Common PCOS symptoms: From restless legs to daytime drowsiness and other sleep issues

Polycystic Ovary Syndrome (PCOS) is a common yet often misunderstood endocrine disorder affecting many women of reproductive age. It presents a range of symptoms that can significantly impact health, including reproductive and metabolic functions, as well as mental well-being.

“PCOS involves elevated levels of male hormones, such as testosterone, leading to hirsutism (excessive hair growth), acne, and androgenic alopecia (hair thinning),” explains Dr Archana Kankal, Director of Obstetrics & Gynaecology at Sahyadri Hospitals MomStory in Nagar Road, Pune. “Additionally, polycystic ovaries have multiple small follicles detectable via ultrasound,” she adds.

Its multifactorial nature is influenced by genetic, environmental, and lifestyle factors. “Beyond its impact on reproductive health, PCOS is a multi-system condition that affects metabolic, cardiovascular, psychological, and even sleep-related aspects of health,” says Dr Kankal, adding, “Sleep disturbances are increasingly recognised as both a symptom and a complication of PCOS."

She lists the following as the most common sleep disorders seen in women with PCOS include

• Obstructive sleep apnea (OSA): Women with Polycystic Ovary Syndrome (PCOS) have a 30-70 percent higher risk of developing Obstructive sleep apnea (OSA) compared to those without PCOS. While obesity is often linked to this condition, non-obese women with PCOS are also at significant risk due to factors such as hyperandrogenism and insulin resistance. OSA is marked by repeated episodes of upper airway obstruction during sleep, which leads to reduced or paused airflow despite ongoing respiratory effort. These episodes result in intermittent hypoxia (low oxygen levels) and frequent awakenings, causing fragmented sleep and poor sleep quality. The presence of OSA in women with PCOS can significantly increase the risk of cardiovascular issues, hypertension, daytime sleepiness, cognitive impairments, and an overall decline in quality of life.

• Insomnia: Insomnia, which involves difficulty in initiating or maintaining sleep or waking up too early without being able to fall back asleep, is a common issue among women with Polycystic Ovary Syndrome (PCOS). Studies indicate that up to 40-50 percent of women with PCOS may experience challenges with sleep onset or maintenance. This high prevalence is largely attributed to hormonal imbalances, particularly elevated levels of androgens and cortisol, which disrupt normal sleep patterns. Additionally, psychological factors such as anxiety, depression, and stress— conditions that are more common in women with PCOS—further contribute to and worsen insomnia, creating a cycle that negatively impacts overall health and well-being.

• Restless leg syndrome (RLS): Restless Leg Syndrome (RLS) is a neurological disorder marked by an uncontrollable urge to move the legs, often accompanied by uncomfortable sensations that typically occur in the evening or at night, disrupting sleep. While the exact connection between PCOS and RLS is not fully understood, several potential mechanisms have been proposed. These include low iron levels, which can affect nerve function; altered neurotransmitter activity, particularly involving dopamine, which is crucial for regulating movement and sensation; chronic inflammation, which is common in PCOS and can impact nerve pathways; and metabolic dysregulation.

• Excessive daytime sleepiness (EDS): Excessive Daytime Sleepiness (EDS) is a common complaint among women with PCOS.  Women find it difficulty staying awake and alert during the day. This can significantly impact daily functioning and productivity. The etiology of EDS in PCOS is often linked to poor sleep quality at night, which can result from underlying sleep disorders such as obstructive sleep apnea (OSA), insomnia, or other disturbances. These conditions lead to fragmented sleep, frequent awakenings, and a lack of restorative sleep, all of which contribute to persistent daytime drowsiness and fatigue.