ABSTRACT
The timing and continuity of sleep in healthy individuals is regulated by the synchronous
function of the sleep homeostasis and the endogenous circadian rhythms. Multiple factors
affect these two processes and the way they interact. Sleep disorders may manifest
differently in men and women and these differences are particularly notable during
pregnancy, lactation, and menopause. Insomnia may occur relatively commonly during
pregnancy and in the postpartum, and may be the result of either a primary sleep disorder,
such as obstructive sleep apnea (OSA), movement disorders such as restless legs syndrome
(RLS), or sometimes depression, especially in the postpartum period. Obstructive sleep
apnea may contribute to a higher risk of hypertension during pregnancy and doubles
the risk for preeclampsia and preterm birth. Snoring, a frequent symptom of OSA, increases
in frequency during pregnancy. Restless legs syndrome is more common in pregnant women,
is more frequent in the third trimester of pregnancy, and tends to improve dramatically
after delivery. Factors associated with increased RLS in pregnancy may be related
to iron and folate metabolism. Risk for OSA increases after menopause and presentation
with insomnia can delay the diagnosis of OSA. Various treatment options for sleep
disorders in women are discussed.
KEYWORDS
Sleep - pregnant - women - biologic rhythms
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Milena PavlovaM.D.
Faulkner Department of Neurology, Brigham and Women's–Faulkner Hospital
Harvard Medical School, 1153 Centre Street, Suite 4970, Boston, MA 02130
Email: Mpavlova1@partners.org