Skip to main content

Advertisement

Log in

Evaluation of sleep disorders, anxiety and depression in women with dysmenorrhea

  • Original Article
  • Published:
Sleep and Biological Rhythms Aims and scope Submit manuscript

Abstract

The purpose of the study is to evaluate sleep disorders in dysmenorrhea patients and investigate the relationship between sleep disorders and anxiety and depression levels in these patients. This cross-sectional study included 55 primary dysmenorrhea patients who were admitted to the emergency department as well as 47 healthy control subjects. All participants were assessed using Beck Depression Inventory, Beck Anxiety Inventory, Epworth Sleepiness Scale (ESS), Berlin Questionnaire, Insomnia Severity Index (ISI), and Pittsburgh Sleep Quality Index (PSQI). Presence of restless legs syndrome (RLS) was evaluated according to International Restless Legs Syndrome Study Group criteria. Primary dysmenorrhea patients had significantly higher ISI, PSQI overall and ESS scores compared to the control group (p = 0.009, p < 0.001, p = 0.007, respectively). While 20% of primary dysmenorrhea patients met RLS criteria, this rate was 4.3% in the control group (p = 0.017). Sleep quality was significantly correlated with severity of pain, anxiety, and depression in primary dysmenorrhea patients (r = 0.409, p < 0.001; r = 0.527, p < 0.001; r = 0.567, p < 0.001; respectively). This study demonstrates increased rates of sleep disorders in dysmenorrhea patients. Furthermore, our results are indicative that sleep disorders in primary dysmenorrhea patients are induced by both physiological and psychological factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology: a report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med. 2003;4:101–19. https://doi.org/10.1016/S1389-9457(03)00010-8.

    Article  PubMed  Google Scholar 

  2. Allen RP, et al. Restless legs syndrome/Willis–Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria–history, rationale, description, and significance. Sleep Med. 2014;15:860–73. https://doi.org/10.1016/j.sleep.2014.03.025.

    Article  PubMed  Google Scholar 

  3. Araujo P, Hachul H, Santos-Silva R, Bittencourt L, Tufik S, Andersen M. Sleep pattern in women with menstrual pain. Sleep Med. 2011;12:1028–30. https://doi.org/10.1016/j.sleep.2011.06.011.

    Article  CAS  PubMed  Google Scholar 

  4. Bahrami A, et al. Neuropsychological function in relation to dysmenorrhea in adolescents. Eur J Obstet Gynecol Reprod Biol. 2017;215:224–9. https://doi.org/10.1016/j.ejogrb.2017.06.030.

    Article  PubMed  Google Scholar 

  5. Baker FC, Driver HS, Rogers GG, Paiker J, Mitchell D. High nocturnal body temperatures and disturbed sleep in women with primary dysmenorrhea. Am J Physiol Endocrinol Metab. 1999;277:E1013–E10211021. https://doi.org/10.1152/ajpendo.1999.277.6.E1013.

    Article  CAS  Google Scholar 

  6. Baker FC, Kahan TL, Trinder J, Colrain IM. Sleep quality and the sleep electroencephalogram in women with severe premenstrual syndrome. Sleep. 2007;30:1283–91. https://doi.org/10.1093/sleep/30.10.1283.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Baker FC, Sassoon SA, Kahan T, Palaniappan L, Nicholas CL, Trinder J, Colrain IM. Perceived poor sleep quality in the absence of polysomnographic sleep disturbance in women with severe premenstrual syndrome. J Sleep Res. 2012;21:535–45. https://doi.org/10.1111/j.1365-2869.2012.01007.x.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Balık G, Üstüner I, Kağıtcı M, Şahin FK. Is there a relationship between mood disorders and dysmenorrhea? J Pediatr Adolesc Gynecol. 2014;27:371–4. https://doi.org/10.1016/j.jpag.2014.01.108.

    Article  PubMed  Google Scholar 

  9. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893–7. https://doi.org/10.1037/0022-006X.56.6.893.

