What Is Abnormal Uterine Bleeding?


Every woman’s body, including their monthly menstrual cycle, is different. For example, some experience moderate cycles that last a full seven days, others may have shorter and lighter periods, and still others may experience heavy bleeding for more than seven days each month. While variation in bleeding can be normal, if bleeding occurs between monthly cycles, it can be a cause for concern.

According to the Journal of Endometrial and Uterine Disorders, abnormal uterine bleeding (AUB) involves bleeding that happens outside of the regular menstrual cycles. Symptoms include spotting or heavy bleeding on an unexpected basis, as well as severe pain and cramping.

AUB, also known as menometrorrhagia, is not uncommon. In fact, research published in the British Medical Journal estimates that the condition impacts between 20-50% of women at some point during their reproductive years. Review this brief guide to learn about the symptoms as well as the treatment options available.

Common Causes of AUB

The causes of abnormal uterine bleeding can vary, as they are related to a range of medical issues and even certain medications. According to the Mayo Clinic and the American College of Obstetricians and Gynecologists, these are some of the most common causes of AUB.

Hormonal Issues

Hormones play a significant role in uterine bleeding as they are the primary factor behind the regulation of menstrual cycles. Hormonal imbalances most frequently occur in women just beginning menstruation and those who are beginning menopause.

Hormonal imbalance and uterine bleeding are often intertwined, and an imbalance can result in one of the following causes of abnormal uterine bleeding:

Polycystic Ovary Syndrome (PCOS)

This common condition involves multiple cysts on the ovaries, impacting hormone balance by increasing androgen hormones. PCOS is one of the primary causes of irregular periods, decreased fertility, acne, facial hair growth, and thinning hair.

Thyroid Disorders

Thyroid disorders refer to any issues related to the thyroid that prevent it from creating hormones that impact the body’s major functions. Both hyperthyroidism (excessive thyroid hormones) and hypothyroidism (low thyroid hormones) can cause irregular periods, missed periods, or heavier/lighter bleeding.

Noncancerous Growths

Noncancerous (or benign) growths found in the uterus can also cause abnormal uterine bleeding.

In some cases, bleeding can result from growths that create a blockage; in others, the growth can bleed, resulting in AUB. Some kinds of growths that can happen in the uterus include:

Polyps

These growths are found in the inner lining of the uterus and are connected to the lining by either a thin stalk or a large base within the uterus. While they are usually benign, they can create issues with bleeding or fertility if they are not treated.

Fibroids

Uterine fibroids are a kind of noncancerous tumor found growing either in or on the uterus. Symptoms are not always experienced, but the most common include back pain, painful sex, frequent need to urinate, and heavy bleeding.

Endometriosis

Endometriosis refers to an inflamed inner lining of the uterus caused by infection. It can occur suddenly (acute endometriosis) and last only a short time, such as after birth, miscarriage, or surgery involving the cervix or uterus. Chronic endometriosis often occurs after menopause or after certain sexually transmitted infections.

Fortunately, benign growths can be addressed by your physician. Learn more about fibroid and endometriosis treatments.

Infections

Certain sexually transmitted infections (STIs) or other types of infections can result in abnormal uterine bleeding.

Some of the most common infections that can cause bleeding include:

Cervicitis

Most often caused by an STI, this infection occurs when the cervix has become irritated and inflamed. Some symptoms that may be experienced are pain during sex, unusual vaginal discharge, or irregular bleeding.

Chlamydia

This common STI can be spread through vaginal sexual intercourse, oral sex, or anal sex. As there are often no symptoms associated with chlamydia aside from irregular bleeding, regular screenings are suggested.

Urinary Tract Infections

UTIs aren’t an indicator of uterine bleeding but of an issue within the urinary tract itself. However, if you notice blood when wiping that occurs outside of your menstrual cycle, it may result from a UTI rather than uterine bleeding.

Medications and Devices

Some medications and medical devices that are meant to treat menstrual or bleeding issues can cause irregular or heavy uterine bleeding.

Medications may include:

  • Blood thinners and aspirin
  • Intrauterine devices
  • Some kinds of birth control
  • Tamoxifen, a drug used to treat breast cancer

Other Medical Issues

There are several other medical conditions that can also contribute to abnormal uterine bleeding.

