Sleep Quality and the Sleep Electroencephalogram in Women with Severe Premenstrual Syndrome
Open accessAbstract
STUDY OBJECTIVES: Women with severe premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) commonly report sleep disturbances, but the few studies using conventional polysomnographic measures have produced conflicting results. We investigated sleep quality and sleep composition using conventional and quantitative electroencephalographic analyses in women with severe PMS, as compared with that of controls. DESIGN AND PARTICIPANTS: Women (aged 18-40 years) were screened to ensure that their PMS symptoms were severe and that they had ovulatory menstrual cycles. Nine women with PMS or PMDD and 12 asymptomatic control subjects then had laboratory-based polysomnographic recordings at 2 phases of the menstrual cycle: follicular phase and late luteal (premenstrual) phase. RESULTS: Women with severe PMS reported a significantly poorer subjective sleep quality during the late luteal phase (P = 0.02), but there was no evidence of disturbed sleep based on the polysomnogram specific to premenstrual symptom expression: both groups of women had increased wakefulness after sleep onset (P = 0.02) and increased sigma power (P < 0.01), especially in the 14-to 15-Hz band during non-rapid eye movement sleep, in the late luteal phase compared with the follicular phase. There were, however, some group differences in electroencephalographic measures regardless of menstrual phase, including decreased delta incidence (P = 0.02) and increased theta incidence and amplitude (P < 0.05) in women with PMS, suggesting the possibility of sleep electroencephalogram trait markers in women with PMS. CONCLUSION: Perceived poor quality sleep is a characteristic of severe PMS, but sleep composition based on polysomnographic measures and quantitative electroencephalographic analysis does not differ in association with premenstrual symptom expression in the late luteal phase.
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The prominent increase in sleep spindle frequency activity during the luteal phase is the most characteristic menstrual cycle-associated sleep change.
“The effects of menstrual phase on quantitative sleep EEG have been investigated by a few groups, yet results indicate a very consistent pattern of findings, making the prominent increase in SFA during the LP the most characteristic menstrual cycle associated sleep change [48, 49, 55]”
From Sleep, hormones, and circadian rhythms throughout the menstrual cycle in healthy women and women with premenstrual dysphoric disorder (2010) · cites this paper as [55]
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]”
From Sleep, hormones, and circadian rhythms throughout the menstrual cycle in healthy women and women with premenstrual dysphoric disorder (2010) · cites this paper as [55]
Healthy women had significantly increased wake after sleep onset and microarousals per hour during the late luteal phase compared with the mid-follicular phase, with no other significant changes between menstrual phases.
“Baker et al. reported that healthy women had significantly increased WASO (min) and microarousals per hour during the late-LP compared to the mid-FP, with no other significant changes observed between menstrual phases [55].”
From Sleep, hormones, and circadian rhythms throughout the menstrual cycle in healthy women and women with premenstrual dysphoric disorder (2010) · cites this paper as [55]
Baker et al. found that healthy women had significantly increased sleep spindle frequency activity during the late luteal phase compared with the mid-follicular phase, with the most prominent peak in the 14.25-15.00 Hz bin.
“Finally, in the recent study by Baker et al., healthy women showed significantly increased SFA (12–15 Hz) during the late-LP compared to the mid-FP, with the most prominent peak again occurring in the 14.25–15.00 Hz bin specifically [55].”
From Sleep, hormones, and circadian rhythms throughout the menstrual cycle in healthy women and women with premenstrual dysphoric disorder (2010) · cites this paper as [55]
PMS/PMDD women demonstrated a menstrual variation for sleep spindle frequency activity, with marked increases during the late luteal phase.
“Similar to what has been shown for healthy controls, PMS/PMDD women demonstrated a menstrual variation for SFA (12–15 Hz), with marked increases during the late-LP.”
