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Menopause, Sleep and Heart Disease Risk

Menopause, Sleep and Heart Disease Risk
One of the commonest symptoms of menopause is sleep disturbance. New research seems to show that along with the other obvious consequences which arise from poor sleep- fatigue for example, poor sleep may pose an increased risk of cardiovascular disease in menopausal women. Also, it is becoming clear that how well a woman sleeps, not just how many hours of sleep they get, may be an important factor in their health risks profile.

This new studies’ findings which were presented at the November meeting of the American Heart Association, found that women who were peri- and postmenopausal who slept poorly scored worse on risk factors related to cardiovascular disease.  Lead researcher for this study, Dr. Brooke Aggarwal, an assistant professor of medical sciences at Columbia University says, “Women who are going through menopause should definitely keep an eye on their sleep habits and take this seriously. They should know that sleep disturbances are common and something they may need to discuss with their health care team.”

Previous research has shown that approximately one half of women going through menopause reported trouble sleeping, making this report all the more important. The risk for sleep apnea, a condition which has also been tied to excess risk of cardiovascular disease, is also increased during menopause, https://pubmed.ncbi.nlm.nih.gov/28926516/  . 

Sleep apnea is also commonly related to weight gain during menopause, obesity further increasing the risk of heart disease. https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/menopause-weight-gain/art-20046058

There have been a  number of studies that document the higher incidence of  obstructive sleep apnea (OSA) in post-menopausal women.

https://pubmed.ncbi.nlm.nih.gov/36983104/#:~:text=Objective%3A%20Menopause%20is%20associated%20with,in%20a%20population%2Dbased%20sample. 

This recent study designed to verify the connection between menopause and sleep apnea had 559 female participants  who completed a comprehensive assessment which was used to generate the study findings. The results of this study confirmed that post-menopausal women had a much higher risk of OSA compared to premenopausal women. The question that remains unanswered is to what degree the higher risk of sleep apnea is associated with weight gain which is common in menopause in  comparison to other factors that relate to menopause. Certainly, optimal care for menopausal women who need it, is appropriate weight reduction guidance as per the Mayo Clinics guidelines for menopausal women  https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/menopause-weight-gain/art-20046058. which include the time tested advice of reducing sweets, and alcohol and increasing physical activity.

In terms of exercise, The University of Penn Medicine Dept. published a paper entitled Why You Should Exercise Your Way Through menopause.

https://www.lancastergeneralhealth.org/health-hub-home/2021/february/why-you-should-exercise-your-way-through-menopause 

Their recommended exercise program includes stretching, muscle strengthening , relaxation techniques and a cardiovascular workout. They point out that although it is still not proven to significantly help the hot flashes of menopause, many other benefits of improved physical conditioning are manifested, including   improved mood , sleep and weight control.

There are many studies which have linked poor  sleep with an increased risk of heart disease and stroke. This resulted in  the American Heart Association adding  sleep duration as another important measure of cardiovascular health risks, and they included importance of good sleep among their  Life’s Essential 8,  for a healthy cardiovascular  life. The other factors are not smoking, maintaining a healthy weight, engaging in physical activity, eating a well balanced healthy diet and monitoring and maintaining normal blood pressure, blood glucose  and cholesterol levels .

In this newly reported study, researchers looked at various  aspects of sleep – aside from how long a person slept- to show the relationship of poor sleep with cardiovascular risk. The study had 291 female subjects. ages 45 to 55 and included pre-, peri- and postmenopausal women.  79% of the subjects reported poor sleep quality. 50% slept less than seven hours per night, and over half reported insomnia.

Poor sleep quality was more prevalent in women who had begun or finished menopause than in those who had not yet entered menopause. Women with poor sleep quality were three times more likely to have poor overall cardiovascular health scores. They were also more likely to score low on the diet component.

Sleep quality, insomnia, sleep apnea risk, and all had a negative impact on overall cardiovascular health.  Twelve percent of the study participants considered themselves night owls, and one-third were considered at high risk for sleep apnea.Women who were night owls and at high risk for sleep apnea had a threefold higher risk of poor overall cardiovascular health scores.

Obesity is a risk factor for sleep apnea and those at high risk for sleep apnea also scored poorly in terms of blood pressure, blood glucose and weight. Insomnia also was linked to poor scores for weight control.  Dr. Michael Grandner, director of the sleep health and research program  at the University of Arizona in Tucson says, “For women in this age group, there is a vulnerability to both heart health issues and sleep problems. They might just assume these sleep problems are due to stress.” – but menopause itself plays a role.

The age at which women go begin menopause is also a time associated with other life stressors, such as work and family needs. There might also be the beginning of concern over mid life medical concerns which may arise. Getting proper sleep is a self care issue that should not be overlooked.