These include:

Pregnancy

While light spotting can occur when the zygote is implanting during early pregnancy, heavier bleeding during late pregnancy can be the result of a serious complication like polyps, infection, placental abruption, or cervical insufficiency. If you are pregnant and begin bleeding, contact your healthcare provider right away.

Miscarriage

Progressively heavier bleeding during pregnancy can indicate a miscarriage. Miscarriage can result from an issue with the developing fetus or one of the issues above.

Ectopic Pregnancy

An ectopic pregnancy occurs when the embryo grows in the fallopian tube, which is not designed to support a growing fetus. Abnormal uterine bleeding can indicate an ectopic pregnancy.

Blood Clotting Disorders

Clotting disorders affect the body’s ability to control its clotting function, either producing excessive clots that don’t result from injury or excessive bleeding. A side effect of treatment for excessive clotting can result in heavy bleeding.

Abnormal Uterine Bleeding Symptoms to Watch For

Abnormal Uterine Bleeding Symptoms to Watch For

Typical menstrual cycles can last anywhere between 21 and 35 days, beginning the first day of menstruation, when endometrial lining is shed from the uterus if an egg has not been fertilized. The period usually lasts between five to seven days.

Bleeding that occurs after the cycle has finished is considered abnormal. Other symptoms can indicate a serious underlying issue as well.

Symptoms that are important to watch out for include:

  • Bleeding or spotting after a menstrual cycle
  • Bleeding or spotting after having sex
  • Bleeding after starting menopause
  • Having a menstrual cycle lasting longer than 35 days or less than 21 days
  • Irregular periods, including having a period more often than the 21-day cycle, and the cycle extending to longer than eight days
  • Very painful menstrual cycles
  • Experiencing extreme tiredness
  • Experiencing symptoms of anemia, such as weakness and shortness of breath

Heavy Menstrual Bleeding

Heavy menstrual bleeding is a common way many women experience abnormal uterine bleeding.

Some symptoms include:

  • Needing more than one sanitary napkin to contain the flow
  • Soaking through one sanitary napkin each hour consistently throughout several hours
  • Bleeding for longer than seven days
  • Waking up throughout the night to change a sanitary napkin
  • Having blood clots that are larger than the size of a quarter
  • Feeling extreme fatigue or out of breath due to loss of blood

Periods that involve heavy bleeding and extreme cramping can make it very difficult for a woman to function normally. Suffering through painful and heavy periods does not have to continue, however, as heavy period treatments are available.

Uterine Bleeding After Menopause

Menopause refers to the time when a woman has stopped getting a monthly cycle for at least twelve months consecutively. Even though the menstrual cycle has finished in menopause, bleeding can still occur.

There may be several reasons for bleeding during and after menopause, such as:

  • Weak uterus due to hormone deficiencies
  • Endometrial hyperplasia
  • Polyps
  • Hormone replacement therapy
  • Some kinds of cancers involving the female reproductive system

Uterine bleeding and menopause can occur at the same time, but it is typically a cause for concern, which is why it is important to seek medical attention. Seek comprehensive and compassionate care for menopause with Arizona Gynecology Consultants menopause services.

When to See a Doctor

Abnormal uterine bleeding can be alarming, but it is not always a reason to call your doctor. Certain symptoms, however, are indicative of a severe issue or an issue that has gone unnoticed and untreated.

Some signs of when to see a doctor for heavy bleeding include:

  • Bleeding heavily and leaking through one sanitary napkin for more than two hours at a time
  • Bleeding even after you have completed a menstrual cycle
  • Bleeding or spotting after menopause
  • Severe pain or cramping if you are not currently having a period
  • Bleeding for longer than seven days
  • Bleeding while also experiencing chest pain, dizziness, difficulty breathing normally, and fever
  • Having periods at unpredictable times
  • Bleeding while also experiencing anemia (including weakness or difficulty breathing)

Even if you don’t believe your symptoms are indicative of a severe issue, if they are making daily life difficult, discuss them with your doctor to pinpoint the cause and explore available treatments.

Seek Medical Attention for Abnormal Uterine Bleeding

When to Seek Medical Attention for Abnormal Uterine Bleeding:

  • Bleeding that occurs between menstrual cycles
  • Heavy bleeding, including soaking through one pad every hour for several hours
  • Bleeding after menopause
  • Severe pain during or after a menstrual cycle
  • Chest pain along with bleeding
  • Fever while bleeding
  • Dizziness as well as bleeding

Diagnosis and Treatment Options

While a diagnosis of menometrorrhagia (or abnormal uterine bleeding) can occur without a known cause, a physician must identify the cause to assess your treatment options. This means that they will need to review your medical history, consider your age, the symptoms you are experiencing, and whether you have any known conditions that can result in AUB.

