WCWOct2022

Womenn’s Health
Issue
How Sleep Changes
Throughout a Woman’s Life
Biological differences explain
some of the sleep differences
between women and men.
Women tend to take longer to
fall asleep, and to spend more
time in restorative slow-wave deep sleep than
men. Older women are also more likely to report
higher levels of sleepiness, and to sleep
20 minutes less per night.
The gender differences in sleep emerge
in puberty. Among high school students, females
are significantly less likely to get their
recommended eight hours of sleep per night
than their male counterparts. They are also
more likely to have comorbid depression.
These sleep issues persist at other major hormonal
transitions in a woman’s life, such as
menstruation, pregnancy, and menopause.
One-third of women experience cramps,
headaches, and bloating that cause sleep disturbances
during their menstrual cycle. And
even though total sleep time stays roughly the
same throughout the menstrual cycle, women
are most likely to report lower sleep quality in
the week before their period. It’s also during
this time that women with severe PMS more
frequently report disturbing dreams, sleepiness,
fatigue, and trouble concentrating.
Women are more likely to have sleep troubles
during pregnancy, especially during their
third trimester when symptoms of RLS, OSA,
pain, and incontinence are more frequent.
Sleep disruptions continue into postpartum,
when hormone levels drop. This sudden
change in hormones, along with raising a
newborn, can worsen sleep quality and daytime
sleepiness.
Women perceive and report their sleep
problems differently than men. For example,
women who seek treatment for sleep apnea
are more likely to focus on symptoms like
fatigue and depression, whereas men will
describe snoring and gasping. This may lead
to fewer women being diagnosed, or to a
misdiagnosis of insomnia when sleep apnea
is the underlying condition.
Hope for Better Sleep
Sleep issues are common among women,
and may change or vary in intensity throughout
life, but there is hope for better sleep.
Start with better sleep hygiene. Avoid naps
during the day, and limit your caffeine,
alcohol, and nicotine intake. Engage in regular
exercise and follow a consistent sleep
schedule. Make your bedroom as cool, dark,
and quiet as possible (and remove the clutter
and electronics).
Why Good Sleep is
so Important
Good sleep is essential for our physical, mental,
and emotional wellbeing. The average
adult needs seven to nine hours of sleep each
night. Unfortunately, fewer than two-thirds of
women actually get that much sleep each
night according to the CDC.
Even one night of poor sleep causes daytime
sleepiness, trouble with memory and
concentration, and impaired performance
at school and work. Worse, chronic sleep
deprivation increases your risk for injury,
accidents, illness, and even death.
Getting good sleep is vital, but so is getting
good quality sleep. Biological conditions
unique to women, like the menstrual cycle,
pregnancy and menopause, all affect
how well a woman sleeps. Women experience
changing levels of hormones, like
estrogen and progesterone, throughout the
month and over her lifetime. Understanding
the effects of these hormones, environmental
factors, and lifestyle habits can help women
enjoy a good night’s sleep.
How Much Sleep
Does a Woman Need?
The average adult woman sleeps eight hours
and 27 minutes per night. Studies show
that women tend to sleep approximately 11
minutes more than men, despite having less
time for sleep due to differences in paid and
unpaid work, increased caregiving responsibilities,
and family and social roles.
However, despite getting more sleep
overall, researchers found that women experience
lower-quality sleep than men. One
reason could be that women are more likely
to get up to take care of others, interrupting
their sleep. Women are also more likely to
nap during the day, which can further disrupt
their sleep quality at night.
Common Sleep Problems
for Women
70 million Americans suffer from sleep
problems, but men and women don’t suffer
equally. Women are more likely to have
sleep problems than men. Women are also
more prone than men to develop certain
sleep disorders, including insomnia and
restless legs syndrome.
Most common sleep issues
that affect women
Insomnia—People with insomnia regularly
have difficulty falling or staying asleep. As a
result, they don’t feel refreshed upon waking
up and have difficulty functioning during
the day. Insomnia is the most common sleep
disorder, but women are 40 percent more
likely to suffer from it than men. They are
also more likely to experience symptoms of
daytime sleepiness.
Hormonal changes associated with
menstruation, pregnancy, and menopause
can alter a woman’s circadian rhythm, and
consequently contribute to sleeplessness.
