Decreased nocturnal levels of prolactin and growth hormone in women with fibromyalgia.

Fibromyalgia (FM) is a complex syndrome, primarily of women, characterized by chronic pain, fatigue, and sleep disturbance. Altered function of the somatotropic axis has been documented in patients with FM, but little is known about nocturnal levels of PRL. As part of a laboratory study of sleep patterns in FM, we measured the serum concentrations of GH and PRL hourly from 2000--0700 h in a sample of 25 women with FM (mean, 46.9 +/- 7.6 yr) and in 21 control women (mean, 42.6 +/- 8.1 yr). The mean (+/-SEM ) serum concentrations (micrograms per L) of GH and of PRL during the early sleep period were higher in control women than in patients with FM [GH, 1.6 +/- 0.4 vs. 0.6 +/- 0.2 (P < 0.05); PRL, 23.2 +/- 2.2 vs. 16.9 +/- 2.0 (P < 0.025)]. The mean serum concentrations of GH and PRL increased more after sleep onset in control women than in patients with FM [GH, 1.3 +/- 0.4 vs. 0.3 +/- 0.2 (P < 0.05); PRL, 16.2 +/- 2.4 vs. 9.7 +/- 1.5 (P < 0.025)]. Sleep efficiency and amounts of sleep or wake stages on the blood draw night were not different between groups. There was a modest inverse relationship between sleep latency and PRL and a direct relationship between sleep efficiency and PRL in FM. There was an inverse relationship between age and GH most evident in control women. Insulin-like growth factor I levels were not different between the groups. These data demonstrate altered functioning of both the somatotropic and lactotropic axes during sleep in FM and support the hypothesis that dysregulated neuroendocrine systems during sleep may play a role in the pathophysiology of FM.

Using women's health research to develop women leaders in academic health sciences: the National Centers of Excellence in Women's Health.

While the number of women entering U.S. medical schools has risen substantially in the past 25 years, the number of women in leadership positions in academic medicine is disproportionately small. The traditional pathway to academic leadership is through research. Women's health research is an ideal venue to fill the pipeline with talented women physicians and scientists who may become academic leaders in positions where they can promote positive change in women's health as well as mentor other women. The Office on Women's Health (OWH) in the U.S. Department of Health and Human Services has contracted with 18 academic medical centers to develop National Centers of Excellence in Women's Health. Emphasizing the integral link between women's health and women leaders, each of the Centers of Excellence must develop a leadership plan for women in academic medicine as part of the contract requirements. This paper describes the training programs in women's health research that have developed at five of the academic medical centers: the University of Wisconsin, Magee Women's Hospital, the University of Maryland, Medical College of Pennsylvania Hahnemann University, and the University of Illinois at Chicago. We discuss some of the challenges faced for both initiation and future viability of these programs as well as criteria by which these programs will be evaluated for success.

Self-reported nap behavior and polysomnography at home in midlife women with and without insomnia.

STUDY OBJECTIVES: To describe self-reported nap behavior and relationships among nap history, nap behavior during the study, indicators of subjective and objective insomnia, and self-reported daytime sleepiness from data previously obtained in a week-long field study of sleep in midlife women with and without insomnia. DESIGN: Descriptive/comparative secondary analysis. SETTING: Individual homes of the participants. PARTICIPANTS: Midlife women (mean age 46+/-4 years) with self-reported insomnia (n=101) and women with adequate sleep (n=30). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Sleep patterns were assessed by polysomnography (PSG), daily diaries, and a sleep history form. Although all women were requested not to nap, 47% of the women reported nap behavior during the study. Strong relationships were observed between a history of daytime naps and nap behavior (chi2 = 25.63, p < or = .001), and a history of feeling sleepy or struggling to stay awake during the daytime (i.e., sleepiness) and nap behavior (chi2 = 18.05, p < or = .001) during the study. There was also a modest significant (p < or = .05) correlation (r = .25) between tiredness and nap duration during the study. There were no statistical differences in sleep variables between the napping and non-napping groups. In the napping group, there were no differences between women with sleep efficiency < 85% (objective insomnia) and those with sleep efficiency > 85%. CONCLUSIONS: Habitual nap behavior may be indicative of daytime sleepiness in women with insomnia, but it is not necessarily related to subjective or objective measures of insomnia. Women who routinely nap may be unable to refrain from napping during the daytime in long-term research studies.

Use of herbal therapies among midlife Mexican women.

