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Open Access 01-12-2014 | Research article

The relationship between mood and sleep in different female reproductive states

Authors: Elena Toffol, Nea Kalleinen, Anna Sofia Urrila, Sari-Leena Himanen, Tarja Porkka-Heiskanen, Timo Partonen, Päivi Polo-Kantola

Published in: BMC Psychiatry | Issue 1/2014

Abstract

Background

Sleep is disrupted in depressed subjects, but it also deteriorates with age and possibly with the transition to menopause. The nature of interaction between mood, sleep, age and reproductive state is not well-defined. The aim of this study was to evaluate the relationship between mood and sleep among healthy women in different reproductive states.

Methods

We analyzed data from 11 younger (20–26 years), 21 perimenopausal (43–51 years) and 29 postmenopausal (58–71 years) healthy women who participated in a study on menopause, sleep and cognition. The 21-item Beck Depression Inventory (BDI) was administered to assess mood. Subjective sleep quality was assessed with the Basic Nordic Sleep Questionnaire (BNSQ). Objective sleep was measured with all-night polysomnography (PSG) recordings. Perimenopausal and younger women were examined during the first days of their menstrual cycle at the follicular phase.

Results

Among younger women, less arousals associated with higher BDI total scores (p = 0.026), and higher SWS percentages with more dissatisfaction (p = 0.001) and depressive-somatic symptoms (p = 0.025), but with less depressive-emotional symptoms (p = 0.001). In specific, less awakenings either from REM sleep or SWS, respectively, associated with more punishment (p = 0.005; p = 0.036), more dissatisfaction (p < 0.001; p = 0.001) and more depressive-somatic symptoms (p = 0.001; p = 0.009), but with less depressive-emotional symptoms (p = 0.002; p = 0.003). In perimenopausal women, higher BNSQ insomnia scores (p = 0.005), lower sleep efficiencies (p = 0.022) and shorter total sleep times (p = 0.024) associated with higher BDI scores, longer sleep latencies with more depressive-somatic symptoms (p = 0.032) and longer REM latencies with more dissatisfaction (p = 0.017). In postmenopausal women, higher REM percentages associated with higher BDI total scores (p = 0.019) and more depressive-somatic symptoms (p = 0.005), and longer SWS latencies with more depressive-somatic symptoms (p = 0.030).

Conclusions

Depressive symptoms measured with the total BDI scores associated with sleep impairment in both perimenopausal and postmenopausal women. In younger women, specific BDI factors revealed minor associations, suggesting that the type of sleep impairment can vary in relation to different depressive features. Our data indicate that associations between sleep and depressed mood may change in conjunction with hormonal milestones.

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Tibblin G, Bengtsson C, Furunes B, Lapidus L: Symptoms by age and sex: the population studies of men and women in Gothenburg, Sweden. Scand J Prim Health Care. 1990, 8: 9-17. 10.3109/02813439008994923.CrossRefPubMed

Kornstein SG, Schatzberg AF, Thase ME, Yonkers KA, McCulloughe JP, Keitner GI, Gelenberg AG, Ryan CE, Hess AL, Harrison W, Davis SM, Keller MB: Gender differences in chronic major and double depression. J Affect Disord. 2000, 60: 1-11. 10.1016/S0165-0327(99)00158-5.CrossRefPubMed

Kuehner C: Gender differences in unipolar depression: an update of epidemiological findings and possible explanations. Acta Psychiatr Scand. 2003, 108: 163-174. 10.1034/j.1600-0447.2003.00204.x.CrossRefPubMed

Angst J, Dobler-Mikola A: Do the diagnostic criteria and imipramine determine the sex ratio in depression?. J Affect Disord. 1984, 7: 189-198. 10.1016/0165-0327(84)90040-5.CrossRefPubMed

Frank E, Carpenter LL, Kupfer DJ: Sex differences in recurrent depression: are there any that are significant?. Am J Psychiatr. 1988, 145: 41-45.CrossRefPubMed

