Martha J. Lentz

The new woman: Health‐promoting and health‐damaging behaviors

Compared with their mothers, contemporary women are better educated, live alone more of their adult lives, and participate in the labor force more consistently throughout their lives. Most studies of the New Woman have focused on the effects of the configuration of her roles on her health and health-related behavior. Few have considered both the influence of womens roles and the broader context of their lives on their health. Moreover, investigators have devoted little attention to the health behavior patterns of the New Woman, despite the demonstrable impact of health-related behaviors on mortality and morbidity. The present study was designed to test models relating womens roles, gender role norms, social demands and resources, and health-promoting and -damaging behaviors. Women who resided in middle-income and racially mixed neighborhoods (N = 659) were interviewed in their homes. The women were a mean age of 32.7 years and had an educational level of 14.2 years. Approximately 57% were married or partnered, and 76% reported some level of employment outside the home. Women who had fewer life stressors and were better educated performed more health-promoting behaviors. Women who experienced more stressors, were less well educated, had more contemporary attitudes toward women, were not partnered, or experienced depressed mood engaged in more health-damaging behaviors. These results underscore the importance of considering womens social context in health promotion efforts and as a deterrent to health-damaging behaviors.

Stress exposure, psychological distress, and physiological stress activation in midlife women with insomnia

Objective The objective of this study was to describe perceived and polysomnograhic (PSG) sleep patterns and determine whether stress exposure, psychological distress, and physiological stress activation differed among midlife women with psychophysiologic-type (PP-type) or subjective only-type (SO-type) insomnia or no insomnia. Methods Women had their sleep monitored, collected urine samples, and completed questionnaires in a week-long field study, and 53 women met criteria for insomnia types or no insomnia based on reported sleep quality and PSG sleep efficiency. Results As expected, women with PP-type insomnia were found to have the lowest sleep efficiency, took longer to fall asleep, had more wakefulness after sleep onset, and had more fragmented sleep. Perceptions of stress exposure, either for major or minor events, did not differ among groups. Despite there being no differences in perceived stress exposure, women with both types of insomnia scored higher on psychological distress (SCL-90R), especially on the somatization subscale, than women with no insomnia. Of the physiological stress activation indicators tested, a morning-to-evening difference in urinary cortisol statistically differed across the groups (p < .005). Women in the PP-type insomnia group had the highest levels of urinary cortisol in an early morning urine sample. Conclusions These data provide support for the hypothesis that, in midlife women, cognitive or emotional arousal with chronic stress neuroendocrine activation underlies chronic insomnia, particularly the PP-type.

Sleep, psychological distress, and stress arousal in women with fibromyalgia

The purpose of this investigation was to compare self-reported sleep quality and psychological distress, as well as somnographic sleep and physiological stress arousal, in women recruited from the community with self-reported medically diagnosed fibromyalgia (FM) to women without somatic symptoms. Eleven midlife women with FM, when compared to 11 asymptomatic women, reported poorer sleep quality and higher SCL-90 psychological distress scores. Women with FM also had more early night transitional sleep (stage 1) (p < 0.01), more sleep stage changes (p < 0.03) and a higher sleep fragmentation index (p < 0.03), but did not differ in alpha-EEG-NREM activity (a marker believed to accompany FM). No physiological stress arousal differences were evident. Less stable sleep in the early night supports a postulate that nighttime hormone (e.g., growth hormone) disturbance is an etiologic factor but, contrary to several literature assertions, alpha-EEG-NREM activity sleep does not appear to be a specific marker of FM. Further study of mechanisms is needed to guide treatment options.

Self-reported sleep quality and fatigue correlates with actigraphy in midlife women with fibromyalgia.

