Women’s Sleep and Health:
Making the Connection; Making it a Priority

Even with my eyes shut and my head in the pillow, I know that it is the middle of the night. Why am I acutely aware of everything? Is my son up? Should I get out of bed and get some work done? Did I call my father? Why am I so restless and uncomfortable? I finally check the clock; it is 4:26 a.m. and I am positive that I will be a wreck in the morning.

Does this scenario sound familiar?

If it does, you are not alone. A recent poll by the Better Sleep Council found that nearly 70 percent of the women questioned were getting less than the recommended 8 hours of sleep each night and that 19 percent were obtaining under 6 hours. The women aged 40 – 60 were more likely than any other age group to average less than 6 hours per night. Nearly 60 percent of the women who participated in this survey, however, agreed that inadequate sleep might interfere with daytime functioning and health. They are right.

While eight hours is the average amount of sleep needed each night, sleep needs can varies from woman to woman, and from one life stage to another. However, regardless of age, sleep deprivation is common for women, as well as men, and consequences can range from mild or moderate changes in mood, alertness and performance to serious car accidents, depression, hypertension, cardiovascular disease, obesity and diabetes.

Sex Differences in Sleep 
In general, women are more likely to complain of insufficient and poor quality sleep than men, particularly after age 40. As a matter of fact, there are numerous developmental and life experiences unique to women, such as menstruation, pregnancy, and menopause, that can affect sleep due to fluctuating hormones and environmental factors. Likewise, certain sleep disorders may affect women differently or women may be at higher risk for some sleep problems in comparison to their male partners, friends, and co-workers.

Sleep-Related Issues
Menstruation, Pregnancy, and Perimenopause-Menopause 
It is estimated that 15 percent of women experience significant sleep disruption during menstruation. In a poll conducted by the National Sleep Foundation, 71 percent of 514 menstruating women reported that their sleep was affected by symptoms, such as bloating and tender breasts, on an average of 2.5 days each month.

Pregnancy is another time in women’s lives where sleep is significantly disrupted. Sleep begins to change as early as 10th week of gestation. Women report more fatigue, daytime sleepiness, and night awakenings during the first trimester (sometimes insomnia). Quality of sleep in the last trimester worsens. Leg cramps increase from about 20 percent during the 1st trimester to 75 percent in the 3rd trimester with up to 20 percent of women developing Restless Legs Syndrome during pregnancy. In the last few weeks of pregnancy, women are bothered by not finding a comfortable position to sleep, waking up frequently to use bathroom, feeling too hot or perspiring, and by the baby’s movements.

Not surprising, nearly 30 percent of women report disturbed sleep and daytime sleepiness and fatigue during first three months postpartum. First-time mothers may experience more disrupted, inefficient sleep than more experienced parents. Depression and sleep difficulties during pregnancy and in the earlier postpartum months may be significant risk factors during this period for some women.

Disturbed, interrupted sleep, difficulty falling asleep, and daytime sleepiness are common symptoms during the menopausal transition. During these perimenopausal-menopausal years, premenstrual symptoms and menstruation may interfere with sleep more than during previous years. Fifty to eighty percent of women experience hot flashes for approximately five or more years, often during sleep. Hot flashes interrupt sleep with frequent wakings and daytime sleepiness. The loss of sleep may be more disruptive than the hot flash itself.

Sleep Disorders
Insomnia is the most common sleep disturbance for women as well as men. Women, however, are more likely than their male friends and partners to experience difficulties falling or staying asleep. Insomnia is characterized by trouble falling asleep, staying asleep, early awakenings, and the inability to fall back to sleep. Some common explanations for insomnia include, stress, depression and/or anxiety, jet lag, alcohol and/or drug use/abuse, physiological changes experienced with aging, respiratory difficulties, leg cramps, need to urinate, and/or discomforts of pregnancy. Other common sleep disorders are sleep-disordered breathing, restless legs syndrome, periodic limb movement disorder, and narcolepsy.

Sleep-disordered breathing or sleep apnea is a breathing disorder characterized by frequent, quite brief interruptions of breathing during sleep. The breathing pauses last at least 10 seconds, and there may be 20 to 30 or more pauses per hour. Yet, individuals with sleep apnea are more likely to present with excessive daytime sleepiness, morning headaches, and/or daytime accidents. Sleep apnea can affect anyone but occurs more often in men, and occurrence increases with age. Women, however, with the condition are less frequently diagnosed than men. Peri-menopausal and postmenopausal women and/or those who are obese or over weight, diagnosed with diabetes, heart disease and/or high blood pressure are at greater risk.

Other Factors to Consider
According to the Better Sleep Council Poll, 44 percent of the women emphasized that stress caused by work and family concerns impacted their ability to get a good night’s sleep. Another 13 percent cited allergies or cold-related problems as their main sleep-depriving culprit. One-in-ten (10 percent) blamed “an uncomfortable mattress or pillows” as the reason for their morning-after under-eye circles, while another 10 percent consumed “too much caffeine” during the day.

Focus on Solutions
Sleep is as important as nutrition and exercise and is often overlooked by health-care providers and women themselves. In any event, practicing good sleep hygiene habits, ensuring that you have an environment conducive to sleep, seeking assistance from a health care provider for a sleep problem, and educating other women about sleep are crucial sleep-smart strategies.

Recommendations and Resources for Women
1. If you are concerned about a sleep disorder, seek an evaluation at a local sleep clinic. Treatment is available for all of the sleep problems that are discussed in this article.

2. General Sleep Tips from the Better Sleep Council and the National Sleep Foundation:

• Maintain a regular bed and wake time schedule, including weekends.
• 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.
• Create a sleep-conducive environment that is dark, quiet, comfortable and cool.
• Sleep on a comfortable mattress and pillows.
• Use your bedroom only for sleep and sex. It is best to take work materials, computers and televisions out of the sleeping environment.
• Finish eating at least two to three hours before your regular bedtime.
• Exercise regularly. It is best to complete your workout at least a few hours before bedtime.
• Avoid nicotine (e.g., cigarettes, tobacco products). Used close to bedtime, it can lead to poor sleep.
• Avoid caffeine (e.g., coffee, tea, soft drinks, chocolate) close to bedtime. It can keep you awake.
• Avoid alcohol close to bedtime. It can lead to disrupted sleep later in the night.

3. Recommended resources:

Better Sleep Council, www.bettersleep.org

National Sleep Foundation, www.sleepfoundation.org

The National Women’s Health Information Center www.womenshealth.gov

American Academy of Sleep Medicine, www.aasmnet.org

Sleep Research Society, www.sleepresearchsociety.org

Sleep Apnea: American Sleep Apnea Association, www.sleepapnea.org

Restless Legs Syndrome: www.rls.org