    Article  CAS  PubMed  Google Scholar 

  10. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–71. https://doi.org/10.1001/archpsyc.1961.01710120031004.

    Article  CAS  PubMed  Google Scholar 

  11. Bilgilisoy Filiz M, Çakır T. Restless legs syndrome with current diagnostic criteria Turkish. J Osteoporos. 2015;2015(21):87–95. https://doi.org/10.4274/tod.71601.

    Article  Google Scholar 

  12. Brass SD, Li CS, Auerbach S. The underdiagnosis of sleep disorders in patients with multiple sclerosis. J Clin Sleep Med. 2014;10:1025–31. https://doi.org/10.5664/jcsm.4044.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–21313. https://doi.org/10.1016/0165-1781(89)90047-4.

    Article  CAS  PubMed  Google Scholar 

  14. Charokopos A, Card ME, Gunderson C, Steffens C, Bastian LA. The association of obstructive sleep apnea and pain outcomes in adults: a systematic review. Pain Med (Malden, Mass). 2018;19:S69–S75. https://doi.org/10.1093/pm/pny140.

    Article  Google Scholar 

  15. Chervin RD, Aldrich MS, Pickett R, Christian G. Comparison of the results of the Epworth sleepiness scale and the multiple sleep latency test. J Psychosom Res. 1997;42:145–55. https://doi.org/10.1016/S0022-3999(96)00239-5.

    Article  CAS  PubMed  Google Scholar 

  16. Clavadetscher SC, Gugger M, Bassetti CL. Restless legs syndrome: clinical experience with long-term treatment. Sleep Med. 2004;5:495–500. https://doi.org/10.1016/j.sleep.2004.05.006.

    Article  PubMed  Google Scholar 

  17. De Cock VC, et al. Daytime sleepiness in Parkinson’s disease: a reappraisal. PLoS ONE. 2014. https://doi.org/10.1371/journal.pone.0107278.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Dede HÖ, et al. Relationship between sleep characteristics and sudden unexplained death risk in epilepsy. Neurologist. 2019;24:170–5. https://doi.org/10.1097/NRL.0000000000000254.

    Article  PubMed  Google Scholar 

  19. Doufas AG, Tian L, Davies MF, Warby SC. Nocturnal intermittent hypoxia is independently associated with pain in subjects suffering from sleep-disordered breathing. Anesthesiology. 2013;119:1149–62. https://doi.org/10.1097/ALN.0b013e3182a951fc.

    Article  CAS  PubMed  Google Scholar 

  20. Gagua T, Tkeshelashvili B, Gagua D, McHedlishvili N. Assessment of anxiety and depression in adolescents with primary dysmenorrhea: a case-control study. J Pediatr Adolesc Gynecol. 2013;26:350–4. https://doi.org/10.1016/j.jpag.2013.06.018.

    Article  PubMed  Google Scholar 

  21. Garcia-Malo C, Miranda C, Peralta SR, Cano-Pumarega I, Ponte SN, Garcia-Borreguero D. Iron replacement therapy in restless legs syndrome. Curr Treat Options Neurol. 2020;22:1–16. https://doi.org/10.1007/s11940-020-0617-7.

    Article  Google Scholar 

  22. Ghorayeb I, Bioulac B, Scribans C, Tison F. Perceived severity of restless legs syndrome across the female life cycle. Sleep Med. 2008;9:799–802. https://doi.org/10.1016/j.sleep.2007.07.018.

    Article  PubMed  Google Scholar 

  23. Hachul H, Andersen M, Bittencourt L, Santos-Silva R, Conway S, Tufik S. Does the reproductive cycle influence sleep patterns in women with sleep complaints? Climacteric. 2010;13:594–603. https://doi.org/10.3109/13697130903450147.

    Article  CAS  PubMed  Google Scholar 

  24. Hamamci M, Hacimusalar Y, Karaaslan O, Inan LE. Evaluation of sleep quality in spouses of people with epilepsy. Epilepsy Behav. 2019;94:233–8. https://doi.org/10.1016/j.yebeh.2019.03.027.

