Sleep Disorders in Women
Sleep Disorders in Women Overview
Women are twice as likely as men to have difficulties falling asleep or staying asleep. Younger women have sounder sleep with fewer disturbances. Some women, however, are prone to sleep problems throughout their reproductive years. Only recently has the medical community focused on women's sleep disorders.
A number of factors may affect women’s sleep. Changes in hormonal levels, stress, illness, lifestyle, and sleep environment may impact sleep. Pregnancy- and menstrual-related hormonal fluctuations may affect sleep patterns, mood, and reaction to stress. Many women have premenstrual sleep disturbances. Difficulty falling asleep, nighttime waking, difficulty waking up, and daytime sleepiness all are linked to premenstrual changes. Insomnia (sleeplessness) is one of the most common symptoms of premenstrual syndrome (PMS).
Psychosocial stress may threaten sleep more than hormonal changes. Many young women reduce sleep to cope with work and their roles as mothers and wives. They ignore fatigue and other effects of inadequate sleep. About 30% of employed women report sleep problems. Sleep problems are more common in women older than 40 years. Getting enough sleep improves job performance, concentration, social interaction, and general sense of well-being.
Pregnancy may also disturb sleep. During the first trimester, women need more sleep and feel sleepier during the day. During the second trimester, sleep improves. During the third trimester, women sleep less and are more awake. The most common reasons for sleep disturbances are frequent urination, heartburn, general discomfort, fetal movements, low back pain, leg cramps, and nightmares. Swelling in nasal passages may cause snoring and sleep apnea during pregnancy.
As women age, physical and hormonal changes make sleep lighter and less sound. Sleep disturbances become more common during menopause. Women wake up more often at night and are more tired during the day. Hot flashes and night sweats linked to lower levels of estrogen may contribute to these problems. During the menopausal years, snoring becomes more frequent. After menopause, women get less deep sleep and are more likely to awaken at night than during menopause.
Pain, grief, worry, certain medical conditions, medications, and breathing disorders may disturb sleep in menopausal and postmenopausal women.
The most common sleep problem in women is insomnia. This includes trouble falling asleep, staying asleep, or early awakening, and inability to resume sleep. Other common sleep disorders are sleep-disordered breathing, restless legs syndrome, periodic limb movement disorder, and narcolepsy.
- Sleep-disordered breathing occurs with loud snoring, interrupted breathing during sleep, disrupted sleep, and daytime sleepiness. Sleep apnea increases in women older than 50 years.
- Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) can disturb sleep profoundly. The causes of these conditions are unknown. RLS occurs before sleep starts and causes calf discomfort and restlessness in the legs that is relieved by movement. PLMD causes periodic leg movements that may awaken the person from sleep. RLS may cause insomnia. PLMD may cause excessive sleepiness. Both conditions are more common in older people.
- Narcolepsy causes excessive daytime sleepiness. The major features of narcolepsy are sleep attacks and cataplexy. Sleep attacks are an irresistible urge to sleep. Cataplexy is a sudden loss of muscle tone typically preceded by emotional states. Other narcolepsy symptoms are sleep paralysis and hypnagogic hallucinations. Patients with narcolepsy often have disrupted sleep.
Carmel Armon, MD, MHS, MSc
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