The cultural traditions of Mexican women living in the United States make it likely that some women promote their health and manage their symptoms using various herbal therapies, yet we know little about this phenomenon. The purpose of this study was to describe and compare midlife Mexican women living in the U.S. who were or were not using herbal therapies with regard to the extent of their acculturation, beliefs about herbs, and factors associated with their utilization of health services. A convenience sample of 30 Mexican women between the ages of 40 and 56 years completed face-to-face interviews in either English or Spanish. Nearly half reported using herbal therapies. With the exception of positive beliefs about herbs, we found few differences between herbal users and nonusers on acculturation or access to, and satisfaction with, health services. Although acculturation did not appear to influence whether the women used herbal therapies, it did relate to the types of herbs selected. Women most commonly reported using herbs popular in traditional Mexican culture, including manzanilla (chamomile), savila (aloe vera), ajo (garlic), uña de gato (cat's claw), and yerba buena (spearmint).

Sleep disturbance in menopause.

Sleep problems (i.e., insomnia) affect midlife women as they approach and pass through menopause at rates higher than at most other stages of life. The purpose of this article is to critically review what is known about insomnia (perceived poor sleep) and physiologically assessed sleep, as well as sleep-related disordered breathing (SDB), in women according to menopausal status and the role of hypothalamic-pituitary-ovarian (HPO) hormones. Self-report evidence that sleep difficulties are related to the hormonal changes of menopause is mixed. Data from studies in which sleep was physiologically measured reveal that sleep problems appear corequisite with hot flashes and sweats. Results are difficult to compare across studies because of varying methodologies in how sleep quality and patterns were assessed and how age cohorts and menopausal status were defined. The risk of SDB increases with age, although women are less susceptible at any age than men. As with men, snoring, obesity, and high blood pressure are clear risk factors. Some women may be underdiagnosed for SDB, as they have somewhat different symptom manifestations than men. Usually, frank apnea is not as evident. Primary care clinicians should be mindful of the potential for SDB in women who are obese, have high blood pressure, are cognizant of snoring, and report morning headaches and excessive daytime sleepiness. Improved care will result from consistently incorporating sleep insomnia assessments into practice as a basis for referring to sleep centers as necessary or prescribing sleep-enhancing behavioral and pharmacological treatments.

Educating the nursing workforce in 2000 and beyond.

Changes in the health care delivery system have comparable impacts on both nursing practice and education, such that tomorrow's nursing practice would best emanate from innovative partnerships between leaders in practice and education. For the foreseeable future, an expert nursing workforce is needed in an expanded form, but an array of challenges to maintaining this workforce are evident. Recent and continuing scientific and technologic advances in health care make the matching of practice and education to evolving trends paramount. Regardless of what the future holds, generative leadership in any realm of practice is essential to move our profession into the forefront of health care.

Effects of selective slow wave sleep disruption on musculoskeletal pain and fatigue in middle aged women.

OBJECTIVE: To determine whether disrupted slow wave sleep (SWS) would evoke musculoskeletal pain, fatigue, and an alpha electroencephalograph (EEG) sleep pattern. We selectively deprived 12 healthy, middle aged, sedentary women without muscle discomfort of SWS for 3 consecutive nights. Effects were assessed for the following measures: polysomnographic sleep, musculoskeletal tender point pain threshold, skinfold tenderness, reactive hyperemia (inflammatory flare response), somatic symptoms, and mood state. METHODS: Sleep was recorded and scored using standard methods. On selective SWS deprivation (SWSD) nights, when delta waves (indicative of SWS) were detected on EEG, a computer generated tone (maximum 85 decibels) was delivered until delta waves disappeared. Musculoskeletal tender points were measured by dolorimetry; skinfold tenderness was assessed by skin roll procedure; and reactive hyperemia was assessed with a cotton swab test. Subjects completed questionnaires on bodily feelings, symptoms, and mood. RESULTS: On each SWSD night, SWS was decreased significantly with minimal alterations in total sleep time, sleep efficiency, and other sleep stages. Subjects showed a 24% decrease in musculoskeletal pain threshold after the third SWSD night. They also reported increased discomfort, tiredness, fatigue, and reduced vigor. The flare response (area of vasodilatation) in skin was greater than baseline after the first, and again, after the third SWSD night. However, the automated program for SWSD did not evoke an alpha EEG sleep pattern. CONCLUSION: Disrupting SWS, without reducing total sleep or sleep efficiency, for several consecutive nights is associated with decreased pain threshold, increased discomfort, fatigue, and the inflammatory flare response in skin. These results suggest that disrupted sleep is probably an important factor in the pathophysiology of symptoms in fibromyalgia.

Sleep, psychological distress, and stress arousal in women with fibromyalgia.

The purpose of this investigation was to compare self-reported sleep quality and psychological distress, as well as somnographic sleep and physiological stress arousal, in women recruited from the community with self-reported medically diagnosed fibromyalgia (FM) to women without somatic symptoms. Eleven midlife women with FM, when compared to 11 asymptomatic women, reported poorer sleep quality and higher SCL-90 psychological distress scores. Women with FM also had more early night transitional sleep (stage 1) (p < 0.01), more sleep stage changes (p < 0.03) and a higher sleep fragmentation index (p < 0.03), but did not differ in alpha-EEG-NREM activity (a marker believed to accompany FM). No physiological stress arousal differences were evident. Less stable sleep in the early night supports a postulate that nighttime hormone (e.g., growth hormone) disturbance is an etiologic factor but, contrary to several literature assertions, alpha-EEG-NREM activity sleep does not appear to be a specific marker of FM. Further study of mechanisms is needed to guide treatment options.