    Article  PubMed  Google Scholar 

  25. Harada T, Momoeda M, Terakawa N, Taketani Y, Hoshiai H. Evaluation of a low-dose oral contraceptive pill for primary dysmenorrhea: a placebo-controlled, double-blind, randomized trial. Fertil Steril. 2011;95:1928–31. https://doi.org/10.1016/j.fertnstert.2011.02.045.

    Article  CAS  PubMed  Google Scholar 

  26. Higgins DM, Kerns RD, Brandt CA, Haskell SG, Bathulapalli H, Gilliam W, Goulet JL. Persistent pain and comorbidity among Operation Enduring Freedom/Operation Iraqi Freedom/operation New Dawn veterans. Pain Med (Malden, Mass). 2014;15:782–90. https://doi.org/10.1111/pme.12388.

    Article  Google Scholar 

  27. Hwang S, Shin Y-W, Jung K-Y. Symptom aggravation in restless legs syndrome during menstrual cycle. J Sleep Med. 2019;16:109–12. https://doi.org/10.13078/jsm.190048.

    Article  Google Scholar 

  28. Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update. 2015;21:762–78. https://doi.org/10.1093/humupd/dmv039.

    Article  CAS  PubMed  Google Scholar 

  29. Iacovides S, Avidon I, Bentley A, Baker FC. Diclofenac potassium restores objective and subjective measures of sleep quality in women with primary dysmenorrhea. Sleep. 2009;32:1019–26. https://doi.org/10.1093/sleep/32.8.1019.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Johns M. A new method for measuring daytime sleepiness: the epworth sleepiness scale. Sleep. 1991;14:540–5. https://doi.org/10.1093/sleep/14.6.540.

    Article  CAS  PubMed  Google Scholar 

  31. Keshavarzi F, Mahmoudzadeh F, Brand S, Bahmani DS, Akbari F, Khazaie H, Ghadami MR. Both melatonin and meloxicam improved sleep and pain in females with primary dysmenorrhea—results from a double-blind cross-over intervention pilot study. Arch Women's Mental Health. 2018;21:601–9. https://doi.org/10.1007/s00737-018-0838-x.

    Article  Google Scholar 

  32. Khalid I, Roehrs TA, Hudgel DW, Roth T. Continuous positive airway pressure in severe obstructive sleep apnea reduces pain sensitivity. Sleep. 2011;34:1687–91. https://doi.org/10.5665/sleep.1436.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Larroy C. Comparing visual-analog and numeric scales for assessing menstrual pain. Behav Med. 2002;27:179–81. https://doi.org/10.1080/08964280209596043.

    Article  PubMed  Google Scholar 

  34. Lettieri CJ, Eliasson AH, Andrada T, Khramtsov A, Raphaelson M, Kristo DA. Obstructive sleep apnea syndrome: are we missing an at-risk population? J Clin Sleep Med. 2005;1:381–5. https://doi.org/10.5664/jcsm.26366.

    Article  PubMed  Google Scholar 

  35. Levy P, et al. Obstructive sleep apnoea syndrome. Nat Rev Dis Prim. 2015;1:15015. https://doi.org/10.1038/nrdp.2015.15.

    Article  PubMed  Google Scholar 

  36. Li K, et al. Decreased serum ferritin may be associated with increased restless legs syndrome in Parkinson’s disease (PD): a meta-analysis for the diagnosis of RLS in PD patients. Int J Neurosci. 2019;129:995–1003. https://doi.org/10.1080/00207454.2019.1608200.

    Article  CAS  PubMed  Google Scholar 

  37. Li M, Li X, Lu Y. Obstructive sleep apnea syndrome and metabolic diseases. Endocrinology. 2018;159:2670–5. https://doi.org/10.1210/en.2018-00248.

