A Link Between Endometriosis and Sleep Apnea?

Endometriosis is a common condition that's estimated to occur in about 5 to 10% of all women. It's characterized by pelvic and abdominal pain, along with infertility, and not too surprisingly, hypothyroidism, chronic fatigue syndrome, fibromyalgia, autoimmune conditions, allergies and asthma. 

 

Does this list sound familiar? Right — upper airway resistance syndrome (UARS). Doing some more research, I came across a health-related website (CureTogether.com, an open source health research site) that anonymously aggregates patients' symptoms and and other conditions to give you statistical data. Here are the top symptoms and the top associated conditions for endometriosis.

 

If you look down the list of associated conditions, many are also seen in patients with UARS. Since endometriosis is more commonly seen in women during the reproductive years, you may not see obstructive sleep apnea as often. I'm willing to bet that many of these women will go on to develop obstructive sleep apnea, especially when much older and if they gain weight after menopause. If you look at their parents, one or both parents will snore heavily. In addition, Raynaud's (cold hands for feet) is also a common feature in both endometriosis and UARS.

 

Knowing that upper airway resistance syndrome can cause profound changes in women's physiology, all these findings are not surprising.

 

Do you or anyone you know have endometriosis? If so, how many of the above symptoms or conditions do you see? Please enter your observations in the comments box below.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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10 thoughts on “A Link Between Endometriosis and Sleep Apnea?

  1. Wow, there's an association I wouldn't have thought of.  But I wouldn't be surprised if you are on to something.  When I was about 36 I was very  surprised to learn I had quite a bit of endometriosis after undergoing a laparoscopy for infertility (hysterosalpingogram had also detected uterine fibroids, which were removed during the same surgical session).    I had few obvious symptoms of endometriosis other than infertility.
    Years later, I can look back over my old lab results  and list of symptoms and see a not quite right hormone pattern that seemed to completely escape detection by my primary care doctor and fertility specialists during my work-ups:  slow but continual rise in my TSH in the "suspicious" upper end of the ref range (and eventually out of range), chronically low basal and daytime temps, estrogen and progesterone always in the low ends of the ref ranges, pre-menstrual spotting, elevated prolactin on some labs, low free testosterone (sometimes undetectable), FBG in the 100-110 range, and weight gain of 5 lbs/yr, and so on.  Part of the problem was only viewing the most recent lab results, instead of comparing lab results over a greater time period (When I was about 43 I charted a decade of various lab results, which was very illuminating).  The other part was only in "seeing through the specialist lens".  
    I can't imagine that the nighttime sudden coughing fits I reported over and over to my primary care physician for years (because it kept me *and my husband* from sleeping well) would ever have been connected to any of these hormone issues (which I'm sure contributed to the development of the endometriosis) because they couldn't even detect the hormone pattern.  It was far easier for all of us to assume it was allergies to dust or something that caused simple post-nasal drip and coughing. But my husband was the one who noticed the coughing fits went away when I was taking a good dose of  thyroid hormone.   I now think the coughing was really a form of apnea, not nasal drip issue at all…and I'm quite sure the pressure from the violent nocturnal coughing is connected to my developing pelvic organ prolapse.
    I like the way you make these connections.  One of the problems with our system of medical specialties is that too often the symptoms and physiology are viewed as completely separate from other systems in the body, but the body *isn't* like simple a bunch of separate systems – they're all interconnected in numerous complex ways.  I do understand the necessity to focus more intensely within a "system" at times, but it is also quite useful to step back and look globally now and then, too, eh?  

  2. Assuming that there is a connection… what then?  Is there a different treatment that you suggest?  I am a candidate for all of the isssues that you have listed and appreciate that you are exploring this unlikely relationship. All the best,  Dr. Park.  LLG

  3.  

    That's a great question. In theory, it sounds great, but how do you put it into practice to make it work for you?

     

    There are two aspects of what I describe in my sleep-breathing paradigm. One is inflammation and the other is narrowed anatomy. There's not much you can do about your anatomy (not quite), but there are a number of things you can do with the inflammation in your upper airways. 

     

    The first thing is to lessen inflammation in your throat by not eating anything or drinking alcohol close to bedtime. Having food in your stomach when you stop breathing occasionally promotes stomach juices to come up into your throat, which can then go into your nose and lungs. Alcohol relaxes your muscles, making things even worse.