Williams JB, Spitzer RL, Linzer M, Kroenke K, Hahn SR, De Gruy FV, Lazev A: Gender differences in depression in primary care. Am J Obstet Gynecol. 1995, 173: 654-659. 10.1016/0002-9378(95)90298-8.CrossRefPubMed

Soares CN, Zitek B: Reproductive hormone sensitivity and risk for depression across the female life cycle: a continuum of vulnerability?. J Psychiatry Neurosci. 2008, 33: 331-343.PubMedPubMedCentral

Bromberger JT, Kravitz HM, Chang Y-F, Cyranowski JM, Brown C, Matthews KA: Major depression during and after the menopausal transition: study of women’s health across the nation (SWAN). Psychol Med. 2011, 41: 1879-1888. 10.1017/S003329171100016X.CrossRefPubMedPubMedCentral

Bromberger JT, Kravitz HM: Mood and menopause: findings from the study of women’s health across the nation (SWAN) over 10 years. Obstet Gynecol Clin North Am. 2011, 38: 609-625. 10.1016/j.ogc.2011.05.011.CrossRefPubMedPubMedCentral

10.

Cohen IR, Wise PM: Effects of estradiol on the diurnal rhythm of serotonin activity in microdissected brain areas of ovariectomized rats. Endocrinology. 1988, 122: 2619-2625. 10.1210/endo-122-6-2619.CrossRefPubMed

11.

Cohen LS, Soares CN, Vitonis AF, Otto MW, Harlow BL: Risk of new onset of depression during the menopausal transition: the harvard study of moods and cycles. Arch Gen Psychiatry. 2006, 63: 385-390. 10.1001/archpsyc.63.4.385.CrossRefPubMed

12.

Freeman EW, Sammel MD, Lin H, Nelson DB: Associations of hormones and menopausal status with depressed mood in women with no history of depression. Arch Gen Psychiatry. 2006, 63: 375-382. 10.1001/archpsyc.63.4.375.CrossRefPubMed

13.

Ohayon MM: Epidemiological study on insomnia in the general population. Sleep. 1996, 19 (suppl 3): 7-15.

14.

Armitage R: Sleep and circadian rhythms in mood disorders. Acta Psychiatr Scandinav. 2007, 115 (Suppl 443): 104-115.CrossRef

15.

Garvey MJ, Schaffer CB: Are some symptoms of depression age dependent?. J Affect Disord. 1994, 32: 247-251. 10.1016/0165-0327(94)90088-4.CrossRefPubMed

16.

Husain MM, Rush AJ, Sackeim HA, Wisniewski SR, McClintock SM, Craven N, Holiner J, Mitchell JR, Balasubramani GK, Hauger R: Age-related characteristics of depression: a preliminary STAR*D report. Am J Geriatr Psychiatry. 2005, 13: 852-860. 10.1097/00019442-200510000-00004.CrossRefPubMed

17.

Hegeman JM, Kok RM, van der Mast RC, Giltay EJ: Phenomenology of depression in older compared with younger adults: meta-analysis. Br J Psychiatry. 2012, 200: 275-281. 10.1192/bjp.bp.111.095950.CrossRefPubMed

18.

Steiger A, Kimura M: Wake and sleep EEG provide biomarkers in depression. J Psychiatr Res. 2010, 44: 242-252. 10.1016/j.jpsychires.2009.08.013.CrossRefPubMed

19.

Ford DE, Kamerow DB: Epidemiologic study of sleep disturbances and psychiatric disorders: an opportunity for prevention?. JAMA. 1989, 262: 1479-1484. 10.1001/jama.1989.03430110069030.CrossRefPubMed

20.

Dryman A, Eaton WW: Affective symptoms associated with the onset of major depression in the community: findings from the US national institute of mental health epidemiological catchment area program. Acta Psychiatr Scandinav. 1991, 84: 1-5. 10.1111/j.1600-0447.1991.tb01410.x.CrossRef

21.

