PCOS and sleep

One of the really unfortunate symptoms of PCOS is disturbed sleep. It’s not bad enough that you have to deal with all the hormonal and metabolic issues related to PCOS, in many cases you’ve also got to do it exhausted.

Obstructive sleep apnoea is common in PCOS sufferers. If you suffer from sleep apnoea (known as apnea in the USA), you may not actually know you have it because you will be tired but you won’t know that you stop breathing. A lot of the time it’s diagnosed because it’s been brought to your attention by a partner or someone who has stayed overnight with you and heard you stop breathing. To the best of my knowledge, it’s not exactly clear what the link is between PCOS and sleep apnoea, although it has been proven in the past that apnoea is linked to being overweight and may also be hereditary. A study from 2001 directly linked the occurrence of sleep apnoea with insulin resistance, but it was a small clinical sample of only 53 patients. Another potential avenue of causation is the chronic inflammation in PCOS sufferers. A study from 1997 linked systemic inflammation with excessive daytime sleepiness and sleep disordered breathing, but again it was a small study group. The good news is that a respiratory or sleep specialist can diagnose it fairly easily with an overnight sleep study and it can be treated by wearing a mask at night that maintains a positive air pressure in your airways and keeps them open.

There’s also a link between PCOS and insomnia, although the mechanism of this is also unclear. There have been studies showing that elevated night-time levels of urinary melatonin levels occur in women with PCOS, although the study group was fairly small and this needs to be confirmed. In practical terms, melatonin is one of the main components responsible for regulating our circadian rhythms (our body clock). It’s what makes people tired when it gets dark and feel awake when it gets light. Elevated levels of melatonin metabolites indicates that instead of being processed properly in the body, melatonin is just being broken down and excreted, rendering the body clock unworkable, or at least poorly functioning.

Unfortunately, excessive daytime sleepiness is commonly reported in PCOS sufferers without any direct link to disordered breathing and appears to be directly related to the metabolic syndrome that’s involved in the regulation of PCOS. That’s bad news for sufferers because it means that treating sleep disturbances may not make much of a difference to quality of life until the actual root cause of the metabolic syndrome is tackled and treated.

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