The two primary differences in sleep between men and women relate to hormones and the prospects of pregnancy. The cyclical hormonal changes in a woman's body throughout her mature life—primarily related to estrogen and progesterone levels—have a major impact on sleep.
In addition, there are environmental and lifestyle factors that can account for the fact that women may not be getting the same quality and quantity of sleep as men. A 1998 National Sleep Foundation (NSF) Women and Sleep Poll found that the average woman (age 30-60) sleeps less than 7 hours a night during the work week. This may be due to pulling double duty as a working parent (working full time, then coming home and working full time in the household raising children, caregiving for elderly parents, or both). More recently, a 2005 NSF Sleep in America poll showed that women struggle more with falling and staying asleep and experience more daytime sleepiness than men.
Many women also work unusual shifts (as medical professional, for instance), which can throw the entire sleep-wake cycle into chaos if maintained over time. When women don't get enough sleep, or the sleep they do get is poor in quality, this can result in daytime sleepiness, placing them at higher risk for car accidents, issues with job or school performance, concentration problems, and a likely increase in health issues including breast cancer and obesity.
Listed below are the most common complaints regarding sleep that are often unique (but not mutually exclusive) to being female.
Insomnia
The inability to sleep seems to plague women at every lifespan event. Insomnia is defined as the failure to fall asleep promptly, the inability to stay asleep, or both, all within the presence of adequate opportunities to sleep. For women, the major shifts in hormones during menstruation, pregnancy, and menopause are due to major drops in progesterone, which is a sleep-promoting hormone.
Sleep breathing disorders
Obstructive Sleep Apnea (OSA) occurs when the upper airway is crowded by an overlarge tongue or adenoids or otherwise obstructed due to narrow airways or swelling caused by allergies, illness, or other health conditions. Women are less likely to suffer from OSA until they are past age 50, but sleep apnea is found among women of all ages, regardless, as it is not a male- or age-specific disease, but one of mechanics.
Women who are pregnant are also more likely to experience sleep apnea for the simple reason that they carry up to forty percent more body fluid during this time. These fluids, while a pregnant woman stands upright, collect in the lower body, leading to the common experience of ankle edema. However, when a pregnant woman reclines to sleep, these fluids redistribute, swelling the tissues of the upper airway and creating the likelihood of obstruction.
Hypersomnia
Excessive daytime sleepiness can be the result of a number of factors not related to gender, but for women who are ovulating, the feeling of extreme sleepiness in the day can also be due to increases in progesterone at this time of the month.
Movement disorders of sleep
These are common in women as well. Restless Leg Syndrome (and its nocturnal cousin, Periodic Leg Movement Disorder) can interrupt the onset of sleep or its overall quality and quantity. Either condition is thought to be due, in part, to imbalances in blood iron. If left untreated, either RLS or PLMD can result in major increases in daytime sleepiness, mood swings, anxiety, and depression.
Pain
Perhaps the most significant enemy of sleep, pain has been shown to affect more women than men, so it's no surprise that issues with migraines, arthritis, heartburn, and other painful conditions are more likely to keep women from falling asleep or from staying asleep.
SLEEP ACROSS THE LIFESPAN
Menstruation
Typically, women report that sleep patterns change most noticeably just prior to menstruation. These patterns might change due to shifting hormones, or could be symptomatic of larger imbalances related to PMS (Premenstrual Syndrome) or PMDD (Premenstrual Dysphoric Dysfunction), both being measurable, legitimate health conditions related to menstruation. Cramping, bloating, cravings, and mood swings can impact sleep behavior just as much as it can affect waking behavior. Insomnia and less REM sleep due to the inability to achieve deep sleep are common complaints. In addition, fluctuations in core body temperature caused by menstruation can alter sleep architecture, leading to the possibility of unwanted early awakenings or less deep sleep.
SEE ALSO: Menstrual Cycle and Sleep || Sleep Health Foundation [PDF]
Pregnancy
The first and third trimesters of pregnancy offer the most opportunities for challenges to quality sleep due to hormonal fluctuations, increases in body fluids, mood shifts, gastroesophageal reflux disease (GERD), movement disorders of sleep, general body discomfort due to growing pains, edema, body temperature changes, shifts in body weight or misalignment in the spine, anxiety about the pregnancy and/or motherhood, and other pregnancy challenges like morning sickness or frequent nighttime wakings to use the bathroom. All of the sleep problems listed previously are likely to impact sleep for pregnant women.