BackgroundLimited data are available on the relationship between self-reported sleep quality, fatigue, and behavioral sleep patterns in women with fibromyalgia (FM). ObjectivesTo compare self-reported sleep quality, fatigue, and behavioral sleep indicators obtained by actigraphy between women with FM and sedentary women without pain, and to examine relationships among these variables. MethodsTwenty-three women with FM (M = 47.3, ± 6.7 years) and 22 control women (M = 43.5, ± 8.2 years) wore an actigraph on the nondominant wrist for 3 consecutive days at home. Each day women reported bedtimes, rise times, and ratings of sleep quality and fatigue in a diary. Self-reported sleep quality, fatigue, and indicators of sleep quality obtained from actigraphy (e.g., total sleep time, sleep efficiency, sleep latency, wake after sleep onset, and fragmentation index) were averaged. The Mann Whitney U test was used to assess group differences. Pearson Product Moment Correlation was used to evaluate relationships between sleep quality and fatigue, and among sleep quality, fatigue, and actigraphy sleep indicators. ResultsWomen with FM reported poorer sleep quality and more fatigue compared to controls (both p < .001). Actigraphy sleep indicators were not different between groups. In women with FM but not in controls, self-reported sleep quality was directly related to actigraphy indicators of total sleep time (r = .635, p < .01) and inversely related to sleep fragmentation (r = − .46, p < .05). Fatigue in women with FM was directly related to actigraphy indicators of wake after sleep onset (r = .57, p < .01), and inversely related to sleep efficiency (r = − .545, p < .01). DiscussionSelf-reported sleep quality and fatigue are associated with behavioral indicators of sleep quality at home in women with FM. Actigraphy is a useful objective measure of improved sleep outcomes in intervention studies.

Perceived stress, physiologic stress arousal, and premenstrual symptoms: Group differences and intra‐individual patterns

The purpose of this study was to examine evidence for perceived stress, hypothalamic-pituitary-adrenal, and autonomic nervous system involvement in premenstrual symptoms. Women with a low severity (LS, n = 40), premenstrual syndrome (PMS, n = 22), and premenstrual magnification symptom patterns (PMM, n = 26) rated perceived stress, turmoil, and fluid retention symptoms for one entire cycle. Daily late afternoon urine samples were assayed for epinephrine, norepinephrine, and cortisol. Using multivariate analysis of variance analyses, we found significant group and cycle phase and group by phase interaction effects for perceived stress. There were no group or cycle phase differences in cortisol, epinephrine, and norepinephrine. Intraindividual analyses using cross-correlation techniques revealed a positive time lagged relationship between perceived stress and norepinephrine and cortisol levels across all groups. Only women with a PMS pattern demonstrated perceived stress leading epinephrine levels. Cortisol, epinephrine, and norepinephrine levels led symptoms for all groups with one exception: there was no cross-correlation between epinephrine and turmoil for the PMS group. Perceived stress led both types of symptoms, regardless of group, and symptoms also led stress. The results provide evidence for a unique relationship between epinephrine, perceived stress, and symptoms for women with PMS, and for a reciprocal relationship between stress and symptoms for each of the groups.

Subjective and objective sleep indices in women with irritable bowel syndrome.

Abstract  Patients with irritable bowel syndrome (IBS) commonly report sleep disturbances. This study examined self‐report (Pittsburgh Sleep Quality Inventory) sleep quality and polysomnography (PSG) sleep variables in 18 women with mild‐to‐moderate IBS, 18 with severe IBS and 38 with age‐ and gender‐matched controls. All women were studied on two consecutive nights in a sleep research laboratory where PSG data were collected. Retrospective and daily measures were obtained of self‐reported sleep quality, psychological distress and gastrointestinal symptoms across one menstrual cycle. Self‐report measures of psychological distress and sleep quality were significantly worse in the IBS‐severe (IBS‐S) group compared with controls. Rapid eye movement (REM) latency was higher in the two IBS groups on Night 1 than the control group (P = 0.06). Percentage time in REM was highest in the IBS‐S on Night 2. All groups demonstrated greater sleep disruption on Night 1 (adaptation) when compared with Night 2. These results highlight the importance of considering the ‘first‐night effect’ in those with IBS and the lack of concordance between self‐report and objective indices of sleep in women with IBS.

Time-Series Analysis-Cosinor Analysis: A Special Case

Cosinor analysis provides an accessible means of evaluating and estimating the parameter of a cyclic phenomenon. Cosinor analysis does not require that the data be equal intervals without missing data. Cosinor analysis does require that the data can reasonably be considered to take the form of a deterministic cycle with a known period.