Riemann D: Insomnia and comorbid psychiatric disorders. Sleep Med. 2007, 8 (suppl 4): S15-S20.CrossRefPubMed

22.

McNamara P, Auerbach S, Johnson P, Harris E, Doros G: Impact of REM sleep on distortions of self-concept, mood and memory in depressed/anxious participants. J Affect Disord. 2010, 122: 198-207. 10.1016/j.jad.2009.06.030.CrossRefPubMed

23.

Voderholzer U, Al-Shajlawi A, Weske G, Feige B, Riemann D: Are there gender differences in objective and subjective sleep measures? a study of insomniacs and healthy controls. Depress Anxiety. 2003, 17: 162-172. 10.1002/da.10101.CrossRefPubMed

24.

Lauer C, Riemann D, Wiegand M, Berger M: From early to late adulthood: changes in EEG sleep of depressed patients and healthy volunteers. Biol Psychiatry. 1991, 29: 979-993. 10.1016/0006-3223(91)90355-P.CrossRefPubMed

25.

Riemann D, Berger M, Voderholzer U: Sleep and depression - results from psychobiological studies: an overview. Biol Psychol. 2001, 57: 67-103. 10.1016/S0301-0511(01)00090-4.CrossRefPubMed

26.

Dijk DJ: Slow-wave sleep deficiency and enhancement: implications for insomnia and its management. World J Biol Psychiatry. 2010, 11: 22-28. 10.3109/15622971003637645.CrossRefPubMed

27.

Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV: Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep. 2004, 27: 1255-1273.PubMed

28.

Eichling PS, Sahni J: Menopause related sleep disorders. J Clin Sleep Med. 2005, 1: 291-300.PubMed

29.

Polo-Kantola P: Sleep and menopause. Womens Health. 2007, 3: 99-106.

30.

Nowakowski S, Meliska CJ, Martinez LF, Parry BL: Sleep and menopause. CurNeurol Neurosci Rep. 2009, 9: 165-172. 10.1007/s11910-009-0025-6.CrossRef

31.

Hachul H, Andersen ML, Bittencourt LRA, Santos-Silva R, Conway SG, Tufik S: Does the reproductive cycle influence sleep patterns in women with sleep complaints?. Climateric. 2010, 13: 594-603. 10.3109/13697130903450147.CrossRef

32.

Polo-Kantola P: Sleep problems in midlife and beyond. Maturitas. 2011, 68: 224-232. 10.1016/j.maturitas.2010.12.009.CrossRefPubMed

33.

Orff HJ, Meliska CJ, Lopez A, Martinez F, Sorenson D, Parry BL: Polysomnographic evaluation of sleep quality and quantitative variables in women as a function of mood, reproductive status, and age. Dialogues Clin Neurosci. 2012, 14: 413-424.PubMedPubMedCentral

34.

Antonijevic IA, Murck H, Frieboes R-M, Uhr M, Steiger A: On the role of menopause for sleep-endocrine alterations associated with major depression. Psychoneuroendocrinology. 2003, 28: 401-418. 10.1016/S0306-4530(02)00031-8.CrossRefPubMed

35.

Kalleinen N: Sleep and Menopause. Hormone therapy and sleep deprivation. PhD thesis. Sarja D, Osa 819. Medica Odontologica. 2008, Turku: Turun Yliopisto

36.

Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh : An inventory for measuring depression. Arch Gen Psychiatry. 1961, 4: 561-571. 10.1001/archpsyc.1961.01710120031004.CrossRefPubMed

37.

Partinen M, Gislason T: Basic nordic sleep questionnaire (BNSQ): a quantitated measure of subjective sleep complaints. J Sleep Res. 1995, 4: 150-155.CrossRefPubMed

38.

