The facts on sleep are exhausting: Most women get less than they should, and a variety of factors – from hormones to sleep disorders – can be the cause. Find out what’s keeping you up…
Sleep is a basic human need, as important for good health as diet and exercise. Sleep lays the groundwork for a productive day ahead.
Although most adults need 7-9 hours of zzz’s each night to function well the next day, the average woman age 30-60 sleeps only 6.9 hours a night during the work week. Women are more likely than men to have difficulty falling and staying asleep and to experience daytime sleepiness at least a few times per week.
Daytime sleepiness that interferes with daily activities isn’t normal and may be a sign of sleep deprivation, a sleep disorder or medical condition.
Both quantity and quality of sleep are essential to optimum functioning. Although continuous sleep is ideal, it’s not uncommon to experience disruptions from a variety of underlying causes. For example, more women than men suffer from nighttime pain. In one study, one in four women reported that pain or physical discomfort interrupted her sleep three nights a week or more. Women are twice as likely to experience depression as men, and they’re more prone to arthritis and headaches, all conditions that can result in fragmented sleep.
Research has shown that too little and poor-quality sleep results in not only daytime sleepiness, but also more accidents, problems concentrating, poor performance on the job, difficulty getting along with others and, possibly, more sickness and weight gain.
Why Your Sex Matters
Biological conditions unique to women can affect how well they sleep; the changing levels of hormones women experience throughout the month and over their lifetimes have an impact on sleep quality. Based on a study of nearly 40,000 people in Taiwan, better-educated women are more likely to report having a good night’s sleep with fewer disruptions.
Your Monthly Cycle and Sleep
On average, women report disrupted sleep for 2-3 days each menstrual cycle. These changes can be linked to the rise and fall of hormone levels in the body.
The hormone progesterone, which rises after ovulation, may cause some women to feel sleepy or fatigued. However, poor-quality sleep is more likely at the beginning of the menstrual cycle when bleeding starts.
During the last part of the monthly cycle, premenstrual syndrome (PMS) symptoms may occur. The bloating, headaches, moodiness, irritability and abdominal cramps associated with PMS may contribute to difficulty sleeping well.
The most common sleep-related problems reported by women with PMS are insomnia, hypersomnia (sleeping too much) and daytime sleepiness. The most common of these, insomnia, consists of difficulty falling asleep or staying asleep, waking up too early, or unrefreshed sleep.
Pregnancy and Sleep
Physical symptoms that occur during pregnancy (body aches, nausea, leg cramps, fetus movements, weight gain and heartburn) as well as emotional changes (depression, anxiety, worry) can interfere with sleep. Overall, women have lower quality of sleep during the last trimester of pregnancy. Progesterone levels rise during pregnancy, increasing feelings of sleepiness.
Heartburn, leg cramps and sinus congestion are common reasons for disturbed sleep, as is an increased need to urinate. (The fetus puts pressure on the bladder.) As might be expected, mothers of newborn babies experience a lot of postpartum sleeplessness and daytime sleepiness, which may contribute to the postpartum blues many mothers experience.
Pregnant women who’ve never snored before may begin doing so during pregnancy. About 15%-30% of pregnant women snore because of pregnancy-related weight gain and increased swelling in their nasal passages, which may partially block the airways. Snoring may also lead to high blood pressure, which can put both the mother and fetus at risk.
If the blockage is severe, sleep apnea may result, characterized by loud snoring and periods of stopped breathing during sleep. The lack of oxygen disrupts sleep and may affect the unborn fetus. If loud snoring and severe daytime sleepiness (another symptom of sleep apnea and other sleep disorders) occur, consult your physician.
During pregnancy, as many as 25% of women develop symptoms of restless leg syndrome, which may be due to lower levels of folic acid, anemia or other unknown factors.
