Jun 03, 2010
Mother's Day has come and gone, and despite the short respite that many mothers received from their loved ones, most mothers are in a constant state of exhaustion. There are many explanations for why this is so, including the demands of modern society, family, career, and so on. But as many fathers will argue, these are the same issues and challenges they face. For women however, there are a number of internal, or physiologic factors that can not only contribute to but sometimes cause women, more so than men, in general to be tired all the time.
Blame It On Hormones…Or Your Anatomy?
We all know about hormonal issues, which has been blamed for everything from PMS and menopause to infertility issues. But one relatively unknown fact that most doctors don't know about is that progesterone is an upper airway muscle dilator. Essentially, it stimulates the tongue, giving it more muscle tone. How is this relevant to how much energy you have?
Modern humans have a number of anatomic issues that makes us predisposed to breathing pauses at night, especially when in deep sleep, due to muscle relaxation. Since our voice boxes are lower in the neck beneath the tongue, our tongues can fall back easily due to gravity, especially when on our backs. Add REM sleep (the dreaming stage) along with muscle relaxation, and the more likely you may stop breathing.
Modern humans are thought to have shrinking jaws with dental crowding due to a major shift in our diets. We went from eating completely off the land (ripping, shredding, grinding, chewing) to eating soft, mushy foods with relatively little nutritional value. Bottle-feeding (another modern, Western invention) is also thought to aggravate dental crowding and malocclusion. The smaller the jaws, the less room there is for the normal-sized tongue, which predisposes it to breathing obstruction at night.
So the less progesterone you have, the more likely your tongue will relax and obstruct your breathing, causing you to wake up and turn over. This condition prevents you from staying in deep sleep. Most people with this condition will naturally like to sleep on their sides or stomachs to compensate.
Life Changes That Aggravate Deep Sleep Deprivation
There are a number of life changes in a woman's life that promote more frequent obstructions and arousals, leading to increased fatigue and tiredness. During a woman's monthly periods, estrogen and progesterone cycles up and down. The week before she has her period, progesterone drops, leading to a temporary state of deep sleep deprivation, leading to a low-grade state of physiologic stress. This also causes a heightening of the involuntary nervous system, leading to heightened senses, irritability and moodiness.
During pregnancy, progesterone naturally increases significantly. As women gain 20 to 40 pounds during pregnancy, they would be expected to develop sleep apnea, but most don't. One major reason is that progesterone helps to protect the upper airway, by tensing the tongue, despite the added throat narrowing from weight gain. But once mom delivers, progesterone drops, and she's left with all the weight. This only adds to the chronic fatigue, depression and problems with weight loss in the post-partum period for most women.
Similarly, long before menopause begins, progesterone begins to slowly drop beginning the late 30s and early 40s. This leads to a slow and gradual lessening of the woman's sleep efficiency. Later on as the drop intensifies, the relative changes in the involuntary nervous system causes the typical symptoms of menopause such as night sweats, hot flashes, mood swings, weight gain and irritability. Once the hormonal changes stabilize, the symptoms get better.
The Effect of Estrogen Dominance
Like everything else in life, balance is key. The relative proportions between estrogen and progesterone has a huge impact on a woman's sleep quality. With the advances in science, medicine, and industrialization, this delicate balance between these two hormones has been significantly altered.
One major shift comes from oral contraceptives. Despite the potential benefits of birth control pills, having excess estrogen of any type can suppress progesterone levels or functional status. Synthetic variants of estrogen are much more powerful than what the body normally makes. There are various combinations of synthetic and bio-identical estrogens and progesterones that are used, but it's safe to say that the overall relative balance is never perfect.
In addition, many of the byproducts of industrialization produces chemicals that can mimic estrogen. Up until recently, Bisphenol-A (or BPA) has been used in plastics that are found in most plastics, including baby bottles. BPA and many other chemicals are though to leech into our environment, acting as endocrine disruptors. There are various reports of earlier onset of puberty and breast development (premature thelarche) in young girls compared with even 10 years ago.
Blame It on Stress
One of the major consequences of inefficient sleep is a physiologic form of stress. Your body thinks it's under attack all the time. This causes hormonal and neurologic changes that not only increases cortisol, it also heightens your involuntary nervous system. It also makes you more hungry in general, with cravings for fatty, sugary or high-carb foods. This can lead to weight gain, which is hard to get rid of since you're not sleeping well.
Your body also doesn't care where stress comes from. Modern life is full of stresses including family and career obligations, along with the typical financial and health considerations. Any degree of external stress whether it's physical, psychological or emotional stress, can also aggravate any internal stress that's going on.
This is why you should do whatever you can do to help your mother feel loved and more relaxed. Mothers have lots of reasons to feel stressed, sleep deprived, and just plain tired all the time. Now you know the reason why.
Steven Y. Park, MD is a surgeon and author of the book, Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired. Endorsed by New York Times best-selling authors Christiane Northrup, M.D., Dean Ornish, M.D., Mark Liponis, M.D., Mary Shomon, and many others. http://doctorstevenpark.com