Diagnostic Tests

The American College of Obstetricians and Gynecologists suggests a full medical history review as well as both a physical exam and pelvic exam.

Other diagnostic and exploratory tests may be needed, such as:

  • An ultrasound
  • A hysteroscopy
  • An endometrial biopsy
  • A sonohysterography ultrasound
  • An MRI

Blood tests may also be necessary to determine whether you have an infection and to check your hormone levels. Additional biopsies may be necessary to eliminate the possibility of cancer.

Treatment Options

Depending on the cause of the bleeding, there are several different treatment options available.

Treatment Options Abnormal Uterine Bleeding

Some of these treatments include:

  • Hormonal regulation to promote regular menstrual cycles for those with ovulation issues.
  • Birth control for those with consistently heavy periods
  • Surgery, which can involve:
    • Hysterectomy (removal of the uterus)
    • Endometrial ablation (removal of the endometrium)
    • Growth removal

Abnormal Uterine Bleeding FAQs

Abnormal uterine bleeding can cause valid concern. While we recommend consulting with your doctor about your specific issues, we’ve answered some commonly asked questions relating to AUB:

Is There a Difference Between Chronic and Acute Abnormal Uterine Bleeding?

AUB is considered a chronic issue if it continues to occur for at least six months. If the abnormal bleeding has occurred suddenly and unexpectedly, then this is considered acute abnormal uterine bleeding. Keeping a log can be helpful for determining the frequency.

Is There a Certain Age When Abnormal Uterine Bleeding Is More Common?

While irregular bleeding can happen to women of all ages, it is more common for women in certain stages of life. Abnormal uterine bleeding is more common between the ages of 9 and 14, when a girl begins getting regular menstrual cycles. It is also common for women approaching perimenopause (the time before menopause), typically around the age of 50. During perimenopause, periods can be irregular, or the flow may become heavier or lighter.

Who Is at Risk for AUB?

Women who are of age to reproduce are at risk for developing AUB.

Additional risk factors for AUB can include: 

  • Adolescence
  • Perimenopause
  • Obesity
  • The use of blood thinners
  • The use of an IUD

Schedule a Visit with Arizona Gynecology Consultants

Schedule a Visit with Arizona Gynecology Consultants

Don’t ignore symptoms like heavy or irregular bleeding. Take control of your health and get answers with help from the professional team at Arizona Gynecology Consultants.

Our experienced team is here to guide you toward the best treatment options—schedule your visit today.

*Editor’s Note: This article was originally published April 2, 2017 and has been updated May 5, 2025.

 


Resources:

  1. Chen, M.-J., Luo, L., Liu, Y.-Y., Liu, M.-E., & Hsu, Y.-C. (2024). Heavy menstrual bleeding and outcomes in women: A narrative review. Taiwanese Journal of Obstetrics & Gynecology, 63(1), 7–13. https://doi.org/10.1016/j.tjog.2023.11.006
  2. Munro, M. G., Fraser, I. S., & Archer, D. F. (2022). Abnormal uterine bleeding in reproductive-aged women. BMJ, 378, e070906. https://doi.org/10.1136/bmj-2022-070906
  3. Mayo Clinic. (2022, January 18). Menorrhagia (heavy menstrual bleeding). Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/menorrhagia/symptoms-causes/syc-20352829
  4. Cleveland Clinic. (2023, May 30). Menometrorrhagia (abnormal uterine bleeding). https://my.clevelandclinic.org/health/diseases/menometrorrhagia-abnormal-uterine-bleeding
  5. American College of Obstetricians and Gynecologists. (2021). Abnormal uterine bleeding. https://www.acog.org/womens-health/faqs/abnormal-uterine-bleeding
  6. Yale Medicine. (n.d.). Abnormal uterine bleeding. Yale University. https://www.yalemedicine.org/conditions/abnormal-uterine-bleeding
  7. University of Utah Health. (n.d.). Uterine bleeding. https://healthcare.utah.edu/womens-health/gynecology/uterine-bleeding

The post What Is Abnormal Uterine Bleeding? appeared first on AZGyn.



