The Sleep-Deprived Woman: Understanding Her Plight

Women are more likely to experience insomnia than men, with sources estimating that between a third and 40% of women experience insomnia that negatively affects their daily lives. Insomnia is a sleep disorder that makes it difficult to fall asleep or stay asleep. Women are also more likely to experience multiple symptoms of insomnia. There are several factors that can contribute to insomnia in women, including hormonal shifts, health conditions, and external factors such as stress and family demands. Understanding and addressing these factors can help women improve their sleep quality and overall health.

Hormone changes during menstruation

During the menstrual cycle, the hormones estrogen and progesterone rise and fall at predictable times. The average cycle lasts 25 to 36 days, with ovulation occurring around day 14. After ovulation, cortisol levels can increase, melatonin levels decrease, body temperature rises slightly, and REM sleep diminishes. These changes can disrupt a woman's sleep quality and duration.

In the days leading up to the period, progesterone levels dip, and premenstrual syndrome (PMS) symptoms can intensify. PMS symptoms such as mood changes, bloating, breast tenderness, and pelvic or muscle pain can make it difficult to fall asleep or stay asleep. Additionally, the drop in estrogen and progesterone during the luteal phase of the menstrual cycle is classically associated with disturbed sleep.

Women with severe PMS, such as premenstrual dysphoric disorder (PMDD), are even more likely to experience insomnia and other sleep disturbances. They may also suffer from anxiety and depression, which can further impact their sleep. Hormonal changes during menstruation can also affect the production of serotonin, a brain chemical that influences mood and sleep.

To mitigate the impact of hormonal changes during menstruation on sleep, women can try various strategies. These include exercising, maintaining a consistent sleep schedule, creating a relaxing bedtime routine, limiting caffeine and alcohol intake, and managing stress through techniques like meditation or deep breathing. Seeking professional help from a doctor or sleep specialist is recommended if sleep problems persist or interfere with daily functioning.

Pregnancy discomforts

Pregnancy can be a tiring time, and it's common to feel exhausted, especially during the first 12 weeks. Hormonal changes can make you feel sleepy, nauseous, and emotional. Progesterone levels increase during the first trimester, making you feel drowsier than normal. By the third trimester, carrying the extra weight and the anxiety of impending labour can make you feel exhausted.

Pregnancy can also bring on a host of sleep problems. Many women experience insomnia during pregnancy, especially in the first and third trimesters. This can be caused by:

• Frequent urination
• Abdominal discomfort
• Congestion
• Heartburn
• Back pain
• Anxiety about labour and delivery
• Stress about balancing work and motherhood
• Uncomfortable mattresses
• Fear of giving birth
• Fear of not getting enough sleep
• Snoring
• Sleep apnea
• Restless legs syndrome
• Gastroesophageal reflux disease (GERD)

To help manage insomnia during pregnancy, you can try:

• Taking naps during the day
• Changing your diet, exercise, and bedtime routines
• Developing a bedtime routine
• Avoiding screen time at least an hour before bed
• Taking a soothing bath (not too hot)
• Drinking plenty of water during the day, but minimizing intake after 7 pm
• Avoiding caffeine starting in the late afternoon
• Eating an early, healthy dinner slowly
• Using a pregnancy pillow
• Getting a massage
• Establishing good sleep habits
• Creating the ideal sleeping environment
• Practising relaxation techniques
• Taking a sedative that's safe during pregnancy (consult your doctor)
• Joining an antenatal yoga or pilates class
• Reducing stress

Menopause

Sleep problems are a common issue for women during menopause, with nearly half experiencing difficulties sleeping. The hormonal changes that occur during menopause are the main cause of sleep issues, with the three main culprits being melatonin, oestrogen and progesterone—all of which are vital for a good night's rest.