Menopause and Sleep
Menopause is a time of major hormonal, physical and psychological change for women. From perimenopause – the transition phase – to postmenopause, women report a marked increase in sleeping problems. Most notable are hot flashes, insomnia and sleep-disordered breathing. Hot flashes may interrupt sleep, and frequent awakenings cause next-day fatigue.
Generally, postmenopausal women are less satisfied with their sleep than premenopausal women; as many as 61% of postmenopausal women report insomnia symptoms. Snoring has also been found to be more common after menopause. Snoring, along with pauses or gasps in breathing, are signs of a more serious sleep disorder, obstructive sleep apnea.
Most Common Sleep Disorders in Women
Insomnia
Insomnia is the most common sleep complaint; at least one-third of American adults say they have it occasionally, and 10%-15% on a chronic basis. Women consistently report that they are more likely than men to experience difficulty falling asleep, frequent awakenings, waking too early and being unable to fall back to sleep, and unrefreshed sleep.
Although they generally sleep longer, according to National Sleep Foundation (NSF) polls, more women than men rate the quality of their sleep as fair or poor. Insomnia can be short-term when it is in response to a current situation, such as the loss of a job or loved one, a dramatic event, or another situation that may cause stress or anxiety. Women often experience a great deal of stress – and sometimes depression – along with the discomfort associated with the biological changes that occur before and during menstruation, pregnancy and menopause.
Although these bouts of short-term insomnia may occur, women have to be careful that they don't develop poor sleep habits or attitudes leading to insomnia becoming long-term. Chronic insomnia is a sleeping disorder that is characterized by occurrence three or more nights per week for a month or longer and results in serious daytime impairment. Effective medications are available; a combination of behavioral change and medications works best for the long term.
Sleep apnea
Sleep apnea is a serious, potentially life-threatening breathing disorder that affects 18 million adults in America. Women are more likely to experience symptoms of sleep apnea as they age. In general, sleep apnea is associated with increased blood pressure, a risk for cardiovascular disease and stroke.
Why Your Sex Matters in Sleep Apnea
Physicians may overlook sleep apnea in women because women with this condition may have different symptoms than men. Women with sleep apnea are more likely to have depression and insomnia, less likely to have been told that they stop breathing during sleep, and more likely to have thyroid disease than men.
Sufferers often experience sleep apnea as partial or full obstruction of airflow through the airway as often as 10 times an hour and throughout the night, leading to pauses in breathing and frequent arousals.
Sleep apnea is characterized by the following signs and symptoms:
Loud and regular snoring
Pauses or interruptions of air flow during sleep and loss of oxygen
Repetitive arousals, often unnoticed or appearing as snorts or gasps, during sleep
Falling asleep at inappropriate times during the day, such as while driving, working or talking
Early-morning headaches
Depression, irritability and sexual dysfunction
Learning and memory difficulties
Recent studies have found that women are less likely to be diagnosed with sleep apnea; yet they do better with treatment. The most effective treatment for sleep apnea is the use of a continuous positive airway pressure (CPAP) machine that forces air through a mask attached to the nose so the patient can breathe well and prevent arousals and disrupted sleep.
Restless legs syndrome (RLS)
Restless legs syndrome (RLS) is a neurological movement disorder that affects as many as 12 million Americans. It's characterized by uncomfortable and unpleasant leg sensations associated with an urge to move that occur while your body is at rest, which are worse at night.
Because the unpleasant feelings occur at rest and are relieved by movement, RLS sufferers have difficulty sleeping. RLS may lead to daytime sleepiness, mood swings, anxiety and depression.
RLS most recently has been associated with iron-deficiency anemia as well as pregnancy or diabetes. Up to 15% of pregnant women develop RLS during their third trimester. RLS may include the following signs and symptoms:
The urge to move the legs, which is often accompanied by uncomfortable sensations in the foot, calf or upper leg (these sensations are usually described as a creeping or crawling feeling and may be experienced as a tingling, cramping or burning sensation)
The need to move the legs to relieve the discomfort by stretching, bending or rubbing the legs, tossing or turning in bed, or getting up and pacing the floor
A tendency to experience the most discomfort late in the day and at night
Continuous nighttime sleep disruption
Daytime fatigue
Medications are available to treat RLS. Women with this disorder should avoid alcohol, nicotine and caffeine. A healthy diet and moderate exercise can also be helpful.