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Do you ever wake up in the morning still feeling exhausted, causing you to wonder if you truly got a good night’s sleep? You may then go about your day feeling just as tired as you were the night before. Getting enough sleep every night is extremely important for your body’s overall health and is just as important as eating well, exercising regularly, and staying hydrated. Without adequate rest, your physical and mental health will suffer, as sleep impacts your mood, energy levels, and even your body’s immune system.

Unfortunately, there is no one-size-fits-all formula for how much sleep a person needs to feel well-rested, as various factors play into the amount required for optimal health. However, some guidelines are available to help you achieve better sleep. Keep reading to discover how much sleep you really need and some practical tips to improve your sleep quality.

Why Sleep Is Essential for Your Health

Sleep is a vital part of both physical and mental health as well as everyday life. In fact, Reproductive Biology and Endocrinology reports that the average person will spend a third of their life sleeping. Take a look at how sleep affects all aspects of health.

Mental and Cognitive Health

Good quality sleep plays a role in many functions of the body that affect mental and cognitive health. For example, proper sleep helps support healthy brain functions, allowing you to concentrate on your daily tasks while giving you the mental clarity to do so. It also improves the way nerve cells communicate with each other. The opposite is also true – when your body lacks sleep, focus and response time slow down, and the brain is unable to build or retain memories.

Physical Health

Getting the proper amount of sleep also plays a part in physical health. In fact, according to the CDC, studies have shown that a lack of sleep can impact the immune system in a variety of ways, which can later lead to the development of certain disorders. Individuals experiencing inadequate sleep are more likely to get sick, as fewer natural immune cells are produced. The CDC found that approximately 72% of immune cells are produced during a full night of sleep, but those with less sleep produced well below this quota.

Sufficient sleep also impacts the body’s hormonal balance as it is released following the individual’s circadian rhythm or the sleep-wake cycle. Women can experience greater disturbances in sleep because of hormonal changes, such as during a menstrual cycle, pregnancy, or menopause. Insufficient sleep can affect the levels of the estrogen and progesterone hormones while also slowing down the thyroid and impeding metabolism. Finally, losing sleep can also increase the production of inflammatory cytokines, which can lead to cardiovascular and metabolic issues.

As you can see, hormone imbalances caused by inadequate sleep can negatively affect your health. When this occurs, hormone replacement therapy may be necessary.

How Much Sleep Do I Need?

How Much Sleep Do I Need?

If your constant sleepiness is beginning to affect your physical and mental health, it’s time to begin determining how much sleep you truly need. While there is no one sleep schedule that fits everyone’s needs, as sleep needs can vary depending on many factors, following the guidelines for your age group may help you feel more rested.

Here are the most current sleep recommendations by age:

  • Newborns (0-3 months) – For the first three months of life, newborns need between 14-17 hours of sleep throughout the day, as they do not typically sleep through the night.
  • Infants (4-12 months) – Between four and twelve months of age, an infant requires 12 to 16 hours of sleep. This usually includes daytime naps.
  • Children (1-12 years) – Toddlers and children require between 9-14 hours of sleep during the night and may sometimes need daytime naps.
  • Teens (13-18 years) – As children become teenagers, they don’t need as many hours of sleep, and between 8-10 hours per night is sufficient.
  • Adults (18-64 years) – The recommended number of hours of sleep needed each night for adults is between 7 and 9 hours.
  • Seniors (65+ years) – Sleep is essential to aging gracefully, especially for women. Getting 7-8 hours per night is recommended.

While these amounts are the general recommendations for each age group, every person’s needs will vary. In fact, the number of hours required may evolve and change within these age brackets, depending on current conditions. For example, young children may need more sleep when going through a growth spurt, while older children may need more sleep if they are experiencing hormonal changes. Pregnant women often need more rest, especially when experiencing disruptions in their ability to sleep at night.

Other factors that can impact your need for sleep include your current lifestyle. For example, if you have a particularly busy lifestyle, you may find yourself becoming exhausted during the day even if you do achieve the recommended hours of sleep. Additionally, high stress levels caused by family, work, health, and other factors may leave you feeling tired and in need of more rest.

Signs You’re Not Getting Enough Sleep

Feeling sleepy can be normal as an occasional occurrence after a night of little sleep, but it’s important to watch for signs of sleep deprivation. Even if you seem to be able to function normally on a regular basis while achieving less sleep than recommended, you can still experience negative side effects.