Rechtschaffen A, Kales A: A manual of standardized terminology, techniques and scoring systems for sleep stages of human subjects. 1968, Los Angeles, CA: Brain Information Service/Brain Research Institute, UCLA

39.

Bonnet M, Carley D, Carskadon M, Eaton P, Guilleminault C, Harper R, Hayes B, Hirshkowitz M, Ktonas P, Keenan S, Pressman M, Roehrs T, Smith J, Walsh J, Weber S, Westbrook P, Jordan B, The Atlas Task Force: ASDA report: EEG arousals: scoring rules and examples. Sleep. 1992, 15: 173-184.

40.

Kalleinen N, Polo-Kantola P, Himanen SL, Alhola P, Joutsen A, Urrila AS, Polo O: Sleep and the menopause - do postmenopausal women experience worse sleep than premenopausal women?. Menopause Int. 2008, 14: 97-104.PubMed

41.

Jöreskog KG: Factor analysis by least-squares and maximum likelihood methods. Statistical methods for digital computers. Volume 3. Edited by: Enslein K, Ralston A, Wilf HS. 1977, New York: John Wiley & Sons, 125-153.

42.

Cronbach LJ: Coefficient alpha and the internal structure of tests. Psychometrika. 1951, 16: 297-334. 10.1007/BF02310555.CrossRef

43.

Tarkkonen L: On reliability of composite scales. Statistical studies 7. 1987, Helsinki: Finnish Statistical Society

44.

Vehkalahti K: Reliability of measurement scales: Tarkkonen’s general method supersedes Cronbach’s alpha. Statistical research reports 17. 2000, Helsinki: Finnish Statistical Society

45.

Environment for creative processing of text and numerical data SURVO. http://www.survo.fi/mm/english.html,

46.

Morphy H, Dunn KM, Lewis M, Boardman HF, Croft PR: Epidemiology of insomnia: a longitudinal study in a UK population. Sleep. 2007, 30: 274-280.PubMed

47.

Jansson-Frojmark M, Lindblom K: A bidirectional relationship between anxiety and depression, and insomnia? a prospective study in the general population. J Psychosom Res. 2008, 64: 443-449. 10.1016/j.jpsychores.2007.10.016.CrossRefPubMed

48.

Kamysheva E, Skouteris H, Wertheim EH, Paxton SJ, Milgrom J: A prospective investigation of the relationships among sleep quality, physical symptoms, and depressive symptoms during pregnancy. J Affect Disord. 2010, 123: 317-320. 10.1016/j.jad.2009.09.015.CrossRefPubMed

49.

Nyer M, Farabaugh A, Fehling K, Soskin D, Holt D, Papakostas GI, Pedrelli P, Fava M, Pisoni A, Vitolo O, Mischoulon D: Relationship between sleep disturbance and depression, anxiety, and functioning in college students. Depress Anxiety. 2013, 30: 873-880. 10.1002/da.22064.CrossRefPubMed

50.

Bruck D, Astbury J: Population study on the predictors of sleeping difficulties in young Australian women. Behav Sleep Med. 2012, 10: 84-95. 10.1080/15402002.2011.592888.CrossRefPubMed

51.

Frey S, Birchler-Pedross A, Hofstetter M, Brunner P, Götz T, Münch M, Blatter K, Knoblauch V, Wirz-Justice A, Cajochen C: Young women with major depression live on higher homeostatic sleep pressure than healthy controls. Chronobiol Int. 2012, 29: 278-294. 10.3109/07420528.2012.656163.CrossRefPubMed

52.

Gottfries CG: Is there a difference between elderly and younger patients with regard to the symptomatology and aetiology of depression?. Int Clin Psychopharmacol. 1998, 13 (Suppl 5): S13-S18.CrossRefPubMed

53.

Shahpesandy H: Different manifestation of depressive disorder in the elderly. Neuro Endocrinol Lett. 2005, 26: 691-695.PubMed

54.

