Womens Health

Understanding and Addressing Sleep Issues in Women

“Sleeplessness is a desert without vegetation or inhabitants,”wrote author Jessamyn West.

As it turns out, West was not as alone as she may have thought. Only a little more than a third (39 percent) of American women report getting a good night’s sleep on most nights, according to a poll by the National Sleep Foundation. In addition, the poll found:

Almost half (46 percent) of women say they have a “sleep problem” nearly every night.

Most (60 percent) report that they sleep well only a few times a week.

More than one-third (34 percent) say they wake up too early and can’t get back to sleep at least a few nights a week.

Sleep medicine specialist Fouzia Siddiqui, MD, of the Sentara RMH Sleep Center, believes that women may tend to suffer from insomnia more than men because of their “intuitive natures” and difficulties quieting their minds at night.

“They tend to take what’s going on in their heads to bed,” Dr. Siddiqui says. “They’re more tuned in to what’s going on around and inside them. So even with good health and no hormonal issues, they may have disturbed sleep.”

Experts at the National Sleep Foundation also suggest that women these days tend to “burn the candle at both ends,” leaving them too little time for sleep.

As well, there is widespread agreement among medical professionals that sleep problems in many women can be attributed, at least in part, to biology.

“Women’s sleep changes across their lifespan, with three major phases that differ from sleep in men: the hormonal changes with menarche and the menstrual cycle, the childbearing years—with or without pregnancy—and menopause,” says William Hammond, MD, a sleep physician at Sentara Martha Jefferson Hospital.

Even with these changes, according to Dr. Siddiqui, “females of any age need the same amount of sleep as males do. Teens need about 10 hours of sleep. Women ages 18 to 65 need seven to eight hours. After age 65, six and a half to seven hours should be adequate.”

But the amount of sleep a person gets doesn’t tell the whole story—the quality of sleep also matters.

“The rule of thumb for good-quality sleep is that you wake up on your own feeling refreshed,” Dr. Siddiqui says. “Ideally, your body should tell you the right time to sleep and the right time to wake up.”

The Role of Hormones in Sleep Issues

Hormones can cause poor sleep at different points in a woman’s life, especially at the start of menses, during pregnancy and at menopause. Medical conditions often play a role, too.

Young women may start experiencing sleep problems when they start menstruating, between ages 12 and 14.

“Sleep architecture, or the cyclical pattern of sleep as it progresses through various stages, seems to change during the menstrual cycle, although we need more data on the subject to make firm conclusions,” says Dr. Hammond.

In general, sleep appears to be better, with fewer awakenings, in the early part of the menstrual cycle when hormones are increasing, he says. As those hormones recede, the number of awakenings tends to increase, leading to poorer sleep quality. There seems to be a significant decline in sleep time and quality during the last week of the cycle, when women are premenstrual.

During pregnancy, physiological and biochemical changes place women at risk for sleep disorders, says Dr. Siddiqui. Many pregnant women (40 percent) experience symptoms of snoring, spells of apnea or restless legs.

During the third trimester of pregnancy, many women report more difficulty falling and staying asleep, says Dr. Hammond. Common complaints include general physical discomfort; frequent urination; back, joint and neck pain; vivid dreams; nasal congestion; leg cramps; fetal movements; and contractions.

After giving birth, new mothers’ sleep is often affected by mood changes due to a sudden drop in hormonal levels—and, of course, the need to wake up frequently to feed their newborns at night. Lack of sleep can have further negative impacts on mood.

Women report the most sleeping problems from perimenopause to postmenopause, including issues such as hot flashes, mood disorders, insomnia and sleep-disordered breathing.

Generally, postmenopausal women are less satisfied with their sleep quality, and as many as 61 percent report symptoms of insomnia. Snoring is also more common and more severe in postmenopausal women. Experienced along with pauses and gasps in breathing, snoring can be a sign of obstructive sleep apnea, a more serious sleep disorder.

Medical and Other Causes

Chronic physical conditions also can prevent women from getting a good night’s sleep:

•  Heartburn is often made worse when lying down, causing sleep problems.

•  Arthritis pain can make it difficult for women to fall asleep and to resettle when shifting positions.

•  People with fibromyalgia—a condition characterized by painful ligaments and tendons—are likely to wake in the morning still feeling fatigued, and as stiff and achy as a person with arthritis.

•  People with diabetes whose blood sugar levels are not well controlled may experience sleep problems due to night sweats, frequent urination or low blood sugar.

•  Hyperthyroidism can cause sleep problems by overstimulating the nervous system, making it hard to fall asleep. The condition also may cause night sweats, leading to nighttime awakenings.

•  Dementia may disrupt sleep with wandering, disorientation and agitation during the evening and nighttime.

Obstructive sleep apnea is the most common medical condition impacting sleep quality for both women and men.

“Women with sleep apnea may not snore, gasp for air or experience daytime fatigue the way men do, but they may experience symptoms such as depression, fatigue and a feeling of unwellness,” Dr. Siddiqui says. “They’re harder to diagnose than men because they often don’t have the physical signs of apnea that men do.”

Tips for a Good Night’s Sleep

Dr. Siddiqui encourages everyone to try to get the sleep they need.

“All of our activities—our health, our immune systems, our work—are dependent on the quality of our sleep,” she says. She has several suggestions for helping you sleep better:

•  Practice good sleep hygiene. Stick to a regular schedule—even on weekends. Get the hours of sleep you need to wake up feeling refreshed.

•  No TV, phone or other electronic devices should be allowed in the bedroom.

•  Avoid arguments or difficult conversations in the evening.

•  Avoid caffeine and exercising at night.

•  Meditate, say your prayers or do deep breathing before bedtime.

•  Write tomorrow’s to-do list before bed so you don’t worry about it during sleeping hours.

•  Pregnant women are encouraged to sleep on their left side. It’s better for mother and baby.

•  If new mothers can’t get solid sleep at night, they can catch up during the day. Two 30-minute daytime naps would give them some quality sleep.

If you try these tips and are still having problems, Dr. Siddiqui advises seeking medical help to treat any potential underlying issues.

You should talk to your doctor in cases of:

•  Not regularly getting 7-8 hours of sleep

•  Not feeling refreshed upon waking

•  Depression

•  Fatigue

•  Restless leg syndrome

•  Neuropathy

•  Snoring and apnea

Dr. Siddiqui also notes that some medications can cause insomnia, so be sure to ask your doctor if any of yours fall into this category. You may be able to address the problem by changing the time of day you take your medications or by switching medications.

If You Need Sleep Services

To contact a Sentara Blue Ridge Region Sleep Center:

• In Charlottesville, call the Sentara Martha Jefferson Sleep Medicine Center at 434-654-5280.

• In Harrisonburg, call the Sentara Sleep Center at 540-564-5500.

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