Some of the most common signs that you’re habitually not getting sufficient rest include:

  • Chronic fatigue
  • Irritability
  • Trouble focusing and staying alert
  • Frequent illness due to a weakened immune system
  • Sudden weight gain
  • Increased blood pressure

If you continue to experience insufficient or poor-quality sleep, the above signs can eventually result in long-term issues. The most common issues resulting from the long-term effects of inadequate sleep involve chronic conditions like heart disease and diabetes. Poor sleep can also impact your mental health, resulting in depression. The cognitive impacts of poor sleep mentioned above may leave you with difficulty concentrating on important tasks, which can have dangerous consequences.

Why Should Women Prioritize Healthy Sleep?

According to a study published in Sleep Medicine, women are more likely to experience trouble sleeping and have a higher risk of developing sleep issues such as insomnia. Women are also more likely to struggle with poor-quality sleep, especially when they are experiencing hormonal changes. In addition, a woman going through extreme changes in their hormones due to pregnancy may have even more trouble sleeping due to feeling uncomfortable or frequently waking to urinate. Menopause may also disrupt sleep, as it can cause night sweats or hot flashes.

Unfortunately, for women, poor sleep can be a vicious cycle. Insufficient sleep can disrupt hormone production, as the release of hormones is affected by the circadian rhythm. It may also impact the menstrual cycle by disrupting the hormones used to help regulate sleep, such as melatonin.

How to Improve Your Sleep Quality

Improve Sleep Quality

There are many ways to achieve better rest and have better health as a result. Below are some tips on how to improve sleep quality.

Stick to a Sleep Schedule

First, it is important to create an optimal sleep schedule. Keep in mind that when you are trying to implement a new habit, consistency is key, so make sure that your new schedule is one that you can follow every night. Start with your desired wake-up time, determine how many hours are ideal for a person your age, and work backward from there. Then, set your bedtime about half an hour before that to give yourself time to wind down and complete your sleep routine.

Develop a Sleep Routine

Determine what will help you to relax and unwind, preparing yourself mentally and physically for sleep. Many women choose to promote relaxation by practicing certain techniques, such as yoga or meditation, before bed, but simply making an effort to empty their mind of any anxieties can be enough.

Consider adding these relaxing activities earlier in the evening to help you release stress before bed:

  • Journaling before bedtime
  • Drinking a cup of herbal tea
  • Reading a book or watching a relaxing television show
  • Listening to instrumental music

Avoid Nighttime Habits That Worsen Sleep

In addition to partaking in relaxing activities before bed, it’s important to avoid activities or habits that can negatively affect your sleep. Before preparing for bed, make sure to avoid eating heavy meals, as they can keep you awake. Similarly, caffeine and alcohol can disrupt your ability to sleep. Finally, consider disconnecting from social media and ongoing text conversations in the hour leading up to bedtime.

Optimize Your Sleep Environment

Optimizing your sleep environment means that you are creating an environment that promotes sleep. The room should be dark without any distracting lights, which includes ensuring all television screens and smartphones are turned off. Keep the room cool so that you won’t wake up due to feeling too hot or sweating throughout the night. Ensure that you create a peaceful and quiet space, free of any loud or persistent noises; however, for some people, a sleep machine or some kind of white noise, such as a fan, can be soothing.

Address Your Hormones

Remember that hormonal imbalances are a major cause of sleep disturbances. Two primary hormones that have a large impact on your quality of sleep are progesterone and estrogen. These hormone levels can vary widely due to the menstrual cycle, pregnancy, perimenopause, and menopause. If you are looking to regulate your hormone levels, consider seeking treatment from Arizona Gynecology Consultants.

When to Seek Help for Sleep Problems

In many cases, sleep issues can be resolved by implementing a better sleep schedule or trying relaxation techniques before bed, but certain sleep problems require the help of a medical professional.

Common sleep disorders, such as insomnia, sleep apnea, and restless leg syndrome (RLS), typically require medical attention to resolve.

  • Insomnia – This sleep disorder is marked by difficulty achieving sleep. Chronic insomnia can cause trouble performing normal tasks and mental health issues, and the NHS reports that approximately 1 in 3 adults experience this common condition.
  • Sleep Apnea – This disorder occurs when a person frequently stops breathing while sleeping, which typically results from blocked airways or the brain failing to control the breathing process properly. Without treatment, the heart can begin to show potentially deadly signs of stress.
  • Restless Leg Syndrome (RLS) – This disorder is characterized by extreme urges to move the legs while trying to rest, which can make it difficult to fall asleep or stay asleep. Those who suffer from this condition usually feel itching, crawling, or throbbing sensations in the legs, which can be temporarily resolved by moving.

