Sleep problems are epidemic among women today. An astonishing three-fourths of all women in the U.S. have sleep problems at least some nights. And almost half of women usually awaken feeling tired or groggy.
Sleep problems can take many forms and can involve too little sleep, too much sleep or inadequate quality of sleep. While millions of women admit they are tired, most cannot tell you how their exhaustion affects every aspect of their health -- physically, mentally, and emotionally.
In my clinical practice, I treat hundreds of women who come to me with sleep complaints such as:
- Not being able to turn off their minds when they get into bed
- Having night sweats that cause them to sleep restlessly
- Waking up at 3:00 a.m. and then feeling exhausted all day long
- Taking more than 30 minutes to fall asleep
- Waking up frequently throughout the night
- Jolting out of bed after too few hours of sleep and being unable to return to sleep
- Having a snoring bed partner that keeps them up
- Having anxiety or fears about falling asleep
- Having a fear of driving long distances because of sleepiness or fatigue
Maybe you think you're exhausted and irritable because your kids wear you down. Or you may think low energy and an inability to focus are attributed to aging, depression, or a low-calorie diet. Quite honestly, some women tell me they've always felt "awful," so sleep problems go undiagnosed and untreated for years -- even a lifetime.
Women's Sleep Is Just Different Than Men's
The fact is -- women are not like men when it comes to sleep. There are major physiological sleep-related distinctions in women and men, like:
- Starting at birth, females have more slow-wave sleep than males. Slow-wave sleep, which occurs during stage 3 and 4 sleep, is the deepest, most refreshing, wake-up-and-feel-great sleep.
- Girls tend to wake up during the night less frequently than boys.
- Women continue to have significant deep sleep well into their 30s while men's deep sleep begins to decline in their 20s.
- Women's sleep systems appear to age more slowly than men's.
But wait -- these differences make it seem like women should, on the whole, sleep better than men. So, why do women have more problems sleeping? There are two primary reasons: hormones and aging.
Hormones Wreaking Havoc Women have more sleep disruptions during the premenstrual and menstrual time of the month -- including difficulty getting to sleep, nighttime awakenings, sleep disturbances, and vivid dreams. Why do these sleep disruptions occur? Hormones. While the hormone estrogen, which is present in both sexes but more abundant in women, increases rapid eye movement (REM) sleep, the female hormone progesterone, which rises mid cycle after ovulation, causes feelings of fatigue or drowsiness. When menstruation begins and progesterone levels begin to fall, women have greater difficulties falling asleep and often experience poor sleep quality for a few days. As the woman's cycle begins again, normal sleep (if not good sleep) usually returns. Other factors affecting women:
- Changes in the rhythm of body temperature throughout the menstrual cycle affect sleep. A woman's sleep pattern seems to closely follow changes in body temperature. In fact, daily body temperature increases right after ovulation, minimizing the normal decline in body temperature that occurs with sleep.
- Lower production of the natural sleep hormone melatonin during the luteal phase or second half of the menstrual cycle after ovulation makes it harder to stay asleep at night, leaving you feeling sleepy the next day.
- Pregnancy and childrearing take a heavy toll on a woman's sleep. One study revealed that women lose hundreds of hours of sleep caring for a child during the first year of the child's life.
Aging Gracefully... But Sleeping Less?
After the childbearing years, women continue to have sleep issues linked to female hormones. During midlife, issues arise due to the decline of estrogen at perimenopause or menopause. As they get older, most women still need the same amount of sleep as when they were younger, however, their sleep is much lighter. In fact, sleep can be so light that you might think you're not sleeping at all.
Both the quantity and quality of sleep change significantly as you age. Usually, the deep sleep decreases in intensity with age, while light sleep (stage 1) increases. Think of deep sleep like muscles. You still have muscles at midlife, but they are not as strong and functional as they used to be. With aging, the number of sleep arousals and periods of wakefulness increase, so your sleep quality may not feel as "fit" as it once did.
The number of times you wake up during the night can increase as you age and decrease total sleep time. Changes in body temperature are common with perimenopause or menopause. As you get older you may experience a total decrease in sleep time. Older women have a tendency to move more frequently from one stage of sleep to another.
I'm a sleep doctor -- but the issue of women and sleep has particular significance. Why? It's simple: women are the gatekeepers for all health information in their households. "Doctor Mom" is not just a cute term; it is a reality in most families. As women understand the importance of sleep, for themselves and their families, I believe that more people will talk to their doctors about sleep problems and finally get the help they need. And it's not just about being tired -- lack of sleep has been shown to play a role in increasing heart disease in women and many other serious health conditions including hypertension and diabetes. Not to mention what lack sleep does to the way you look, your ability to lose weight, and in general the way you feel.
Remember, women are born to sleep better than men. Take advantage of those tools, and make sleep a priority. It's a gift you can learn to give yourself. Next blog: sleep and the menstrual cycle. If you have topics you are interested in, your comments and questions are welcome!
Michael J. Breus, PhD
The Sleep Doctor™
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