Hormonal Changes

During menopause, the body produces less oestrogen and progesterone, which are hormones involved in the reproductive cycle. These changes affect many systems and processes in the body, including sleep. Oestrogen withdrawal causes the brain to become more reactive to temperature changes, triggering hot flashes and night sweats. This can make it difficult to fall and stay asleep.

Sleep Disorders

Women going through menopause are also at an increased risk of developing sleep disorders such as sleep apnea and restless leg syndrome. Sleep apnea is caused by a loss of reproductive hormones, which can lead to obstructions in the airway and disrupted sleep. Restless leg syndrome causes uncomfortable sensations in the legs when lying down, making it difficult to fall asleep.

Treatments

There are several treatments available to help improve sleep during menopause. These include:

• Hormone replacement therapy (HRT): This is the traditional treatment for menopause-related sleep issues and can help control night sweats and hot flashes.
• Medications: Certain medications, such as low-dose antidepressants, gabapentin, and clonidine, can help relieve hot flashes and improve sleep.
• Lifestyle changes: Making small changes to your routine and environment can improve sleep. This includes maintaining a regular sleep schedule, avoiding stimulants like caffeine, and keeping your bedroom cool and dark.
• Cognitive behavioural therapy (CBT): This type of therapy can help address factors such as stress that may be contributing to poor sleep.

Higher rates of depression and anxiety

Women are twice as likely as men to experience anxiety and depression. These mental health conditions are bidirectionally linked to insomnia, meaning that they can both cause insomnia and be caused by it. For instance, depression can make a person more likely to experience insomnia, and insomnia can also aggravate the symptoms of depression.

Women are more likely to experience insomnia before and during their period. This is due to the hormonal changes that occur during the menstrual cycle, which can cause sleep disruptions. Specifically, the sleep-wake cycle is ruled by hormones that affect when a person feels tired, alert, and hungry. Hormone-driven changes in sleep architecture can reduce the amount of time women spend in deep sleep.

Pregnancy can also cause insomnia due to physical discomfort, acid reflux, the frequent need to urinate, and the baby's movements. Many people also develop restless leg syndrome or obstructive sleep apnea during pregnancy, which increases their vulnerability to insomnia.

Sleep problems become increasingly common in the years preceding and following menopause. This is due to factors such as hot flashes, frequent waking at night, and the development of conditions like restless leg syndrome, sleep apnea, depression, and anxiety.

Additionally, women are more likely than men to develop pain conditions such as migraines, tension headaches, carpal tunnel syndrome, irritable bowel syndrome, and rheumatoid arthritis. This puts women at greater risk of developing insomnia due to chronic pain.

Sleep disorders

Hormones are thought to be a key factor in this disparity. Women experience different levels of estrogen and progesterone than men, and these levels fluctuate throughout the menstrual cycle. Doctors believe that these hormonal shifts can affect the ability to fall or stay asleep, and may impact the circadian rhythm. Periods, for instance, can keep women up at night due to cramps, headaches, bloating, breast tenderness, and mood and anxiety changes.

Pregnancy can also disrupt women's sleep due to physical discomfort, the need to urinate frequently, and conditions like restless leg syndrome and sleep apnea, which women are more likely to develop during pregnancy.

Menopause is another factor, as hormonal changes during this time can cause night sweats and hot flashes that interfere with sleep. Additionally, the prevalence of obstructive sleep apnea increases significantly as women go through menopause.

Women are also more likely to have certain health conditions that make sleep difficult, such as polycystic ovary syndrome (PCOS), fibromyalgia, and urinary incontinence. PCOS, for example, can cause hormone imbalances that worsen sleep problems, and it also increases the risk of sleep apnea.

Stress, anxiety, and depression can also contribute to sleep disorders in women. These mental health conditions are more common in women and can create a cycle where the insomnia and mental health issues exacerbate each other.

Treating sleep disorders in women often involves addressing the underlying causes, such as hormonal imbalances or mental health issues. Cognitive-behavioral therapy, medication, and lifestyle changes can all be part of the treatment plan.

Frequently asked questions