# Sleep Health and Psychological Wellbeing in Adult Women: A Specific Focus on Endometriosis—A Survey Study

## TL;DR

This study explores how sleep health and psychological wellbeing are affected in women with endometriosis, finding that sleep issues are linked to worse mental health.

## Contribution

The study is one of the first to explore bidirectional associations between sleep health and psychological wellbeing in women with endometriosis.

## Key findings

- Women with endometriosis reported more severe insomnia and lower psychological wellbeing than controls.
- Sleep health was significantly associated with disease stage and psychological difficulties in endometriosis patients.
- A bidirectional relationship was found between sleep health and psychological wellbeing in the matched sample.

## Abstract

Background: Endometriosis is a chronic, oestrogen-sensitive inflammatory disease, which can have a significant impact on women’s wellbeing. Nevertheless, the sleep health of this population has been poorly investigated. This exploratory study aimed at describing sleep health, psychological wellbeing, and prevalence of endometriosis among a sample of female students and at evaluating the impact of endometriosis on sleep health and psychological wellbeing in women suffering from the disease. Methods: Women were recruited with a two-stage procedure in a cross-sectional study using online questionnaires: Insomnia Severity Index, Hospital Anxiety and Depression Scale, and Difficulties in Emotion Regulation Scale—Short form. Furthermore, specific questions were used to measure the five dimensions of sleep health: satisfaction, vigilance, efficiency, duration, and timing. Results: In the first stage of the enrolment procedure, 1068 students (18–45 years old) responded to the questionnaire, and 8.7% reported a physician diagnosis of endometriosis. Additionally, in the second stage of the enrolment procedure, 75 women were recruited through social media and reported a diagnosis of endometriosis. Then, all women with endometriosis (169) were age-matched with 169 women without the disease. Multivariate regression analyses showed a bidirectional association between sleep health and psychological wellbeing in the matched sample. Independent samples t-test showed that women with endometriosis reported more severe insomnia symptoms and lower psychological wellbeing than controls. Statistically significant differences were also found in global sleep health and satisfaction, vigilance, and efficiency. Among women with endometriosis, pain and anxiety symptoms were bidirectionally associated, while sleep health was significantly associated with disease stage and psychological difficulties. Conclusions: Considering and treating sleep difficulties in this population may contribute to an improvement in psychological wellbeing and quality of life.