    Article  CAS  PubMed  Google Scholar 

  38. Littner MR, et al. Practice parameters for the dopaminergic treatment of restless legs syndrome and periodic limb movement disorder. Sleep. 2004;27:557–9. https://doi.org/10.1093/sleep/27.3.557.

    Article  PubMed  Google Scholar 

  39. Moldofsky H. Sleep and pain. Sleep Med Rev. 2001;5:385–96. https://doi.org/10.1053/smrv.2001.0179.

    Article  PubMed  Google Scholar 

  40. Morin CM. Insomnia: psychological assessment and management. New York: Guilford Press; 1993.

    Google Scholar 

  41. Mustafa M, et al. Frequency of sleep disorders in patients with rheumatoid arthritis. Open Access Rheumatol. 2019;11:163–71. https://doi.org/10.2147/OARRR.S201556.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131:485–91. https://doi.org/10.7326/0003-4819-131-7-199910050-00002.

    Article  CAS  PubMed  Google Scholar 

  43. Olmos SR. Comorbidities of chronic facial pain and obstructive sleep apnea. Curr Opin Pulm Med. 2016;22:570–5. https://doi.org/10.1097/MCP.0000000000000325.

    Article  PubMed  Google Scholar 

  44. Pajediene E, Bileviciute-Ljungar I, Friberg D. Sleep patterns among patients with chronic fatigue: a polysomnography-based study. Clin Respir J. 2018;12:1389–97. https://doi.org/10.1111/crj.12667.

    Article  CAS  PubMed  Google Scholar 

  45. Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ. 2006;332:1134–8. https://doi.org/10.1136/bmj.332.7550.1134.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Purabdollah M, Lakdizaji S, Rahmani A, Hajalilu M, Ansarin K. Relationship between sleep disorders, pain and quality of life in patients with rheumatoid arthritis. J Caring Sci. 2015;4:233–41. https://doi.org/10.15171/jcs.2015.024.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Roehrs T, Diederichs C, Gillis M, Burger AJ, Stout RA, Lumley MA, Roth T. Nocturnal sleep, daytime sleepiness and fatigue in fibromyalgia patients compared to rheumatoid arthritis patients and healthy controls: a preliminary study. Sleep Med. 2013;14:109–15. https://doi.org/10.1016/j.sleep.2012.09.020.

    Article  PubMed  Google Scholar 

  48. Sandberg JC, Grzywacz JG, Talton JW, Quandt SA, Chen H, Chatterjee AB, Arcury TA. A cross-sectional exploration of excessive daytime sleepiness, depression, and musculoskeletal pain among migrant farmworkers. J Agromed. 2012;17:70–80. https://doi.org/10.1080/1059924X.2012.626750.

    Article  Google Scholar 

  49. Sanford SD, Lichstein KL, Durrence HH, Riedel BW, Taylor DJ, Bush AJ. The influence of age, gender, ethnicity, and insomnia on Epworth sleepiness scores: a normative US population. Sleep Med. 2006;7:319–26. https://doi.org/10.1016/j.sleep.2006.01.010.

    Article  PubMed  Google Scholar 

  50. Seidel S, et al. Quality of sleep, fatigue and daytime sleepiness in migraine—a controlled study. Cephalalgia. 2009;29:662–9. https://doi.org/10.1111/j.1468-2982.2008.01784.x.

    Article  CAS  PubMed  Google Scholar 

  51. Shaver JL. Women and sleep. Nurs Clin N Am. 2002;37:707–18. https://doi.org/10.1016/S0029-6465(02)00033-6.

    Article  Google Scholar 

  52. Shechter A, Boivin DB. Sleep hormones, and circadian rhythms throughout the menstrual cycle in healthy women and women with premenstrual dysphoric disorder. Int J Endocrinol. 2010;2010:259345. https://doi.org/10.1155/2010/259345.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Stewart R, et al. Insomnia comorbidity and impact and hypnotic use by age group in a national survey population aged 16 to 74 years. Sleep. 2006;29:1391–7. https://doi.org/10.1093/sleep/29.11.1391.

