SUEÑO Y MUJER
Las diferencias entre hombres y mujeres van más allá de las condiciones físicas o las cargas sociales, pues todas ellas influyen en el descanso, elemento fundamental en nuestra calidad de vida. Se ha demostrado que las mujeres duermen menos horas que los hombres. Teniendo en cuenta que la falta de sueño es la principal causa de la falta de concentración, errores laborales, el aumento de enfermedades o incluso de peso, conocer las causas puede servirnos para mitigar esta situación.
Durante la vida de la mujer ocurren cambios asociados con las variaciones hormonales, fundamentalmente estrógenos y progestágenos, que determinan un patrón cíclico asociado a la menstruación, aumento durante el embarazo retornando después del parto y disminuyendo en la perimenopausia y menopausia. El sueño puede estar influenciado por estos cambios del ciclo de la mujer.
Comparando con los hombres, las mujeres tienen mayores quejas de sueño insuficiente o no restaurador y reportan mayor necesidad de horas de sueño.
Sueño y ciclo menstrual
El ciclo menstrual dura usualmente de 28 a 30 días, está dividido en dos fases y cada una de ellas perdura entre 14 y 15 días. La etapa inicial, folicular, comienza el día uno de la menstruación y la hormona que predomina es el estrógeno. La segunda etapa, la lútea, comienza con la ovulación que coincide con el pico de los niveles de estrógenos y progestágenos que luego disminuyen hasta la menstruación.
Los síntomas negativos relacionado con la menstruación se observan al final de la fase lútea y en los primeros días de la menstruación, que coincide con los niveles hormonales más bajos del ciclo menstrual.
La calidad de sueño empeora inmediatamente antes y durante los primeros días de la menstruación. Los disturbios del sueño como despertares más frecuentes, somnolencia diurna y fatiga estarían asociadas a los dolores abdominales, cefalea, tensión mamaria, sensación de sangrado y cambios en el humor. A pesar de las quejas subjetivas de los disturbios del sueño, la arquitectura de sueño y los ritmos circadianos permanecen relativamente estables a lo largo del ciclo menstrual.
Las mujeres debemos considerar que hay una relación temporal de las quejas de sueño con las fases del ciclo menstrual y reconocer que en la mayoría de los casos esto es una condición natural. En caso de ser necesario podría ser beneficioso incrementar las horas de descanso durante estos días.
Sueño durante el embarazo
Durante el embarazo, la cantidad de horas de sueño necesarias se incrementan en el primer trimestre y disminuyen hacia el final del mismo. La fragmentación del sueño es común durante el embarazo, fundamentalmente durante el tercer trimestre y en la mayoría de los casos está relacionado con cambios fisiológicos como inconfort músculo-esquelético, tensión mamaria, acidez, náuseas, micción nocturna frecuente, contracciones uterinas y movimientos fetales. Aunque la alteración del sueño está relacionada en muchos casos con estos cambios, diferenciar entre un sueño normal de uno patológico es un desafío.
El embarazo puede predisponer el desarrollo de disturbios del sueño y además puede exacerbar condiciones preexistentes como apneas del sueño, piernas inquietas, insomnio, y narcolepsia.
Hay que tener en cuenta que la falta de sueño se asocia a resultados adversos como depresión, parto pretérmino y fatiga. Por lo tanto, el manejo de los trastornos del sueño juega un papel importante en la salud y bienestar de la embarazada y el feto.
Probablemente la interrupción del sueño durante el embarazo no siempre sea reconocida por las mujeres. Por lo tanto, es importante que el médico de atención primaria pregunte al respecto y evalúe si es necesario una intervención.
Sueño durante la perimenopausia y menopausia
La menopausia se define como el cese de la menstruación. La perimenopausia es un período de transición durante el cual ocurren cambios en la frecuencia y duración del ciclo menstrual secundario a la disminución de los niveles de los estrógenos y progestágenos, puede durar años previo a la menopausia.
Las quejas frecuentes durante este período incluyen los sofocos, sudoración nocturna, ganancia de peso, fatiga, somnolencia diurna, sequedad vaginal y aumento de la frecuencia miccional.
Los sofocos se caracterizan por episodios de calor facial y torácico asociado con sudoración y enrojecimiento de la piel. Cuando ocurren durante el sueño pueden alterarlo, ocasionando disminución del tiempo total de sueño por aumento de los despertares.
Otros factores que pueden ser la causa de la pobre calidad de sueño son los trastornos clínicos comórbidos (ej. Dolor crónico); psiquiátricos (ej. Depresión) y trastornos primarios del sueño como apneas del sueño.
En caso de presentar alteraciones del sueño en esta etapa de la vida, es primordial reconocer que hay factores hormonales que pueden ocasionarlo, y por consiguiente la consulta con el médico permitiría identificar estos trastornos y mediante una intervención adecuada mejorar el sueño.
Conclusión:
El patrón hormonal cambiante a lo largo de la vida reproductiva de la mujer, desde la pubertad hasta los años postmenopáusicos, tienen una importante influencia en el sueño. Es importante identificar sus trastornos y optimizar el tratamiento dado que el sueño es fundamental en la salud y bienestar de la mujer.
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