Women's health issues with fibromyalgia syndrome.

BACKGROUND: Fibromyalgia syndrome (FMS) involves multiple sensory, somatic, and cognitive symptoms that are bound to affect or be affected by physical and mental health status and behavioral components of daily life. METHODS: From a telephone survey of 442 women with and 205 women without FMS as volunteers, data were compared on (1) general health status, (2) reproductive and sleep-related diagnoses, and (3) lifestyle health behaviors. RESULTS: All multiple or logistics regression analyses for group differences were controlled for age, body mass index (BMI), race, employment status, marital status, having a college degree, low household income, and having ever been diagnosed with depression, with a Bonferroni p value correction for multiple indicators. Accordingly, FMS negatively impacted both perceived physical and mental health status, although relatively more so for physical (p < 0.017). Women with FMS were more likely to have had reproductive health or sleep-related diagnoses, including premenstrual syndrome, dysmenorrhea, breast cysts, bladder cystitis, sleep apnea, restless leg syndrome, and abnormal leg movements (p < 0.0125). They were calculated to use less than half as many calories per week as control women (689 +/- 1293 vs. 1499 +/- 1584 kcal/week, p < 0.05) and had more sleep pattern difficulties (p < 0.0125), more negative changes in sexual function (greater odds for 5 of 10 indicators at p < 0.005), and lower alcohol use (odds ratio = 0.39, p < 0.05). CONCLUSIONS: Patients with FMS deserve careful assessment for reproductive conditions and sleep-related functional disorders. Besides more research into mechanisms underlying symptoms, intervention testing specifically to alleviate sleep problems, low physical activity levels, and sexual dysfunction should be paramount.

Decreased sleep spindles and spindle activity in midlife women with fibromyalgia and pain.

OBJECTIVES: To compare sleep-spindle incidence (number of spindles per minute of non-rapid eye movement [NREM] stage 2 sleep) and duration, spindle wave time (seconds per epoch in NREM stage 2 sleep), spindle frequency activity, and pain measures (pressure pain threshold, number of tender points, skinfold tenderness) between midlife women with fibromyalgia (FM) and moderate to high pain to a control group of sedentary women without pain. A second goal was to explore the extent to which pain pressure thresholds, age, and depression explain the variance in spindle incidence. DESIGN: A cross-sectional descriptive study. SETTING: A university-based sleep research laboratory and a referral clinic for chronic fatigue and pain. PARTICIPANTS: Thirty-seven medication-free women with FM (mean age, 44.9 +/- 8 years) and 30 women with self-reported good sleep and no pain (mean age, 44.1 +/- 7.7 years) completed a psychiatric interview and the Beck Depression Inventory prior to 2 consecutive nights of polysomnography, with pain measures obtained in the morning. Time domain analysis of spindle incidence and spectral analysis of spindle frequency activity were conducted on night 2 of polysomnography recordings. INTERVENTIONS: NA. RESULTS: Women with FM had fewer mean spindles per minute of NREM stage 2 sleep and lower mean spindle time per epoch of NREM stage 2 sleep (both P values < .02), but mean spindle duration, although slightly shorter, was not statistically significantly different (P < .06) compared to control women. Women with FM had a lower mean pressure pain threshold, a higher average number of positive tender points, and higher skinfold tenderness compared to control women (all P values < .001). Group differences in spindle frequency activity were found after controlling for age, depression, and psychiatric diagnosis in a general linear model (P < .02). One-way analysis of variance revealed significantly lower spindle activity in the 3 frequency bins (12-12.5 Hz, 13-13.5 Hz, 14-14.5 Hz) at C3 (all P values < .04), Fz (all P values < .02), and Cz (all P values < .02). Finally, after controlling for age and depression, pain pressure threshold significantly predicted spindles per minute and spindle time per epoch of NREM stage 2 sleep (r2 = .26; P < .001). CONCLUSIONS: Women with FM and pain have fewer sleep spindles and reduced electroencephalogram power in spindle frequency activity compared to control women of similar age. These data imply that some aspect of thalamocortical mechanisms of spindle generation might be impaired in FM.

Variations in sleep hygiene practices of women with and without insomnia.

Sleep hygiene education is a basic component of behavioral treatment for chronic insomnia, yet the actual sleep hygiene practices of people with insomnia have not been well documented. In this descriptive secondary analysis, midlife women ages 41-55 years with either chronic insomnia (n = 92) or good sleep (n = 29) kept diaries of sleep perceptions and sleep hygiene practices during 6 nights of somnographic monitoring at home. In both groups few reported smoking cigarettes (<10%), most drank caffeine (>80%), and many averaged 30 min of exercise per day ( approximately 50%). Very few in either group (<10%) had regular (<30 min variation) bedtimes or getting-up times. Compared to women with good sleep, those with insomnia reported drinking less caffeine per day, being more abstinent from alcohol, and having smaller variations in day-to-day alcohol intake and bedtimes. Although some women with insomnia limit or refrain from caffeine and alcohol intake, many have not optimized behaviors believed to help prevent or modulate insomnia.

Pain, psychological variables, sleep quality, and natural killer cell activity in midlife women with and without fibromyalgia.