Lifestyle Practices and Nocturnal Sleep in Midlife Women with and without Insomnia

Relationships between common lifestyle practices important to sleep hygiene (e.g., smoking cigarettes, drinking alcohol, ingesting caffeine, exercising, bedtimes, getting-up times) and nocturnal sleep have not been documented for women with insomnia in their home environments. This community-based sample of 121 women, ages 40 to 55 years, included 92 women who had experienced insomnia for at least 3 months and 29womenwith good-quality sleep. Women recorded lifestyle practices and sleep perceptions (time to fall asleep, awakenings during sleep, feeling rested after sleeping, and overall sleep quality) in diaries while undergoing 6 nights of somnographic sleep monitoring at home. Compared to women with good-quality sleep, women with insomnia reported greater nightto-night variation in perceived sleep variables, poorer overall sleep quality (M = 2.8,SD = 0.7 vs.M = 1.9,SD = 0.5,P < 0.05), and longer times to fall asleep (M = 25 min,SD = 14.2 vs.M= 12.9 min,SD = 5.8,P < 0.05). Correlations between mean individual lifestyle practice scores and mean perceived or somnographic sleep variables were low, ranging from 0 to 0.20. An aggregated sleep hygiene practice score was not associated with either perceived or somnographic sleep variables. Regression analysis using dummy variables showed that combinations of alcohol, caffeine, exercise, smoking, and history of physical disease explained 9% to 19% of variance in perceived or somnographic sleep variables. Lifestyle practices, and combinations thereof, do warrant consideration when assessing or treating insomnia, but these data fail to support a dominant relationship between lifestyle practices and either perceived or somnographic sleep variables.

Luteal phase ovarian steroids, stress arousal, premenses perceived stress, and premenstrual symptoms.

The purpose of this study was to examine the relationships among perceived stress, ovarian steroids (estradiol and pregnanediol), stress arousal indicators (cortisol, catecholamines) and premenstrual symptoms (turmoil, fluid retention). Women (N = 74) with low symptom severity (LS), premenstrual syndrome (PMS), or premenstrual magnification (PMM) symptom patterns provided daily urine samples over one cycle and recorded their symptoms and perceived stress levels in a health diary. Multiple regression analysis was used to test models of premenstrual symptoms in separate analyses for women with the LS and PMS symptom patterns and the LS and PMM symptom patterns. Data from the LS and PMS groups revealed that greater stress ratings accounted for turmoil symptoms and higher luteal phase cortisol levels for fluid retention symptoms. For LS and PMM groups, lower luteal phase norepinephrine levels, higher global stress ratings, and a more gradual drop in estradiol premenses accounted for turmoil symptoms. Premenses norepinephrine and epinephrine levels and premenses stress ratings accounted for fluid retention. These findings support an important relationship among perceived stress, stress arousal indicators, and premenstrual symptoms that differs for women with a PMS and PMM symptom pattern.

Self-Report and Polysomnographic Measures of Sleep in Women with Irritable Bowel Syndrome

BACKGROUND Women who report chronic gastrointestinal symptoms compatible with a diagnosis of irritable bowel syndrome (IBS) frequently report sleep disturbances. OBJECTIVES The purposes of this study were to (a) compare self-reported and polysomnographic indicators of sleep quality in women with IBS symptoms (IBS-SX, n= 16) and controls (n= 16); (b) examine the relationship between the indicators of sleep quality; and (c) determine the relationship between sleep indicators and psychological distress. METHOD The women slept in a laboratory for 2 consecutive nights. Polysomnographic measurements were recorded during sleep, and a sleep questionnaire was completed upon awakening each morning. Psychological distress was measured with the Symptom Checklist-90-R during the initial interview. RESULTS Women in the IBS-SX group reported significantly greater numbers of awakenings during sleep (p = .008) and had a longer latency to REM sleep (p = .04) than did the controls. Self-reported and polysomnographic indicators were more highly correlated in the control group than in the IBS-SX group. In the IBS-SX group, the greater the psychological distress, the less alert (rs = .419) and rested (rs = .564) the women felt in the morning and the more time the women spent in stages 3 and 4 sleep (rs = .479) and less in stage 2 (rs = -.447) and REM (rs = -.414) sleep. In the control group, psychological distress was not significantly associated with self-reported measures but was significantly associated with the number of awakenings (rs = .506) and time in stages 3 and 4 sleep (rs = -.677). CONCLUSIONS Although the women in the IBS-SX group reported significantly more awakenings, the weak relationship between self-reported and polysomnographic indicators suggests that clinicians must keep in mind that further assessments may be necessary.