     

    The next thing is to clear up any nasal inflammation and congestion by controlling any allergies, addressing any structural problems, and using nasal saline on a regular basis.

     

    Make sure that you're sleeping in your most comfortable sleep position.

     

    Regularly practice relaxing techniques such as yoga, breathing exercises, meditation, acupuncture, etc., to calm your autonomic nervous system.

     

    Take up a hobby, profession or activity where you spend more time exhaling than inhaling. While you sing, whistle, or hum, it's hard to be sad. Play a wind instrument. Find opportunities to talk more. All these activities stimulate the parasympathetic nervous system, which is the relaxing half of your involuntary nervous system.

     

    Look for certain food sensitivities such as dairy, gluten, etc.

     

    About 50% of people who start with these basic anti-inflammatory principles feel significantly better. If you want to go to the next level, then you have to change your physical anatomy, which is a topic for another discussion.

     

    Lastly, if you haven't done so already, read my book, Sleep, Interrupted, which connects all the dots back to poor breathing at night.

  4. Hi Dr. Park,
    Thank you so much for posting this! We are excited about the power of patients coming together to make discoveries, and hope to gain deeper insight into these and other conditions.

    I tweeted a link to this post @accarmichael.
    Be well and have a wonderful day!
    Alexandra, Co-Founder, CureTogether

  5. I was just diagnosed with UARS and my sister was as well. I have endometriosis, Raynauds, rosacea, allergies, depression, reflux, GI issues, chronic sinus/throat infections and headaches often…Hope this helps.

  6. I had my tonsils removed at a young age because I snored and couldn’t breathe well through my nose. Recently my doctor diagnosed me with endometriosis. I have many symptoms you mentioned above, my weight yo-yo’s, I am always exhausted regardless of my diet or sleep ( I slept 12 hours yesterday and I still feel tired) , I get excruciating pelvic pain during my menstrual, pain during sex, low libido and very heavy periods.
    I haven’t been diagnosed with hypothyroid or sleep apnea yet. I am in the process of getting additional testing because my blood work shows my thyroid being normal and I want to get a sleep study done.

    I also think there is a very strong link between endometriosis, hypothyroid and sleep apnea. I want to get the proper treatment but not one that will harm me in the long term. I am searching for natural and alternative ways to cope with all my symptoms, especially the weight gain I can’t be in my normal range unless I am a slave to the gym and a restricted diet. Do you have any suggestions?

  7. I have Endometriosis, including diaphragmatic endo, sleep paralysis, raynauds, allergies and I believe undiagnosed fibromyalgia.

  8. I have just been diagnosed with UARS at age 46. I’ve been chronically tired for at least 30 years, I can ‘sleep’ for 10 to 12 hours every night without ever feeling refreshed.
    As a child I had recurrent tonsilitus. At 14 I had four teeth removed from my over-crowded mouth. After my first general anaesthetic at 27 I was told that I have a very small mouth. I have a small nose and can never get glasses to fit well (a minor issue compared to everything else!). I wish these things could have been looked into as a whole and not individually and I could’ve been diagnosed with UARS much sooner.
    I was really interested to read about a connection between UARS and endometriosis. I had chronic endo throughout my 20s and 30s, culminating in a hysterectomy at 41. My surgeon, who is recognised as one of the best in the UK, said my endo was amongst the worse he’d seen.
    I had infertility problems and three rounds of failed IVF.
    Over the years my tiredness was blamed on the endometriosis or diagnosed as depression. No one looked for a sleep disorder. I’m still on antidepressants, I’ve been off work for a year and only just beginning treatment for UARS. So far CPAP hasn’t made any difference. I also have breathing problems during exercise and I feel as though I just can’t get enough air in to keep going.

  9. My name is Deborah Grubb, I have had endometriosis for years which have required, 3 separate D&C’s,, hysterectomy, and then 15 yrs later, I had massive amounts of endometrial adhesions which included, both ovaries abcessed because they were covered on it.. It was adhered to bladder wall, intestinal walls, abdominal muscles. I have all of the problems you listed with one exception. No infertility. First, developed hyperthyroidism, then I chose to radiation of thyroid. So, now am hypothyroid. Everything else is exactly how you describe it.