From Sleep, hormones, and circadian rhythms throughout the menstrual cycle in healthy women and women with premenstrual dysphoric disorder (2010) · cites this paper as [55]
PMS/PMDD women had increased wake after sleep onset and microarousals per hour during the luteal phase compared with the follicular phase, indicating more disturbed sleep during the symptomatic phase, but results were not different from healthy controls.
“PMS/PMDD women were found to have increased WASO (min) and microarousals per hour during the LP compared to the FP, indicating more disturbed sleep during this symptomatic phase, but in that study, results were not different than healthy controls [55].”
From Sleep, hormones, and circadian rhythms throughout the menstrual cycle in healthy women and women with premenstrual dysphoric disorder (2010) · cites this paper as [55]
Compared with controls, PMS/PMDD women showed a trend for increased EEG activity in the 12-13 Hz range.
“Interestingly, compared to controls, these women showed a trend for increased EEG activity in the 12-13 Hz range [55].”
From Sleep, hormones, and circadian rhythms throughout the menstrual cycle in healthy women and women with premenstrual dysphoric disorder (2010) · cites this paper as [55]
Women with severe PMS and healthy controls both experienced similar increases in wake after sleep onset and microarousals per hour during the late luteal phase compared with the follicular phase.
“Results from this comparative study showed that women with severe PMS and healthy controls both experienced similar increases in WASO (min) and microarousals per hour during the late-LP compared to the FP.”
From Sleep, hormones, and circadian rhythms throughout the menstrual cycle in healthy women and women with premenstrual dysphoric disorder (2010) · cites this paper as [55]
Compared with controls, PMS/PMDD women showed increased REM sleep onset latency in both menstrual phases.
“Compared to controls, PMS/PMDD women showed increased ROL (min) in both menstrual phases.”
From Sleep, hormones, and circadian rhythms throughout the menstrual cycle in healthy women and women with premenstrual dysphoric disorder (2010) · cites this paper as [55]
SFA increases in association with progesterone during the luteal phase.
“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.”
From Sleep, hormones, and circadian rhythms throughout the menstrual cycle in healthy women and women with premenstrual dysphoric disorder (2010) · cites this paper as [55]
Women with PMS/PMDD have shown increases in SFA 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.”
From Sleep, hormones, and circadian rhythms throughout the menstrual cycle in healthy women and women with premenstrual dysphoric disorder (2010) · cites this paper as [55]
There is a robust variation of SFA across the menstrual cycle.
“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.”
From Sleep, hormones, and circadian rhythms throughout the menstrual cycle in healthy women and women with premenstrual dysphoric disorder (2010) · cites this paper as [55]
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- Authors
- Baker, F. C., Kahan, T. L., Trinder, J., & Colrain, I. M.
- Affiliations
- SRI International (US)
- Santa Clara University (US)
- The University of Melbourne (AU)
- Corresponding author
- Baker, Fiona C.
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-10
- Volume
- 30
- Issue
- 10
- Pages
- 1283-1291
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- PMC
- PMC2266284
- OpenAlex
- W1601669038
- Cited by
- 146
- References
- 44
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 10 · 2023: 13 · 2022: 5 · 2021: 5 · 2020: 12 · 2019: 7 · 2018: 10 · 2017: 7 · 2016: 8 · 2015: 6 · 2014: 11 · 2013: 8 · 2012: 11
- FWCI
- 5.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- SLEEP (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Scholar Commons (Santa Clara University) (submittedVersion)
- Funders
- University of Pennsylvania
- University of Virginia
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U54HD028934, U54-HD-28934)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Menstrual Health and Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- premenstrual syndrome, premenstrual dysphoric disorder, sleep quality, sleep EEG, sleep architecture, menstrual cycle, luteal phase, wake after sleep onset, sigma power, theta activity, subjective sleep quality
- MeSH terms
- Adult, Affect, Analysis of Variance, Electroencephalography, Female, Humans, Premenstrual Syndrome, Quality of Life, Severity of Illness Index, Sleep Wake Disorders, Women's Health, Polysomnography
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