Sleep Science Friday: St. Valentine’s Day Sleep and love – dyadic processes 

Sleep Science Friday: St. Valentine’s Day Sleep and love – dyadic processes 

12 February 2021

How do love and sleep relate? Does love help or disrupt our sleep? Or does sleep disruption affect our intimate relations?  

Does sleep in females differ from sleep in males? What are the factors mediating these differences? How do they depend on age and various life periods? Prof. TarjaPorkka-Heiskanen reviews sex-related differences in sleep in a 15-minute e-lesson.

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Sleep is mainly investigated as a physiological process of the individual. However, in a partnership, sleep is often a shared behavior, and bedfellows’ activities and schedules have mutual effects leading to complex and bidirectional associations between sleep and partner relations (Hasler et al., 2010Grey et al., 2018).  

How do love and sleep relate? Does love help or disrupt our sleep? Or does sleep disruption affect our intimate relations?  

The concordance of sleep timing, duration and quality in couples was shown by both diary- (Lee et al., 2018) and actigraphy-based (Gunn et al., 2015) sleep assessments. Interestingly, a male’s sleep duration is predicted by the female partner’s sleep duration but not vice versa. At the same time, sleep concordance varies depending on relationship characteristics, such as relationship security (attachment style) and satisfaction (Gunn et al., 2015), and emotional synchrony, with some studies suggesting that higher sleep-wake concordance can be a negative marker of the couple’s emotional relations. In general, more positive interactions, or more warmth, affection and support from a partner predicts higher sleep-wake concordance. Some exceptions are noted: in couples with good marital adjustment, sleep-wake concordance in the previous night predict more negative marital interactions the following day (Gunn et al., 2021). Aggression (destructive conflict strategies) is associated with the worsening of sleep while negotiation (constructive conflict strategies) predicts better sleep parameters (El-Sheikh et al., 2015El Sheikh et al., 2013). Subjects assessing their marriage or relationship as a happy one report fewer sleep disturbances (Troxel et al., 2009).   

 

Romantic love, although a favorite and glorified topic of artists, as opposed to long-standing relations, might be a critical life event associated with symptoms of depression and anxiety and poor sleep in both young adults and adolescents (Brand et al., 2014). Adolescent studies demonstrate that romantic love is one of the causes of short or poor quality sleep in teenagers, mainly in girls, and may be associated with symptoms of depression and anxiety (Kuula et al., 2020). These results were confirmed by both subjective and objective (actigraphy-based) sleep measurements. However, these associations might be mediated by culture-related issues, as shown by studies from Middle Eastern countries. There, the experience of romantic love is not associated with any sleep changes or depressive symptoms in adolescents (Bajoghli et al., 2011Bajoghli et al., 2017). Moreover, in young adults, the experience of being in love is associated with better sleep quality, fewer awakenings, and shorter sleep onset latency (Bajoghli et al., 2014).  

“Love has its subjects in all ages”, and the relationship between sleep quality and partner relations is present not only in younger, but also in older individuals. A large British cohort study confirms that while negative relationships are related to poorer sleep quality, positive support from the closest person is related to better sleep quality in elderly (Stafford et al., 2017). Some studies suggest that conflictual interactions and partner hostility are associated with certain polysomnographic sleep measures, including sleep efficiency and slow-wave-sleep duration (Fillo et al., 2017).  

A partner’s sleep quality might also be associated with one’s wellbeing (Strawbridge et al., 2004, in addition to general (Troxel et al.,2010) and cardiometabolic health, with marital discord leading to greater risk of obesity, metabolic abnormalities (Kiecolt-Glaser et al., 2017), and an increase in inflammatory markers (Uchino et al., 2019). In a prospective study (Shih et al., 2018) with over a 4-year follow-up, husbands whose wives had insomnia complaints (mainly difficulties in falling asleep) demonstrated a higher likelihood of developing heart disease. Intriguingly, there was no relationship between male’s insomnia and cardiovascular risk in females.  

