PCOS and Sleep Apnea: causes, diagnosis, treatment

Polycystic ovarian syndrome (PCOS) is one of the most common hormonal disorders in women worldwide, affecting up to 13% of women of reproductive age. Caused by an excess of androgen hormones, PCOS usually presents with symptoms like irregular periods, painful periods, PCOS related excessive hair growth on the face and body, acne and weight gain. It is strongly associated with several metabolic disorders like insulin resistance, type 2 diabetes, hypertension, dyslipidemia and obesity as well as mood disorders and an impeded quality of life.

Research published in the European Journal of Endocrinology also suggests that women who have PCOS are more likely to suffer from sleep apnea than women who don't have this condition. This may be due to the fact that it is harder for women with PCOS to lose weight, and obesity and sleep apnea have a close connection.

Sleep apnea is a breathing disorder in which the patient's breathing stops and starts several times during sleep. This can happen for one of three reasons:

Our brain sends signals to our breathing muscles to do their job. When these signals are interrupted a few times during the night, this is known as central sleep apnea.
When the throat muscles relax during sleep and obstruct the upper airways, this is known as obstructive sleep apnea.
A mix of central and obstructive sleep apnea is known as complex sleep apnea.

People with sleep apnea tend to snore and wake up several times during the night. This loss of sleep, in turn, may lead to further health problems such as unwanted weight gain.

PCOS sleep issues: causes and risk factors
PCOS sleep apnea diagnosis
Treatment of PCOS with sleep apnea

Doctors for PCOS and Sleep Apnea

PCOS sleep issues: causes and risk factors

Sleep is essential to our well-being. Adults need at least seven to eight hours of sleep daily to function normally. However, people with sleep apnea wake up several times during the night, as their breathing stops and starts again.

Indeed, snoring and feeling fatigued despite spending seven to eight hours in bed at night are common signs of sleep apnea.

Here's why people with PCOS often have sleep issues:

Obesity: Surveys show that eight in 10 women with PCOS are overweight or obese. Research also shows that anywhere between 40% and 90% of severely obese people (with a body mass index over 40) have obstructive sleep apnea.
In fact, doctors recommend weight loss for women with PCOS as it reduces many of the symptoms and discomforts of PCOS.

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Age: If you already have PCOS, then your risk of having both - PCOS and sleep apnea - together increases with age as the muscles of the tongue, throat and respiratory tract weaken.
Insulin resistance: According to one estimate, 69% of women who have PCOS have insulin resistance. This means that the cells in their body don’t respond to insulin in the way they’re supposed to and this prompts the body to produce even more insulin. Insulin is the hormone that maintains blood sugar levels in our body. Studies show that excess insulin in the body leads to weight gain and obesity, which in turn increases the chances of sleep apnea.

Sleep deprivation can increase the risk of many chronic conditions such as diabetes and obesity as well. And since obesity increases the risk of sleep apnea, it becomes a vicious cycle that is hard to break out of.

Sleep apnea is a type of respiratory disorder in which the patient stops breathing for a few seconds up to a few minutes, several times during the night. Women who have PCOS and are overweight are at a higher risk of developing sleep apnea. In addition to this, advancing age and chronic diseases such as insulin resistance and high blood pressure increase the risk of sleep apnea in PCOS.

While having PCOS can increase ones risk for sleep apnea, there have also been cases where sleep apnea has preceded PCOS in women. Another important thing to consider while suffering from both sleep apnea and PCOS is that sleep apnea can aggravate the symptoms of PCOS like insulin resistance, hypertension, difficulty in losing weight and tiredness.

If you are overweight, tired despite devoting enough time for sleep and you have PCOS, you should get tested for sleep apnea.

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PCOS sleep apnea diagnosis

Sleep apnea can be diagnosed by taking a record of the sleeping patterns of the patient. There are two methods for recording sleeping pattern:

The more accurate method is to use an electroencephalogram to record the electrical activity of the brain during sleep and attach respiratory monitors to the body to record breathing patterns. Typically this is only possible in a sleep lab.
If the patient is unable to stay in a sleep lab, a sleep study can also be performed at home: your partner can give a general idea of whether you snore and how many times you wake up during the night. Your doctor may also ask you if you feel tired soon after you wake up in the morning. Several wearable devices also monitor sleep duration and quality - though they are not as effective as sleep lab equipment. A combination of these may be used by your doctor to confirm the diagnosis.
Do let your doctor know if you have been diagnosed with PCOS or if your periods are irregular and/or painful in addition to the sleep problems.

Treatment of PCOS with sleep apnea

PCOS is a syndrome - it causes a set of health issues like hormonal imbalance, ovarian dysfunction, obesity, menstrual irregularity and hirsutism. All of this is managed through medicines, diet and weight loss.

When PCOS is accompanied by sleep apnea, management of sleep apnea becomes important too. For this, the first line of action is to lose weight.

Patients may also be asked to use a continuous positive airway pressure (CPAP) machine to assist in proper sleep. The CPAP machine includes a mask that fills up with air under pressure - this continuously forces the air into the patient's mouth while she sleeps.

If the patient is unable to use a CPAP machine for any reason, another oral device is used to pull the jaw forward - this provides an unobstructed pathway for the air.