sectional design, 492 women (292 pregnant and 200 nonpregnant healthy controls) were included in this study between November 2014 and June 2015. Participants completed a survey on sociodemographic characteristics, the Pittsburgh Sleep Quality Index (PSQI), and the European Quality of Life-5 Dimensions (EQ-5D). The PSQI total and EQ-5D scores of pregnant women were significantly worse than the controls (P = .017 and P < .001, respectively). Linear regression analysis showed that only pregnancy status was related to PSQI scores (β = .117; P = .009). Compared with the first trimester, the risk of poor sleep quality increased 2.11-fold in the second trimester (P = .048) and 1.86-fold in the third trimester (P = .054). Compared with the first trimester, EQ-5D scores significantly decreased in the second (P = .038) and third (P < .001) trimesters. Sleep quality and health-related quality of life of pregnant women were worse than those of nonpregnant healthy controls. Healthcare professionals need to be aware of deteriorations in sleep quality and health-related quality of life of pregnant women.

Sleep disorders in pregnancy

Sleep disturbances are common in pregnancy and may be influenced by a multitude of factors. Pregnancy physiology may predispose to sleep disruption but may also result in worsening of some underlying sleep disorders, and the de novo development of others. Apart from sleep disordered breathing, the impact of sleep disorders on pregnancy, fetal, and neonatal outcomes is poorly understood. In this article, we review the literature and discuss available data pertaining to the most common sleep disorders in perinatal women. These include restless legs syndrome, insomnia, circadian pattern disturbances, narcolepsy, and sleep-disordered breathing.

Severe Fatigue and Depressive Symptoms in Lower-Income Urban Postpartum Women

The purpose of this study was to identify whether severe postpartum fatigue at 1 and 3 months postpartum was associated with depressive symptomatology at 6 months in lower-income urban women. A convenience sample of 43 lower-income postpartum women completed the Modified Fatigue Symptoms Checklist and Edinburgh Postpartum Depression scale at 1, 3, and 6 months postpartum. Participants who were severely fatigued at both 1 and 3 months postpartum were significantly more likely to exhibit depressive symptomatology at 6 months. Fatigue and depressive symptoms were moderately to strongly correlated at 1 ( r = .68), 3 ( r = .74), and 6 ( r = .70) months postpartum ( p = .001). Severe fatigue and depressive symptomatology often co-exist for months after childbirth. Future research should examine whether interventions to targeting severe postpartum fatigue in lower-income urban women may also effectively reduce depressive symptoms.

Sleep characteristics in hospitalized antepartum patients

OBJECTIVE

To describe sleep characteristics in high-risk antepartum inpatients.

DESIGN

Prospective descriptive design.

SETTING

Tertiary hospital in southern California.

PARTICIPANTS

A convenience sample of 39 antepartum women.

METHODS

Data were collected from participants' medical records, questionnaires (General Sleep Disturbance Scale), actigraphy on days 3 to 4 after admission, and a sleep diary that included reasons for awakening and morning and evening fatigue ratings.

RESULTS

Week gestation ranged from 24 to 35 weeks. Sleep time varied from 310 to 492 minutes and averaged 6.7 hours/night. The women were awakened 9 to 32 times/night and averaged 18 awakenings. They napped an average of 124 minutes throughout the day. Women averaged 3.9 on the General Sleep Disturbance Scale when retrospectively considering 7 days before hospitalization and scored 4.1 when considering the current 3 days of hospitalization. In the diary, most rated their sleep quality as Fairly Good or Very Good (62%-71%), but 29% said Very Bad on night 2, and 38% said Very Bad on night 3.

CONCLUSION

Frequent interruptions during the night do not allow for mothers to receive the restorative sleep they need.

Sleep disturbances in women with HIV or AIDS: efficacy of a tailored sleep promotion intervention

BACKGROUND

Poor sleep is a frequent complaint of persons with HIV infection.

OBJECTIVES

To pilot test a tailored sleep promotion intervention protocol based on principles of sleep hygiene in a convenience sample of 30 HIV seropositive women.

METHODS

At baseline and 1 week after implementing the intervention, sleep was assessed by self-report measures and wrist actigraphy. Objective sleep measures include total sleep time, number of awakenings, and sleep efficiency, as well as level of daytime activity, 24-hr activity rhythm, and amount of sleep during the day.

RESULTS

Prior to the intervention, women averaged 6.4 hr (SD = 1.99) of sleep, and 67% (n = 20) of the sample napped more than 30 min per day. After allowing 1 week to implement sleep hygiene principles to promote healthy sleep behaviors, there was a significant improvement in their perception of sleep and a significant change in their 24-hr activity rhythm. This involved more activity and less napping during the day.

DISCUSSION

Although there was minimal change in objective measures of nighttime sleep for the group as a whole, those with initiation insomnia and maintenance insomnia benefited most from the intervention. These findings support the utility of a tailored sleep promotion intervention for women who are HIV positive to address their unique form of sleep disturbance.

A depressive symptoms responsiveness model for differentiating fatigue from depression in the postpartum period

Fatigue is both a symptom and a predictor of depression in women after childbirth. At the same time, postpartum fatigue is experienced by most non-depressed women. Health care providers experientially know that not all women who experience postpartum fatigue will manifest depression. However, while researchers agree that fatigue and depression are distinct concepts, they have not yet identified a means for describing or measuring this distinctness. A new model proposing how fatigue may be differentiated from depression after childbirth is presented. The Depressive Symptoms Responsiveness Model proposes that depression-related postpartum fatigue may potentially be differentiated from non-depression-related postpartum fatigue on the basis of whether depressive symptoms abate when fatigue is relieved. The ability to differentiate between fatigue and depression in postpartum women has the potential to improve women's health through improvements in practice and resource utilization. Furthermore, differentiation may lead to a better understanding of the role of fatigue in postpartum depression.