If you know you are experiencing any of the above disorders, it’s crucial to seek medical attention to address them and get a doctor’s help with working toward better sleep.

If you’re unsure whether you need medical assistance, look for the following warning signs that your sleep issues cannot be addressed on your own:

  • Constant fatigue, even if you have slept a sufficient amount of time the night before
  • Difficulty staying awake while performing daily tasks, such as driving or reading
  • Memory issues or trouble concentrating
  • Waking up frequently in an attempt to regain your breath

In addition, hormone issues may be affecting the quality or quantity of your sleep. If you suspect that a hormone imbalance is causing your sleep disturbances, it is important to consult with a doctor to explore hormone regulation for better quality sleep. Schedule a consultation with Arizona Gynecology Consultants to explore solutions.

Achieve Better Quality Sleep with the Help of Arizona Gynecology Consultants

Get Better Quality Sleep with Arizona Gynecology Consultants

Getting good quality sleep is vital for your overall health and is as essential as getting enough food and water. For most people, achieving better sleep is possible when you implement healthy sleep schedules, engage in relaxing habits while eliminating those that can cause poor sleep, and ensure that you create an environment that promotes rest rather than distractions. However, for others, these efforts are not enough to achieve healthy sleep patterns.

It’s important to monitor any concerning symptoms that may indicate a sleep disorder. Avoid ignoring warning signs, as continued poor sleep can result in more serious health issues. If you’re experiencing poor sleep that isn’t remedied by better sleep habits, be sure to notify your physician.

Are you struggling to get good quality sleep each night? Don’t let chronic sleep issues and the resulting fatigue or physical and mental health effects continue to negatively impact your life. Contact Arizona Gynecology Consultants to schedule a consultation and develop personalized solutions to improve your sleep and overall health.

*Editor’s Note: This article was originally published May 9, 2017 and has been updated April 24, 2025.


Resources:

  1. Centers for Disease Control and Prevention. (n.d.). About sleep. U.S. Department of Health & Human Services. https://www.cdc.gov/sleep/about/index.html
  2. Centers for Disease Control and Prevention. (n.d.). Work hours, sleep and fatigue: Training for nurses – Module 2: Impact of long work hours. National Institute for Occupational Safety and Health (NIOSH). https://www.cdc.gov/niosh/work-hour-training-for-nurses/longhours/mod2/05.html
  3. Cleveland Clinic. (n.d.). Restless legs syndrome (RLS). https://my.clevelandclinic.org/health/diseases/9497-restless-legs-syndrome
  4. Cleveland Clinic. (n.d.). Sleep apnea. https://my.clevelandclinic.org/health/diseases/8718-sleep-apnea
  5. Healthline. (n.d.). Hormonal insomnia: Symptoms, causes, and treatment. https://www.healthline.com/health/insomnia/hormonal-insomnia-symptoms#causes
  6. Mayo Clinic Staff. (n.d.). How many hours of sleep are enough?. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/how-many-hours-of-sleep-are-enough/faq-20057898
  7. National Heart, Lung, and Blood Institute. (n.d.). Why is sleep important?. U.S. Department of Health & Human Services. https://www.nhlbi.nih.gov/health/sleep/why-sleep-important
  8. National Institute of Neurological Disorders and Stroke. (n.d.). Brain basics: Understanding sleep. National Institutes of Health. https://www.ninds.nih.gov/health-information/public-education/brain-basics/brain-basics-understanding-sleep
  9. National Library of Medicine. (2020). Physiology, sleep stages. In StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK526136/
  10. Parthasarathy, S., Vasquez, M. M., Halonen, M., Bootzin, R., Quan, S. F., Martinez, F. D., & Guerra, S. (2012). Persistent insomnia is associated with mortality risk. Sleep, 35(5), 585–592. https://doi.org/10.1016/j.sleep.2012.01.011
  11. Zhou, E. S., Haack, M., Nguyen, J., & Mullington, J. M. (2022). The impact of sleep on mental and physical health. Journal of Clinical Sleep Medicine, 18(2), 509–520. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8764829/

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