Partner snoring and sleep-disordered breathing are the most common complaints driving referrals to sleep centers (Smith et al., 2009). Without sleep disturbance reported by wives, the majority of sleep apnea cases would be left undiagnosed. Restless leg syndrome, even when treated (Ondo, 2018), and REM sleep behavior disorder (Lam et al., 2016) also largely affect partner’s sleep and family relations. Surprisingly, the majority of partners continue sharing a bed in spite of the risk of sleep-related injuries and sleep disturbance. Some somatic diseases (e.g., associated with chronic pain) can also affect a spouse’s sleep (Martire et al., 2013). 

The role of a partner is inestimable in the diagnosis and treatment of sleep disorders (Henry et al., 2013). Engagement of a spouse/partner in treating sleep-disordered breathing facilitates CPAP use and increases CPAP adherence (Ye et al., 2017Gentina et al., 2019). Recent studies demonstrate that the involvement of a bed partner/spouse in treatment of insomnia improves intervention outcomes (Ellis et al., 2015), thus partner-assisted CBT-I is a promising approach for insomnia treatment (Mellor et al., 2019). 

When discussing love, partnership and sleep, one cannot gloss over the issue of intimate relations. Research has shown that having sex and experiencing orgasm are associated with better self-perceived sleep (Lastella et al., 2019), so the authors suggest that safe sexual activity before bedtime can be viewed as a sleep-improving behavioral strategy. Sex differences in the sleep-promoting effects of orgasm are considered to be related to hormonal mechanisms involving oxytocin which regulates corticotropin-releasing hormone (Hiller, 2004), prolactin, GABA, endorphins, and the role of hypocretin system is also discussed. Narcoleptics can display cataplexy during sex and orgasm (orgasmolepsy), which suggests that hypocretin deficiency and reward dysregulation may be involved (Poryazova et al., 2009). From a psychological perspective, the desire for emotional bonding, physical affection and communication are associated with shorter sleep latency onset after sexual intercourse (Kruger and Hughes, 2011). In general, healthy and sufficient sleep is important for a healthy sex life (Kalmbach et al., 2015). Sleep disorders (e.g., insomnia and obstructive sleep apnea (Kling et al., 2017Kalmbach et al., 2019), are related to sexual dysfunction in both males and females (Yilmaz et al., 2017), mediated by both organic and psychogenic causes (Onem et al., 2008Skoczynsky et al., 2019). Predictors of sexual dysfunction in obstructive sleep apnea are different in males (body mass index, hormonal status and inflammatory markers) and females (menopausal status, hormone levels and SaO2 < 90%), however, the sex-related differences in response to OSA treatment (Budweiser et al., 2013) are underreported (Steinke et al., 2016). In addition, sexual dysfunction is proposed to be a marker of sleep problems. Relatedly, it is likewise crucial that, when counseling a patient with a sleep disorder, that a screening of sexual dysfunction is performed (Smith et al., 2019). 

While the efficient treatment of sleep disorders (e.g., snoring, REM behavior disorder) can lead to better relationships and sexual activity, interventions to improve marital functioning can also be beneficial for sleep measures (Troxel et al., 2017). Therefore, the dyadic assessments of sleep and sleep disorders are important for a better understanding of the bidirectional associations between sleep parameters, interpersonal interactions and their health impact. Marital or couple’s therapy can be a potent approach for sleep improvement. 

Recent publications from ESRS members: 

  1. Gorgoniet al. (2021). The Distinctive Sleep Pattern of the Human Calcarine Cortex: A Stereo-EEG Study. Sleep.  
  2. Vejeet al. (2021). Sleep architecture, obstructive sleep apnea and functional outcomes in adults with a history of Tick-borne encephalitis. PLoS One.   
  3. Zapateret al. (2021). Canonical Pathways Associated with Blood Pressure Response to Sleep Apnea Treatment: A Post Hoc Analysis. Respiration.  

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