Vandekerckhove M, Cluydts R: The emotional brain and sleep: an intimate relationship. Sleep Med Rev. 2010, 14: 219-226. 10.1016/j.smrv.2010.01.002.CrossRefPubMed

55.

Talamini LM, Bringmann LF, de Boer M, Hofman WF: Sleeping worries away or worrying away sleep? physiological evidence on sleep-emotion interactions. PLoS One. 2013, 8: e62480-10.1371/journal.pone.0062480.CrossRefPubMedPubMedCentral

56.

Rodríguez MR, Nuevo R, Chatterji S, Ayuso-Mateos JL: Definitions and factors associated with subthreshold depressive conditions: a systematic review. BMC Psychiatry. 2012, 12: 181-10.1186/1471-244X-12-181.CrossRefPubMedPubMedCentral

57.

Balázs J, Miklósi M, Keresztény A, Hoven CW, Carli V, Wasserman C, Apter A, Bobes J, Brunner R, Cosman D, Cotter P, Haring C, Iosue M, Kaess M, Kahn JP, Keeley H, Marusic D, Postuvan V, Resch F, Saiz PA, Sisask M, Snir A, Tubiana A, Varnik A, Sarchiapone M, Wasserman D: Adolescent subthreshold-depression and anxiety: psychopathology, functional impairment and increased suicide risk. J Child Psychol Psychiatry. 2013, 54: 670-677. 10.1111/jcpp.12016.CrossRefPubMed

58.

Bertha EA, Balázs J: Subthreshold depression in adolescence: a systematic review. Eur Child Adolesc Psychiatry. 2013, doi:10.1007/s00787-013-0411-0

59.

Amore M, Di Donato P, Papalini A, Berti A, Palareti A, Ferrari G, Chirico C, De Aloysio D: Psychological status at the menopausal transition: an Italian epidemiological study. Maturitas. 2004, 48: 115-124. 10.1016/j.maturitas.2003.08.010.CrossRefPubMed

60.

Zöllner YF, Acquadro C, Schaefer M: Literature review of instruments to assess health-related quality of life during and after menopause. Qual Life Res. 2005, 14: 309-327. 10.1007/s11136-004-0688-z.CrossRefPubMed

61.

Terauchi M, Hiramitsu S, Akiyoshi M, Owa Y, Kato K, Obayashi S, Matsushima E, Kubota T: Associations among depression, anxiety and somatic symptoms in peri- and postmenopausal women. J Obstet Gynaecol Res. 2013, 39: 1007-1013. 10.1111/j.1447-0756.2012.02064.x.CrossRefPubMed

62.

Young T, Rabago D, Zgierska A, Austin D, Laurel F: Objective and subjective sleep quality in premenopausal, perimenopausal, and postmenopausal women in the Wisconsin sleep cohort study. Sleep. 2003, 26: 667-672.PubMed

63.

Kravitz HM, Zhao X, Bromberger JT, Gold EB, Hall MH, Matthews KA, Sowers MR: Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women. Sleep. 2008, 31: 979-990.PubMedPubMedCentral

64.

Woodward S, Freedman RR: The thermoregulatory effects of menopausal hot flashes on sleep. Sleep. 1994, 17: 497-501.PubMed

65.

Polo-Kantola P, Erkkola R, Helenius H, Irjala K, Polo O: When does estrogen replacement therapy improve sleep quality?. Am J Obstet Gynecol. 1998, 178: 1002-1009. 10.1016/S0002-9378(98)70539-3.CrossRefPubMed

66.

Polo-Kantola P, Erkkola R, Irjala K, Helenius H, Pullinen S, Polo O: Climacteric symptoms and sleep quality. Obstet Gynecol. 1999, 94: 219-224. 10.1016/S0029-7844(99)00284-7.PubMed

67.

