The impact of primary dysmenorrhea on sleep and the consequences for adolescent academic performance

Citation:

Ishikura IA, Hachul H, Pires GN, Tufik S, Andersen ML. The impact of primary dysmenorrhea on sleep and the consequences for adolescent academic performance. J Clin Sleep Med. 2020;16(3):467–468.

We are writing to highlight the potential damage caused by primary dysmenorrhea (PD), the most common menstrual symptom affecting adolescents, on academic performance. It is defined as painful menstruation in the absence of pelvic pathology and is accompanied by several comorbidities that may affect sleep, including nausea, vomiting, diarrhea, headaches, and muscle cramps. Although it is a recurrent pathology that significantly affects the life of women, little attention has been given to this question. The studies lack in number of patients investigated, exclusion of secondary dysmenorrhea diagnosis or even of a nonapplicable pain scale to measure the severity of primary dysmenorrhea. Detriment in sleep pattern, such as disturbed sleep,¹ poor sleep efficiency¹ and reduction in stage N1 sleep² were findings observed in two polysomnography studies with women experiencing PD. It is important to note that in one of these studies, the mild and severe PD affected sleep not only during the menstruation phase, but throughout the menstrual cycle.¹

In accordance to the importance of sleep in adolescent´s life, a recent multinight sleep restriction study reported that insufficient sleep affected adolescent academic performance with a significant reduction in the retention of factual knowledge. These results were still evident after 6 weeks, when forgetting was 65% higher than in the non–sleep-restricted group.³ Another recent study by the same group observed that a short daytime nap avoided this cognitive damage in adolescents, improving their academic performance, specifically for information learned after the nap.⁴ Although the study did not seek to simulate the sleep disturbance attributed to dysmenorrhea, the results provide evidence of the importance of sleep in cognition and learning abilities. Important to highlight that women might be more suscetible to the effects of sleep loss, since longer sleep duration and earlier bedtimes were associated to better performance in a microeconomics trained-item test in women but not in men.⁵

Considering the PD outcomes, data from a meta-analysis study performed in adolescents with PD showed that 20% were absent from school and 40% reported that classroom performance, such as concentration levels or test-taking abilities, were negatively affected during menstruation phase.⁶ Another study found even greater effects for dysmenorrhea. Of the 88.3% of students who reported a negative effect of PD, 80% reported school absence, 66.8% a loss of concentration in class, 47.4% a loss in participation in class, and 15.4% a reduction in test taking skill.⁷

Recent literature has explored a number of issues outside of the classroom that may affect one’s academic performance. Some examples are sleep disorders,⁸ eveningness,⁹ attention deficit-hyperactivity disorders¹⁰ and poor social support.¹¹ Children and adolescents who are exposed to any of these factors might have their academic performance hindered, as well as present higher school absence and dropout rates. From a social perspective, it might be observed that the students who experience these issues might have their adult professional development impacted by events that took place during school age. In most cases, a correct treatment or management of these issues might solve the problem, allowing the adolescent to develop their academic capabilities accordingly. According to recent literature, we can now include PD to the list of factors that may impact academic performance.

In conclusion, the evidence suggests that the sleep disturbance associated with dysmenorrhea may well have an impact on academic performance. Policy makers and educators should be aware of it, and strategies should be developed, in order to prevent adolescent girls to have their academic potential limited by this pathology. There is a need for more sleep studies of adolescents with this condition in order to develop a better understanding of the considerable effects of this pathology on adolescent girls and their learning.

DISCLOSURE STATEMENT

The authors report studies supported by the Associação Fundo de Incentivo à Pesquisa (AFIP). S.T. and M.L.A. have received CNPq fellowships. The authors report no conflicts of interest.