Beyond hormonal therapies in menopause.

Women in midlife often access health care providers with reports of hot flashes, sleep problems, and depressed mood, perhaps directly or indirectly associated with menopausal hormone shifts. Evidence that stress conditions have profound effects on reproductive function is suggestive that stress adaptation is important to understanding menopausal symptoms. This paper briefly outlines salient interactions between neurohormonal mechanisms of stress responses and reproduction known to be affected by exercise, dietary intake and cognitive strategies, as a basis for advocating research that tests these therapies as alternatives or complements to drug therapies for menopausal symptoms. Reductions in hot flashes and positive mood and sleep changes are evident with such therapies but specific study in midlife women is lacking. Specifically, exercise (type, duration, intensity, and timing), dietary intake (type and amount of macronutrients or micronutrients, fiber, and timing), and cognitive techniques (type, amount, duration, and timing), deserve testing for effects on catecholamines, serotonin, opioids, and other neuromediators; ovarian hormones and related steroids, as well as gonadotropins; and circulating neuromediator precursors in midlife women. Further outcomes for testing include body weight, temperature regulation, menstrual cycle regulation, fertility, mood state, eating and sleeping patterns, social patterns, disease risk factors, and symptoms.

Sleep, psychological distress, and somatic symptoms in perimenopausal women.

OBJECTIVE: Self-report and somnographic data from 135 volunteer, disease-free, women (37-59 years) were used to determine the prevalence of perceived poor sleep and to compare women with and without "poor" sleep on menopausal status, somnographic sleep, psychological distress, and somatic symptom cluster frequencies. METHODS: Data from identical measures done on two groups of perimenopausal-age women, one recruited for menopausal age and the other for same age but sleep problems plus controls, were tested using a two-way analysis of variance for the main effects of recruitment group and the presence or absence of "poor" sleep as well as the joint effects of both. RESULTS: "Poor" sleep was reported by more than one-third of the women, but menopausal status and perceived sleep quality were not statistically related. Women with "poor" sleep took longer to fall asleep, spent longer in bed, and had higher scores for psychological distress and for four out of five somatic symptom clusters (p < or = 0.03), compared to women with "good" sleep. CONCLUSION: In sum, midlife women reporting poor sleep are likely to have trouble falling asleep and to have higher psychological distress and somatic symptoms, especially musculoskeletal discomfort and fatigue, coinciding with their perceived poor sleep.

Sleep quality subtypes in midlife women.

Eighty-two midlife women (40-59 years) were classified as poor or good sleepers according to either self-reported sleep quality or a sleep efficiency index (SEI) criterion, for comparison of wakefulness, fragmentation and other somnographic sleep variables; as well as psychological (SCL-90) and somatic symptom distress. When classified solely by self-report, the good and poor sleeper groups did not differ on any somnographic variables but self-declared poor sleepers had higher psychological distress scores than good sleepers (p less than or equal to 0.01). When classified solely by the SEI criterion, the good and poor sleepers did not differ on psychological distress but, as expected, differed on various somnographic wakefulness as well as rapid eye movement and stage 2 sleep variables. Further analysis of four subgroups derived by combining objective and subjective, good and poor sleep scores indicated that 15% of this sample (n = 12) perceived but had no objective evidence of poor sleep, and this group scored highest in psychological distress. Only seven women perceived poor sleep in concert with demonstrating low SEI. They scored highest in menopausal symptoms but not in general psychological distress.

Stress, support, psychological states and sleep.

A stress-support model incorporating indicators of life events, social support and SCL-90 measures of psychological distress was hypothesized to affect both reported and objective (somnographic) sleep. To determine the effects of these antecedents on sleep among 69 mid-life women, two models were tested, using both partial correlations and path analysis. Of all the measures of life events and social support examined in this study only negative LEs and contacts with non-supportive persons were associated (positively) with psychological distress, differentially explaining between 9% and 19% of the variance in each of five SCL-90 subscales. Both negative life events and contacts with non-supportive persons influenced depression and the SCL-90 PST index, whereas only negative life events affected anxiety, phobic anxiety and paranoid ideation. Anxiety, depression and the PST index, as indicators of psychological distress, had direct inverse effects on reported sleep with significant adjusted R2 values ranging from 10% to 16%. The model did not hold for somnographic sleep. The factors which are likely to contribute to the absence of an observed relationship between psychological distress and somnographic sleep are discussed.