Endometriosis And Sleep

Introduction

Endometriosis is one of the gynaecological diseases with the highest impact on people assigned female at birth that are of reproductive age.¹ This condition can significantly impact the daily life of those who suffer from it due to the symptoms they experience daily. Endometriosis impacts the patients physically, inducing pain and other debilitating symptoms, but also psychologically. These symptoms can often cause problems with sleep. However, this sleep disorder can be treated in various ways.¹

What is endometriosis?

Endometriosis is one of the most common diseases in people AFAB, affecting approximately 10% of them.¹ This disease occurs when endometrial glands and stromal tissue, which typically line the uterus, develop outside of it. In turn, this triggers a chronic inflammatory  reaction in the pelvis, causing pain and, in some cases, even forming scar tissue.²

This condition affects people AFAB of reproductive age, which typically extends from approximately 14 to 45 years.¹ Given that this is a chronic disease, it is necessary for doctors to create a treatment plan that not only addresses the immediate needs of the patient but also their long-term objectives in terms of quality of life and fertility. 

Symptoms

Endometriosis can present in a variety of ways as symptoms can differ significantly between patients. It is important to emphasise  that the frequency and severity of these symptoms  aren’t directly associated with  the amount of endometriosis that is formed. In fact, many people can suffer from this condition and remain asymptomatic. 

However, there are a series of  symptoms that are common amongst people with endometriosis.² including:   

• Painful menstruation (dysmenorrhea)
• Pain during or after intercourse (dyspareunia)
• Painful urination (dysuria)
• Painful defecation (dyschezia)
• Pain in the lower back and  abdominal region, especially during your period
• Chronic pelvic pain, that is, pain in the pelvic and abdominal regions that lasts at least six months
• Feeling ill during your period
• Constipation, diarrhoea or presence of blood in your urine or feces during your period

Fertility issues Additionally, endometriosis  is also associated with psychological symptoms in some patients,³ including:

• Anxiety
• Bipolar disorder
• Depression
• Stress
• Decreased quality of life
• Fatigue
• Insomnia

Overall, endometriosis can cause an array of  consequences for  people AFAB who suffer from it,  including infertility.³

While this is a chronic disease without a cure, endometriosis can be treated. As mentioned previously, treatment depends on the patient’s condition, their immediate symptoms and their long-term objectives, all of which have to be carefully considered by the  doctors who organise  the treatment plan.²

Lack of sleep and endometriosis can cause a cycle

​​Taking into account the above, we can affirm that endometriosis can lead to a lack of sleep. However, that can, in turn, also trigger and worsen the symptoms associated with this disease, creating a vicious cycle. Understanding this relationship and how endometriosis and sleep impact each other is essential to determine how to break this cycle. 

Sleep problems are a common side effect of endometriosis

As mentioned previously, sleep disturbance is one of the possible consequences of endometriosis. In general, any condition associated with pain can affect sleep, so it’s not hard to imagine how patients afflicted with severe pain caused by endometriosis can suffer from sleep disturbances. 

Many studies have found a causal relationship between endometriosis and insomnia and have linked this disease not only to lack of sleep but also to lower quality of sleep and difficulties falling asleep.⁴

While the exact mechanism behind this association hasn’t been deciphered, it’s thought that it may be due related to the hormonal alterations caused by endometriosis.⁵

Lack of sleep may also be caused by the psychological problems associated with endometriosis. Indeed, most of the symptoms described as psychological consequences of this disease influence the production of melatonin, which is vital to induce sleep and regulate the circadian rhythm, and therefore may cause insomnia in people with endometriosis. 

Poor sleep can flare up symptoms of endometriosis

On the other hand, sleep and melatonin also have an impact on endometriosis and its symptoms. 

This again relates to the body's melatonin level, which is typically altered when people suffer from sleep disorders. Studies have shown that changes to the organism’s level of melatonin can worsen the symptoms associated with endometriosis, given that melatonin helps regulate inflammation and influences the body’s immune response to stress.⁴

Suppose that a patient is suffering from a significant lack of sleep and that, as a result, their body produces less melatonin. A low level of this hormone will affect the hormonal cycle and cause more inflammation, enabling or even triggering more pain and leading to disease progression.^1,5

Ways to improve sleep when struggling with an endometriosis flare up

Considering the vital role that sleep plays in our physical and physiological health, it is fundamental to find ways to improve it when patients struggle with an endometriosis flare-up. 

As mentioned, a vicious cycle  can form between the symptoms associated with endometriosis and a lack of quality sleep. As such, to tackle this issue, it’s important to adopt strategies that both alleviate endometriosis symptoms and that help improve sleep directly.

There are several strategies that can be used to help ease the symptoms associated with endometriosis, especially pain, including:

• Heat in the form of hot water bottles, hot baths or something similar
• Physiotherapy and exercise, to help strengthen the muscles in the pelvic region, reduce pain, and ease stress and anxiety
• Transcutaneous Electrical Nerve Stimulator (TENS) machines which send electrical pulses into the body, blocking pain and triggering the production of endorphins
• Painkillers like ibuprofen and paracetamol
• Hormone medicines and contraceptives, which help regulate hormones associated with this disease
• Surgery to remove endometriosis tissue, scar tissue, or even the organs affected by endometriosis

On the other hand, it can also be useful to make changes to your sleeping habits that can directly help improve your sleep, such as:

• Create a routine with strict times to go to bed and wake up
• Invest in relaxing activities like taking a bath, especially in the hour immediately before going to sleep
• Avoid using technological devices in the hour before going to bed
• Create a comfortable environment to sleep in that is dark and quiet
• Exercise throughout the day
• Avoid heavy meals, exercise and substances like alcohol, nicotine or coffee at least six hours before going to bed

Certain substances and medications, often referred to as “sleeping aids”, can also help sleep better., For examples, as mentioned before,it can be beneficial to raise the body’s melatonin levels when experiencing trouble sleeping. Some studies have shown that supplementation with melatonin helps diminish pain and improve sleep for some patients with endometriosis.⁵

While some of the strategies highlighted can help break this cycle and improve sleep for people with endometriosis, if this issue becomes persistent or severe, it may be necessary to consult a doctor to obtain a professional opinion and elaborate a medical plan to help treat these symptoms.^3,5

Conclusion

Endometriosis is a common disease amongst people AFAB of reproductive age. This disease has several physical and psychological symptoms, including insomnia. Given that the production of melatonin is associated with sleep and this hormone plays a key role as an antioxidant and anti-inflammatory agent, its absence can lead to more significant inflammation and, therefore, worsen the symptoms of endometriosis. As such, strategies like taking melatonin supplements may help solve sleep problems for people with endometriosis; however, it may be necessary for patients  to consult with a doctor to elaborate an individualized treatment plan.