SEE ALSO: Pregnancy & Sleeping || National Sleep Foundation
Insomnia is perhaps the biggest sleep complaint among women going through this major change in the lifespan. It can be a side effect of menopause or it can be caused by symptoms of menopause (such as hot flashes, bloating, cramping, cravings, or mood swings). Shifting hormone levels lead to difficulty falling asleep, frequent awakenings, difficulty maintaining sleep, unwanted early awakenings, and the sense of having not slept well, which results in waking up unrefreshed.
SEE ALSO: Menopause and Sleep Concerns || The Cleveland Clinic
Post-menopause
Sleep problems don't end for women with the end of menopause. After menopause, hormone levels may stop fluctuating, but the nervous and endocrine systems may no longer make enough serotonin, progesterone, estrogen, and other hormones related to sleep regulation. In addition, fewer hormones can result in less muscular tension in the upper airway; match that with increases in body fat resulting from menopause, and the risk for developing obstructive sleep apnea goes way up. Add the likelihood of chronic pain from arthritis, the development of GERD, and other common problems of aging, and it's easy to see how women can continue to struggle with sleep issues even after menopause.
SEE ALSO: Sleep Complaints of Post-Menopausal Women || National Institutes of Health [PDF]
WHAT CAN I DO?
Here's a punch list of easy things you can try to help improve your sleeping habits. If your sleeping life is plagued with problems, and you suspect they are related to "female problems," you are best advised to tackle these problems in a partnership with your primary care physician, obstetrician-gynecologist, midwife, or other members of your healthcare team.
- Eat a well-balanced diet. Lots of healthy foods pack nutrition that can enhance your ability to fall and stay asleep. Adequate amounts of iron can be essential as well.
- Consider replacing your regular daily vitamin with a prenatal vitamin. These are formulated specifically to the needs of women, regardless of their pregnancy status.
- Keep a sleep diary during your cycle to get a good snapshot of your energy/sleepiness levels over the course of menstruation. Knowing how your sleep process changes during your cycle is good information to refer to in the future when you are struggling to get adequate sleep. You can at least plan ahead for a few sleepless nights by booking out some extra time to sleep or nap, for instance.
- Always get out of bed at the same time every day. When you wake up in the morning, you set your rhythms to the circadian cycles that govern all living things on the planet. Natural morning light is critical to this function.
- However... go to bed only when you are tired. Your body has its own sleep drive; let it tell you when you are ready to sleep, and then go to bed.
- Put away electronics an hour before bedtime. That means smartphones, laptops, handheld tablets, and the like. Their blue spectrum light emissions can mess with your brain's production of melatonin, and this can significantly delay sleep onset.
- Put at least two hours between your last meal and your bedtime. Avoid greasy, rich foods and caffeinated and/or carbonated drinks at night... anything that can give you heartburn.
- Also off the table... alcoholic beverages! Alcohol may help you fall asleep, but it will significantly change your sleep architecture and is often the hidden enemy of good sleep for women who like that bedtime glass of wine.
- Get some good exercise during the day, but don't exercise right before bed. This changes your hormone levels (adrenaline!) and your body temperature; both can wreak havoc on sleep cycles.
- Review all of your medications with your healthcare team and pharmacist. Often a hidden drug interaction can be to blame for sleep problems.
- Keep your bedroom cool. Use multiple lighter blankets and remove and replace them for comfort as needed. A too-warm room can alter your ability to achieve deep sleep.
- Eliminate distractions in your bedroom. Block invasive light wherever possible; wear earplugs if your sleeping partner snores. Turn off the TV and/or audio devices to eliminate any reason to stay awake.
- Find relaxing activities to help you fall asleep. Reading a book on a non-backlit electronic reading device (or an old-fashioned book with a reading light filtering blue spectrum emissions) can be very relaxing. Learn meditation techniques, including yogic breathing, to help shut down the busy mind at night. Write down the things on your mind in a nightstand journal so you can capture them on the page and let these thoughts "go" until the morning.
- Make sure your pillow and mattress are supportive and comfortable. Use additional pillows as necessary to help with muscle or joint pain.
- Avoid smoking cigarettes at least 30 minutes before going to bed. Nicotine is a double-edged sword: it can help relax you initially, but will work as a stimulant shortly after.
- Avoid smoking marijuana. Despite what some people will insist, marijuana has long been known to negatively alter sleep stages, especially deep sleep, which is necessary for good health.