In women with fibromyalgia (FM), central nervous system (CNS) dysfunction in pain, mood, and sleep processes could be associated with changes in immune system indicators. The primary purpose of this study was to compare pain, psychological variables, subjective and objective sleep quality, lymphocyte phenotypes and activation markers, and natural killer activity (NKA) in midlife women with and without FM. A secondary purpose was to explore relationships among these variables in a step-wise regression. Subjects had pain pressure tender points assessed, completed a psychiatric interview and questionnaires (Beck Depression Inventory, SCL-90, Profile of Mood States, subjective sleep), and underwent polysomnograhic assessment for two consecutive nights. Lymphocyte phenotypes, activation markers, and NKA were assessed from blood drawn the morning after sleep laboratory night 2. Compared to controls, women with FM had lower pain thresholds, more psychological distress, higher depression scores, and reduced subjective and objective sleep quality. They also had fewer NK cells (p <.009) and more NK cells that expressed the IL-2 receptor (p <.04), but these differences were not statistically significant after correction for multiple comparisons. NKA was not statistically significantly lower in the women with FM compared to controls. In a multiple regression of age, tender point threshold, depression, psychological distress, and sleep efficiency, only the effect of group was significant (F = 5.479, p <.03) on NKA. In conclusion, we found little evidence to support the hypothesis that pain, mood, and sleep symptoms are associated with changes in the enumeration of peripheral lymphocytes or function in FM.

Self-reported sleep quality and fatigue correlates with actigraphy in midlife women with fibromyalgia.

BACKGROUND: Limited data are available on the relationship between self-reported sleep quality, fatigue, and behavioral sleep patterns in women with fibromyalgia (FM). OBJECTIVES: To compare self-reported sleep quality, fatigue, and behavioral sleep indicators obtained by actigraphy between women with FM and sedentary women without pain, and to examine relationships among these variables. METHODS: Twenty-three women with FM (M = 47.3, +/- 6.7 years) and 22 control women (M = 43.5, +/- 8.2 years) wore an actigraph on the nondominant wrist for 3 consecutive days at home. Each day women reported bedtimes, rise times, and ratings of sleep quality and fatigue in a diary. Self-reported sleep quality, fatigue, and indicators of sleep quality obtained from actigraphy (e.g., total sleep time, sleep efficiency, sleep latency, wake after sleep onset, and fragmentation index) were averaged. The Mann Whitney U test was used to assess group differences. Pearson Product Moment Correlation was used to evaluate relationships between sleep quality and fatigue, and among sleep quality, fatigue, and actigraphy sleep indicators. RESULTS: Women with FM reported poorer sleep quality and more fatigue compared to controls (both p <.001). Actigraphy sleep indicators were not different between groups. In women with FM but not in controls, self-reported sleep quality was directly related to actigraphy indicators of total sleep time (r =.635, p <.01) and inversely related to sleep fragmentation (r = -.46, p <.05). Fatigue in women with FM was directly related to actigraphy indicators of wake after sleep onset (r =.57, p <.01), and inversely related to sleep efficiency (r = -.545, p <.01). DISCUSSION: Self-reported sleep quality and fatigue are associated with behavioral indicators of sleep quality at home in women with FM. Actigraphy is a useful objective measure of improved sleep outcomes in intervention studies.

Stress exposure, psychological distress, and physiological stress activation in midlife women with insomnia.

OBJECTIVE: The objective of this study was to describe perceived and polysomnograhic (PSG) sleep patterns and determine whether stress exposure, psychological distress, and physiological stress activation differed among midlife women with psychophysiologic-type (PP-type) or subjective only-type (SO-type) insomnia or no insomnia. METHODS: Women had their sleep monitored, collected urine samples, and completed questionnaires in a week-long field study, and 53 women met criteria for insomnia types or no insomnia based on reported sleep quality and PSG sleep efficiency. RESULTS: As expected, women with PP-type insomnia were found to have the lowest sleep efficiency, took longer to fall asleep, had more wakefulness after sleep onset, and had more fragmented sleep. Perceptions of stress exposure, either for major or minor events, did not differ among groups. Despite there being no differences in perceived stress exposure, women with both types of insomnia scored higher on psychological distress (SCL-90R), especially on the somatization subscale, than women with no insomnia. Of the physiological stress activation indicators tested, a morning-to-evening difference in urinary cortisol statistically differed across the groups (p <.005). Women in the PP-type insomnia group had the highest levels of urinary cortisol in an early morning urine sample. CONCLUSIONS: These data provide support for the hypothesis that, in midlife women, cognitive or emotional arousal with chronic stress neuroendocrine activation underlies chronic insomnia, particularly the PP-type.

Women and sleep.

Naturally fluctuating hormones (menstrual cycle, through pregnancy or menopausal transition) are not related to marked sleep disturbances in women. It is likely, however, that subsets of women will display a central nervous system vulnerability to hormonal fluctuations so that sleep disturbances manifest as a part of a complex of discomforting symptoms. Sleep is impacted directly through the circadian system or brain sleep regulation or through the development of concurrent functional changes and symptoms. Women are susceptible to sleep-related disorders that are also common in men, such as primary insomnia and SBD although the contributing factors and manifestations may not be the same.