The prevalence of insomnia among women
increases significantly in older age, as they
transition through menopause. Hot flashes
and night sweats disrupt sleep, and are experienced
by 75 to 85 percent of women with
menopause. Women are also nearly twice as
likely as men to report depression and anxiety
— two conditions which are closely connected
with insomnia.
Treatment for insomnia often begins with
better sleep habits, such as following a regular
sleep schedule, reducing one’s caffeine
and alcohol intake, and improving the sleep
environment. If an underlying condition is
contributing to the insomnia — such as depression,
bladder problems, or pain — a doctor
may focus on treating that first through
medication, therapy, and lifestyle changes.
Pain and Sleep
Pain is strongly associated with insomnia13.
Pain makes it difficult to get comfortable
enough to fall asleep. It also makes it challenging
to stay asleep, as certain conditions
may force you to readjust during the night to
avoid waking up in pain.
Some conditions associated with chronic
pain are more common among women, including
migraine, tension headaches, heartburn,
arthritis, and fibromyalgia.
Treatment for pain-related sleep problems
may focus on the source of pain, the sleeping
difficulty, or both. A combination of relaxation
techniques, cognitive behavioral therapy,
lifestyle changes, and over-the-counter
and prescription medications may help.
Other Sleep Disorders
Nocturnal sleep-related eating disorder (NS-
RED) is a parasomnia where one eats food
during the night while asleep, yet have no
recollection of it upon waking up. Women
are significantly more likely to have NS-RED.
NS-RED can occur during sleepwalking and
may coexist with other sleep disorders that
trigger sleep eating.
NS-RED can be treated with medication,
therapy, stress management techniques, and
lifestyle changes, such as limiting caffeine
and alcohol.
Restless legs syndrome (RLS) causes unpleasant
crawling and tingling sensations in
the legs, which occur when lying down and
are accompanied by an uncontrollable urge
to move the legs. Because symptoms occur
when lying down and can only be relieved
through movement, many women with RLS
have difficulty sleeping. These sleep issues
can lead to daytime sleepiness, mood swings,
anxiety and depression — all of which can
worsen sleep problems in turn.
Women are twice as likely as men to have
RLS. The risk for RLS is higher among women
with multiple children, and increases twofold
from pregnancy to menopause. Iron deficiency,
which is more common in women,
may be a risk factor for RLS. Treatment may
include iron supplements, other medications,
and lifestyle changes to improve sleep.
About 80% of people with RLS also
have periodic limb movement disorder
(PLMD), a sleep disorder where the individual
experiences involuntary leg jerks or
twitches during sleep. These movements can
occur every 20 to 30 seconds, and like RLS,
can disrupt sleep quality.
Shift Work and Sleep
Nearly 15 million Americans work outside
of the normal 9 a.m. to 5 p.m. Shift workers,
especially those who work the night shift,
often have to sleep at non-traditional hours.
This causes disruptions to their natural sleepwake
cycle, with ramifications that can lead
to less restful sleep, less sleep overall, and
more sleep-related accidents and illnesses,
especially for those who work the night shift.
While further research is necessary, scientists
believe the changes in exposure to
light and lost sleep caused by shift work
may have biological or hormonal effects
that disrupt the sleep-wake cycle. Irregular
work schedules can also put strain on
family and social life, which can lead to
stress and other emotional problems that
worsen sleep. Light therapy, medication, and
lifestyle changes may be proposed as treatment.Sleep
apnea is a sleep disorder characterized
by temporary pauses in breathing
during sleep. These pauses cause loud
snoring, choking, and gasping sounds that
disrupt sleep and lead to excessive daytime
sleepiness. Sleep apnea is twice as common
in men, although it increases in women after
age 50. Women are also more likely to have
comorbid depression.
Obesity and older age are the two largest
risk factors for sleep apnea. During menopause,
women experience hormonal changes
that trigger an increase in abdominal fat, as
well as lower progesterone levels. Both of
these may explain their increased risk of
sleep apnea.
A number of effective treatment options
are available, including CPAP therapy. Hormonal
replacement therapy for menopause
may lower their risk, as can changing their
diet and exercise.
Finally, speak to a doctor about the sleep
issues you are experiencing. They can help.
28 WEST COAST WOMAN OCTOBER 2022