Introduction
In recent years the problems with sleep that women may experience have been better appreciated. Women are among the most chronically sleep deprived members of society, with women from age 30-60 averaging just under 7 hours of sleep per night during the week. This is contributed to by a combination of factors, including the multiple roles many women have as wage earner, homemaker and mother. In addition, physiological differences due to changing hormone levels add unique issues for women with what we now recognize as an important effect on sleep quality.
Sleep and Menstrual Cycle
Studies have shown that hormonal changes in the menstrual cycle can and do interfere with sleep for an average 2-3 days per monthly cycle. The interference with sleep appears due to a bloated feeling but clearly contributed to by other factors. The most marked disturbance occurs during the first few days of menstruation. A second time of disrupted sleep occurs as progesterone levels fall towards the end of the menstrual cycle. There may be difficulty falling asleep in this time period. The premenstrual period, the last few days before menstruation commences, is also associated with poorer sleep with insomnia common but sometimes hypersomnia or increased daytime sleepiness may also occur. While no specific solutions exist for these problems, careful attention to good sleep hygiene can help.
Sleep and Pregnancy
Pregnancy is associated with a host of physical and emotional changes. Physical changes include morning sickness; body aches including back pain, heartburn and of course fetal movement. Emotional changes include a huge range including anxiety, fear and depression. Emotions can swing wildly. According to a National Sleep Foundation poll as well as other research, 78% of women experience more disruption of sleep than they normally experience. These changes vary with the stage of pregnancy:In the first trimester there are high levels of progesterone. This may be associated with increased sleepiness. Some of the physical changes may also disrupt nighttime sleep, leading to further increases in daytime sleepiness. The second trimester usually has less severe disruption of sleep than earlier or later stages, but still not normal quality sleep.The third trimester is associated with the most significant changes in sleep. The physical changes of pregnancy are their greatest and include general discomfort, increased nocturnal urination, heartburn, back pain and nasal congestion. Studies have suggested that virtually all women have some disruption of their sleep in the third trimester. Again, there are no perfect solutions to these problems. Taking naps may help to at least relieve some of the daytime sleepiness.
Pregnancy and Other Sleep Disorders
In addition to the disruption of sleep that is a consequence of the physical and hormonal changes, certain specific sleep problems may also occur in pregnancy. Because of the increased weight and the swelling of tissues that occurs in pregnancy, many women have the onset of snoring for the first time in pregnancy. If the airway obstruction is significant enough and in particular if there is a predisposition due to genetic factors, obstructive sleep apnea may also occur. This condition is not only characterized by loud snoring but by obstruction of airflow which in turn leads to significant interruptions of sleep and drops in oxygen level. The interrupted sleep can lead to marked daytime sleepiness. If daytime sleepiness does occur and is more severe than might be reasonably expected from hormonal changes alone, the diagnosis of sleep apnea should be considered.In the third trimester as many as 15% of woman may also experience a sensation of discomfort, often described as a "creepy crawly" sensation in the legs which leads to a need to move, kick or even get out of bed and walk. The consequence can range from being slightly annoying to severely disruptive of sleep. The condition can be treated with medication but some of these can be harmful to the fetus.
Menopause and Sleep
Menopause occurs on average at age 51 and is associated with a variety of symptoms due to the hormonal changes that occur. There is a gradual decrease in estrogen levels that leads to hot flashes. These sensations are often associated with intense sweating. A National Sleep Foundation poll revealed that 36% of menopausal women experience hot flashes in sleep. The result was poorer quality sleep for an average of 5 days per month with hot flashes persisting for an average of 5 years. The result is daytime fatigue. Treatment involves hormone replacement therapy but there remains some controversy over the potential side effects of this. Treatment decisions must therefore be made by the woman and her physician. Alternative therapies including some herbal medications and soy products have also been suggested.
Other Sleep Disorders in Women
Insomnia
Insomnia is common in the population as a whole. It seems, however, to be more common in women than men. The percentage of women with insomnia averages over 50% and increases with age. Many women who try and juggle multiple roles as mother, wage earners and home makers are particularly prone to problems. Treatment options include behavioral changes and sometimes medication. The first step is usually to be sure you are following good sleep hygiene practices. If these do not help, then you may need an evaluation by your physician or a sleep specialist.
Obstructive Sleep Apnea
For many years it was believed that obstructive sleep apnea was unusual in women. More recently we have discovered that while it is less common than in men it is non-the-less common in women, occurring in as many as 2% of all adults. The condition is often marked by serious snoring and daytime sleepiness. Of even greater concern, it is associated with an increased risk of cardiovascular diseases, including high blood pressure and stroke. So, identification is not just about curing a socially unpleasant snore, but about your health and well being. Fortunately, once identified, treatment for sleep apnea is available.
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