Sleep EEG studies during early and late partial sleep deprivation in premenstrual dysphoric disorder and normal control subjects

Parry et al. found increases in REM sleep onset latency and stage 1 sleep, and decreases in REM sleep and stage 3 sleep during the late luteal phase compared with the mid-follicular phase in healthy controls.

“The results from eighteen healthy controls studied by Parry et al. at the mid-FP and late-LP as part of a larger study of sleep in PMDD found increases in ROL (min) and stage 1 sleep (%), and decreased REM sleep (min) and stage 3 (min and %) during the late-LP compared to the mid-FP [52].”

In healthy women, sleep homeostasis and sleep quality remain stable at different menstrual phases, while sleep architecture shows observable changes.

“These have indicated that while sleep homeostasis [49, 51, 55] and quality [43, 49, 52] remain stable at different menstrual phases, there are observable changes in sleep architecture [49, 51–53]”

A sleep restriction study in PMDD patients demonstrated a significant correlation between increasing REM sleep and improved mood.

“Interestingly, a sleep restriction study in PMDD patients [52] (see Section 9.2) demonstrated a significant correlation between increasing REM sleep and improved mood, which implies that the reduced REM sleep sometimes observed in PMDD patients may contribute to symptom development.”

A larger study with 23 PMDD patients and 18 controls showed no intergroup differences, though significant menstrual phase effects were noted: in both groups, REM sleep onset latency increased and REM sleep and stage 3 sleep decreased in the luteal phase compared with the follicular phase.

“A larger study with 23 PMDD patients and 18 controls also showed no intergroup differences, though significant menstrual phase effects were noted. In both groups, ROL (min) was increased, while REM sleep (min) and stage 3 (min and %) were decreased in the LP compared to the FP [52].”

Reduced REM sleep sometimes observed in PMDD patients may contribute to symptom development.

“which implies that the reduced REM sleep sometimes observed in PMDD patients may contribute to symptom development.”

Compared to baseline late luteal phase, both early sleep deprivation and late sleep deprivation were effective in improving sleep quality in PMDD patients during a night of recovery sleep in the luteal phase.

“A study by Parry et al. demonstrated that, compared to baseline late-LP, both early-SD and late-SD were effective in improving sleep quality in PMDD patients during a night of recovery sleep in the LP. Reference [52]”

During recovery sleep after early or late sleep deprivation in the luteal phase, PMDD patients showed increased total sleep time, sleep efficiency, slow-wave sleep, and REM sleep, and decreased sleep onset latency, REM onset latency, wake after sleep onset, stage 1 sleep, and stage 2 sleep percentage.

“Total sleep time, SE (%), SWS (min), and REM sleep (min and %) were increased, whereas SOL (min), ROL (min), WASO, stage 1 sleep (min and %), and stage 2 sleep (%) were decreased.”

Responders in the study showed improved mood scores during the luteal phase after early sleep deprivation, which were significantly correlated with changes in REM sleep and REM onset latency.

“Responders in this study showed improved mood scores during the LP after early-SD, which were significantly correlated with changes in REM sleep and ROL, indicating REM parameters to be important for the therapeutic effects of SD.”

The therapeutic effects of sleep deprivation were only studied during experimental nights and at a single recovery night, so the duration of improvement is unknown.

“The therapeutic effects of SD, however, were only studied during experimental nights and at a single recovery night [52]; therefore the duration of improvement in response to such a treatment is unknown.”

Women with PMS/PMDD have shown decreases in REM sleep during the luteal phase compared to the follicular phase.

“Similarly, women with PMS/PMDD have also shown decreases in REM sleep [52, 56] and increases in SFA [55] during the LP compared to the FP.”

The most consistently observed menstrual cycle-related change in the sleep profile of healthy women is a reduction of REM sleep.

“The most consistently observed menstrual cycle-related changes in the sleep profile of healthy women are a reduction of REM sleep [49, 51–53, 56], with a maintenance of homeostatic sleep mechanisms throughout the cycle [90], and a robust variation of SFA across the menstrual cycle [48, 49, 55], which increases in association with progesterone during the LP.”

Nonpharmacological therapies for PMDD symptoms which target the sleep-wake cycle and circadian rhythms, such as phototherapy and sleep deprivation, are often effective in improving mood and sleep quality in these patients.

“Finally, nonpharmacological therapies for PMDD symptoms which target the sleep-wake cycle and circadian rhythms, such as phototherapy [110–112] and sleep deprivation [52, 65, 113, 114], are often effective in improving mood and sleep quality in these patients.”