    Article  PubMed  Google Scholar 

  54. Takahashi M, Iwakiri K, Sotoyama M, Hirata M, Hisanaga N. Arm pain and daytime sleepiness among nursing home employees. Ind Health. 2006;44:669–73. https://doi.org/10.2486/indhealth.44.669.

    Article  PubMed  Google Scholar 

  55. Tang NK, Wright KJ, Salkovskis PM. Prevalence and correlates of clinical insomnia co-occurring with chronic back pain. J Sleep Res. 2007;16:85–95. https://doi.org/10.1111/j.1365-2869.2007.00571.x.

    Article  PubMed  Google Scholar 

  56. Viola-Saltzman M, Watson NF, Bogart A, Goldberg J, Buchwald D. High prevalence of restless legs syndrome among patients with fibromyalgia: a controlled cross-sectional study. J Clin Sleep Med. 2010;6:423–7.

    Article  Google Scholar 

  57. Wang H, Hui X, Ha L, Zhao B, Yao Q. The efficacy and safety of moxibustion for primary dysmenorrhea: a systematic review protocol. Medicine. 2019;98:e18133. https://doi.org/10.1097/MD.0000000000018133.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Wei Y, et al. Extracts of compound Muniziqi granule suppressed uterus contraction and ameliorated oxytocin-induced primary dysmenorrhea. J Ethnopharmacol. 2018;223:33–40. https://doi.org/10.1016/j.jep.2018.05.024.

    Article  PubMed  Google Scholar 

  59. Woosley JA, Lichstein KL. Dysmenorrhea, the menstrual cycle, and sleep. Behav Med. 2014;40:14–211. https://doi.org/10.1080/08964289.2013.829020.

    Article  PubMed  Google Scholar 

  60. Wu M, Li X, Feng B, Wu H, Qiu C, Zhang W. Poor sleep quality of third-trimester pregnancy is a risk factor for postpartum depression. Med Sci Monit. 2014;20:2740–5. https://doi.org/10.1259/MSM.891222.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Yazar HO, Yazar T, Yildirim T, Keşkek A, Altunkaynak Y. Assessment of serum uric acid levels in patients with restless legs syndrome. Acta Neurol Belg. 2019;119:461–6. https://doi.org/10.1007/s13760-019-01177-5.

    Article  PubMed  Google Scholar 

  62. Yoshihisa A, et al. Prognostic impact of restless legs syndrome on patients with heart failure. Int Heart J. 2019;60:1098–105. https://doi.org/10.1536/ihj.19-049.

    Article  CAS  PubMed  Google Scholar 

  63. Zhu X-Y, et al. Correlates of nonanemic iron deficiency in restless legs syndrome. Front Neurol. 2020;11:298. https://doi.org/10.3389/fneur.2020.00298.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

Authors

Contributions

The authors declares that all authors substantially contribute to the writing. Conceptualization: İÇ, MH, MDÇ; methodology: İÇ, MH, MDÇ, TO; formal analysis and investigation: MH, MDÇ, TO; writing—original draft preparation: İÇ, MH; writing—review and editing: İÇ, MH, MDÇ, TO; resources: İÇ, MH, MDÇ; supervision: TO.

Corresponding author

Correspondence to İbrahim Çaltekin.

Ethics declarations

Conflict of interest

All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and the authors declare that they have no conflict of interest.

Ethical approval

The University School of Medicine Ethics Committee approved the study protocol (protocol number: 2017-KAEK-189_2019.10.16_09) and all of the participants provided written informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Çaltekin, İ., Hamamcı, M., Demir Çaltekin, M. et al. Evaluation of sleep disorders, anxiety and depression in women with dysmenorrhea. Sleep Biol. Rhythms 19, 13–21 (2021). https://doi.org/10.1007/s41105-020-00283-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41105-020-00283-9

Keywords

Navigation