Issue 4 Stories
Womens Health

Bedtime Bothers for Women

How Hormones Can Affect Sleep Issues

When it comes to sleep, women seem to struggle more than men to get a good night’s rest.

While around 40 million American men and women are estimated to have some type of sleep disorder, more women than men are affected, according to the National Sleep Foundation (NSF). In its 2005 Sleep in America poll, the NSF revealed that women are more likely than men to have difficulty falling asleep and staying asleep, and also experience more daytime sleepiness. Women experience a wide range of sleep disorders, including insomnia, obstructive sleep apnea and restless leg syndrome.

So why are women more prone to sleep problems? Hormones may be partly to blame.

“Women’s bodies go through a lot of changes throughout their lives, from starting the menstrual cycle to pregnancy to menopause,” says neurologist Chris Winter, MD, medical director of the Sentara Martha Jefferson Hospital Sleep Medicine Center and author of The Sleep Solution: Why Your Sleep is Broken and How to Fix It, released in April 2017. “Many factors can contribute to these problems, but it’s certainly important to understand the role hormones play and manage them effectively to help improve sleep quality.”

Trouble Sleeping. Period.

Since many women experience pain, cramps, bloating and changes in body temperature control during the menstrual cycle, that time of the month can wreak havoc on sleep. These symptoms often begin in the days before a woman starts her period—the dreaded premenstrual syndrome (PMS) phase—when her progesterone levels drop sharply, according to nurse practitioner Heather Miller, BSN, MSN, ANP-C, a sleep medicine specialist at Sentara RMH Medical Center. During this stage, falling asleep may take longer, and women may waken more frequently than usual throughout the night. The body’s levels of melatonin, a hormone that helps regulate the sleep-wake cycle, also decrease with premenstrual symptoms, exacerbating sleep problems.

There is a bit of good news, however: Sleep tends to get better once PMS passes.

“During the menstrual phase, progesterone levels rise rapidly, which can have a sedative effect, making sleep more consolidated and refreshing,” Miller explains.

Oh, Baby: Sleeping (or Not) During Pregnancy

The effects of pregnancy on sleep vary with each stage. During the first trimester, for example, a woman is likely to rest better due to the sedative effect of increasing levels of progesterone.

“In the second trimester, progesterone continues to be released in large amounts, where it acts as a respiratory stimulant,” continues Miller. “This can have a positive effect in reducing the risk or severity of obstructive sleep apnea, an airway blockage that causes disruptive pauses in breathing during sleep.”

The effects of pregnancy on sleep shift dramatically during the third trimester, however. As the growing baby crowds out the mother’s lungs, abdomen, bladder and other internal organs, she may experience frequent heartburn, shortness of breath and overall increased discomfort—all factors that may contribute to insomnia. Pregnant women also may be more likely to struggle with sleep apnea and restless leg syndrome, an unusual sensation that increases the need to move the legs or arms and makes it difficult to fall asleep.

After the baby’s birth, sleep doesn’t usually improve much, unfortunately—at least not during the first few months. A new mom typically experiences interrupted sleep as the baby wakes every two to three hours for feedings and diaper changes, and falling back to sleep at these times may prove difficult. In part due to the lack of sleep during these challenging months, new moms and other family members should watch carefully for signs of postpartum depression, which could be exacerbated by sleep issues.

The Change: Up All Night With Menopause

Sleep efficiency—the time spent sleeping versus the time spent lying awake in bed—worsens for both men and women as they age, Miller notes. “However, women complain about their sleep with the onset of menopause more at this time of life than at any other,” she says.

During menopause, estrogen and progesterone levels drop, leading to an increased risk for obstructive sleep apnea. Women also often begin to experience hot flashes and sweating during this time, causing them to awaken more frequently during the night and experience increased irritability. These factors often put women at risk for anxiety and depression.

“Women report more insomnia during menopause,” Miller says. “They may be experiencing a spiraling of several disorders, meaning that sleep disturbances caused from hot flashes, night sweats and fragmented sleep cause the insomnia, which then results in anxiety and depression. In these cases, it’s important to find the cause of the insomnia so that appropriate treatment can be provided.”

Finding Answers

When sleep problems begin to interfere with daily activities, work or relationships, or affect a woman’s overall sense of wellness, talking to a sleep expert is a good idea. In general, Dr. Winter doesn’t recommend sleep aids to treat sleep disorders. Instead, he recommends getting to the root of the problem.

“The majority of sleep problems can be solved without using some sort of sleeping pill,” Dr. Winter notes. “It’s important to solve the medical issue that’s affecting sleep, whether it’s anxiety and depression or pain caused by arthritis or some other problem.”

Dr. Winter recommends developing good “sleep hygiene”—habits that are conducive to sleep. Here are some steps you can take to maximize your chances for a good night’s rest:

•    Create a sleep environment that is free from electronics—don’t work on your laptop or watch television in bed.

•    Keep your bedroom dark and at a cool, comfortable temperature.

•    Set a regular bedtime and wake time, and don’t try to make up for missed sleep on weekends.

•          Make dietary changes such as eliminating caffeine and not eating too closely to bedtime.

Meet the Providers:

Chris Winter, MD, D-ABSM, D-ABIM (sleep), D-ABPN (neurology), F-AASM

Neurologist and Medical Director, Sentara Martha Jefferson Hospital Sleep Medicine Center

A native of Salem, Va., Chris Winter, MD, started doing sleep research as an undergraduate student at the University of Virginia (UVa) in the early 1990s. After graduating from Emory University School of Medicine, he completed a residency in neurology at UVa and a fellowship in sleep medicine at the University of North Carolina at Chapel Hill. He is board-certified in neurology and sleep medicine.

Dr. Winter, who also owns Charlottesville Neurology and Sleep Medicine, is a dynamic speaker and researcher on the science of sleep. He consults with nearly 30 professional sports teams, including the Cleveland Indians, Los Angeles Dodgers, New York Rangers and Washington Wizards, to help optimize their travel schedules to promote good sleep, which can enhance athletic performance. He also works with individual players to address sleep issues. His book, The Sleep Solution: Why Your Sleep is Broken and How to Fix It, was published in April 2017.

“I just love talking about sleep,” says Dr. Winter, who joined Sentara Martha Jefferson Hospital in 2004. “It’s just so interesting, and it affects everybody. People have such interesting stories about their sleep, and we all spend so much of our time doing it—it’s a topic that has universal appeal.”


Heather A. Miller, BSN, MSN, ANP-C

Sleep Medicine Specialist, Sentara RMH Sleep Center

The daughter of a career U.S. Army dad, Heather Miller grew up living in places all over the United States and Europe. A former sixth-grade teacher, Miller decided to switch careers and pursue a nursing degree at the University of Alabama at Birmingham (UAB). After graduating with her second bachelor’s degree (she earned her first at Auburn University), Miller spent the next four years in the Army, serving as an emergency room nurse in Fort Campbell, Ky., and Iraq. Upon completing her Army service, she returned to school at UAB to earn her Master of Science in Nursing degree, specializing as an adult primary care nurse practitioner.

Miller, who joined Sentara RMH in 2016, became interested in sleep medicine after seeing immediate improvements in the lives of family members who were diagnosed and treated for sleep disorders.

“Sleeping problems can affect lives in so many ways,” Miller says. “Most patients have been symptomatic for so long that they think the way they feel is the way everyone feels—and that just isn’t the case. Sleep disorders can all be evaluated, diagnosed and treated. Enormous improvements in quality of life can occur with often simple methods. It’s very gratifying work.”

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