Ohayon MM: Severe hot flashes are associated with chronic insomnia. Arch Intern Med. 2006, 166: 1262-1268. 10.1001/archinte.166.12.1262.CrossRefPubMed

68.

Campbell S, Whitehead M: Oestrogen therapy and the menopausal syndrome. Clin Obstet Gynaecol. 1977, 4: 31-47.PubMed

69.

Schmidt PJ, Nieman L, Danaceau MA, Tobin MB, Roca CA, Murphy JH, Rubinow DR: Estrogen replacement in perimenopause-related depression: a preliminary report. Am J Obstet Gynecol. 2000, 183: 414-420. 10.1067/mob.2000.106004.CrossRefPubMed

70.

Silverstein B: Gender differences in the prevalence of somatic versus pure depression: a replication. Am J Psychiatry. 2002, 159: 1051-1052. 10.1176/appi.ajp.159.6.1051.CrossRefPubMed

71.

Silverstein B: Gender difference in the prevalence of clinical depression: the role played by depression associated with somatic symptoms. Am J Psychiatry. 1999, 156: 480-482.PubMed

72.

Brown JP, Gallicchio L, Flaws JA, Tracy JK: Relations among menopausal symptoms, sleep disturbance and depressive symptoms in midlife. Maturitas. 2009, 62: 184-189. 10.1016/j.maturitas.2008.11.019.CrossRefPubMedPubMedCentral

73.

Baker FC, Mitchell D, Driver HS: Oral contraceptives alter sleep and raise body temperature in young women. Pflugers Arch. 2001, 424: 729-737.CrossRef

74.

Baker FC, Waner JI, Vieira EF, Taylor SR, Driver HS, Mitchell D: Sleep and 24 hour body temperatures: a comparison in young men, naturally cycling women and women taking hormonal contraceptives. J Physiol. 2001, 530: 565-574. 10.1111/j.1469-7793.2001.0565k.x.CrossRefPubMedPubMedCentral

75.

Ho MA: Sex hormones and the sleep of women. Sleep Research. 1972, 1: 184-

76.

Lee KA, Shaver JF, Giblin EC, Woods NF: Sleep patterns related to menstrual cycle phase and premenstrual affective symptoms. Sleep. 1990, 13: 403-409.PubMed

77.

Burdick RS, Hoffmann R, Armitage R: Short note: oral contraceptives and sleep in depressed and healthy women. Sleep. 2002, 25: 347-349.PubMed

78.

Hachul H, Andersen ML, Bittencourt L, Santos-Silva R, Tufik S: A population-based survey on the influence of the menstrual cycle and the use of hormonal contraceptives on sleep patterns in São Paulo, Brazil. Int J Gynaecol Obstet. 2013, 120: 137-140.CrossRefPubMed

79.

Oinonen KA, Mazmanian D: To what extent do oral contraceptives influence mood and affect?. J Affect Disord. 2002, 70: 229-240. 10.1016/S0165-0327(01)00356-1.CrossRefPubMed

80.

Rapkin AJ, Morgan M, Sogliano C, Biggio G, Concas A: Decreased neuroactive steroids induced by combined oral contraceptive pills are not associated with mood changes. Fertil Steril. 2006, 85: 1371-1378. 10.1016/j.fertnstert.2005.10.031.CrossRefPubMed

81.

Beck AT, Steer RA, Carbin GM: Psychometric properties of the beck depression inventory: twenty-five years of evaluation. Clin Psychol Rev. 1988, 8: 77-100. 10.1016/0272-7358(88)90050-5.CrossRef

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-244X/14/177/prepub

Title: The relationship between mood and sleep in different female reproductive states
Authors: Elena Toffol
Nea Kalleinen
Anna Sofia Urrila
Sari-Leena Himanen
Tarja Porkka-Heiskanen
Timo Partonen
Päivi Polo-Kantola
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2014
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/1471-244X-14-177

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

The relationship between mood and sleep in different female reproductive states

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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