A Link Between Endometriosis and Sleep Apnea?

January 14, 2010

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.

Written by Steven Park · Filed Under Blog
Tagged: ,cold hands, endometriosis, Raynaud's, sleep apena, UARS, upper airway resistance syndrome

6 Responses to “A Link Between Endometriosis and Sleep Apnea?”

Anna on January 14th, 2010 10:02 am

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?
Linda on January 14th, 2010 2:24 pm

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
Steven Park on January 14th, 2010 7:01 pm

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.
Alexandra Carmichael on January 15th, 2010 10:39 am

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
Amarjit s on March 13th, 2010 11:43 pm

i got well with my ulcerative colitis after suffering between 1986 and 1999, im now COMPLETLY of medications , i tried alternate methods…amarsujok@yahoo.co.in

Amarjit s..india
Carmella M on August 5th, 2011 1:02 pm

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.