About 80% of RLS sufferers may also experience periodic limb movements: jerking or kicking the legs and sometimes the arms while sleeping. Although this can be very disturbing to the bed partner, limb movements are common in all sleep disorders. They also occur with many medications and with disrupted sleep in general. Limb movements alone should not require treatment.
Narcolepsy
Narcolepsy is a chronic neurological disorder that affects the region of the central nervous system that regulates sleep and wakefulness. It affects approximately one in 2,000 people. People with narcolepsy experience excessive daytime sleepiness and have involuntary sleep attacks at inappropriate times (for example, while having dinner, talking, driving or working).
Narcolepsy symptoms, which frequently appear in teen years, include the following:
Sudden episodes of loss of muscle tone in response to an intense emotion such as laughter or anger, called cataplexy. The loss may range from slight weakness (such as limpness at the neck or knees, sagging facial muscles, or inability to speak clearly) to complete body collapse
Inability to talk or move when falling asleep or waking up
Vivid, often unpleasant, dream-like experiences that occur while dozing or falling asleep
Disrupted nighttime sleep with frequent awakenings
Performance of routine tasks with little awareness or memory of the action
Learning and memory difficulties
Recent scientific breakthroughs have led to new understanding of the cause of this condition, and new treatments have given doctors more ways to help manage its symptoms.
Nocturnal sleep-related eating disorder
Nocturnal sleep-related eating disorder (NS-RED), an uncommon condition, is one of a class of sleep disorders called parasomnias. People with NS-RED eat food during the night while they appear to be asleep. Since parts of the brain that control memory are asleep, people with NS-RED cannot remember nighttime eating.
One study indicates that more than 66% of sufferers are women. NS-RED can be caused by medications, psychological issues or sleep disorders.
When to See a Doctor
Many sleep problems can be improved by following the tips below and changing your sleep habits, reducing stress, improving your diet or exercising.
If sleep problems persist, seek professional help. Your doctor will determine the cause of your sleep problem and may refer you to a sleep disorders center. Most centers are staffed with sleep specialists who will ask you questions about your sleep problems and may monitor your sleep overnight. They will then provide you with a diagnosis and treatment program so you can get better sleep and have a productive, safe and healthy quality of life.
The NSF’s Top 10 Healthy Tips for Better Sleep
1. Maintain a regular bedtime and wake time schedule, including weekends.
2. Establish a regular, relaxing bedtime routine, such as soaking in a hot bath or hot tub and then reading a book or listening to soothing music.
3. Create a sleep-conducive environment that is dark, quiet, comfortable and cool.
4. Sleep on a comfortable mattress and pillows.
5. Use your bedroom only for sleep and sex. It's best to remove work materials, computers and televisions from the sleeping environment.
6. Finish eating at least 2-3 hours before your regular bedtime.
7. Exercise regularly, but finish your workout at least 3 hours before bedtime.
8. Avoid nicotine (cigarettes, tobacco products) close to bedtime – it can lead to poor sleep.
9. Avoid caffeine (coffee, tea, soft drinks, chocolate) close to bedtime – it can keep you awake.
10. Avoid alcohol close to bedtime, which can lead to disrupted sleep later in the night.
Excerpted from The Savvy Woman Patient: How and Why Sex Differences Affect Your Health (Capital Books) by the Society for Women’s Health Research.
To learn more about the Society for Women’s Health Research, visit their website.
Are You Smart About Sleep?
Getting a good night's sleep affects every aspect of your day, including your mood and your ability to be productive. And if that doesn't get your attention, listen up: Your sleep habits can even affect the number on the scale.
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