- How do Sleep Disorders in Women Work?
- Sleep Disorders in Women Causes
- Sleep Disorders in Women Symptoms
- Exams and Tests fo Sleep Disorders in Women
- Sleep Disorders in Women Treatment
- Self-Care at Home for Sleep Disorders in Women
- Medical Treatment for Sleep Disorders in Women
- Medications for Sleep Disorders in Women
- Surgery for Sleep Disorders in Women
- Sleep Disorders in Women Follow-up
- Prevention of Sleep Disorders in Women
- Outlook for Sleep Disorders in Women
- For More Information on Sleep Disorders in Women
How do Sleep Disorders in Women Work?
Women are twice as likely as men to have difficulties falling asleep or staying asleep. Younger women have more sound sleep with fewer disturbances. Some women 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. A significant portion 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. After childbirth, the irregular sleep pattern of the newborn can also significantly impact the mother's sleep.
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. There is also an increase on obstructive sleep apnea in post-menopausal 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, but it is often associated with low iron stores in the body. RLS occurs before sleep starts is more pronounced in the evening with an urge to move the legs. RLS 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 is an uncommon form of hypersomnia characterized by 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.
Sleep Disorders in Women Causes
- The changing hormonal levels during the menstrual cycle can disturb sleep and cause daytime sleepiness. Hormonal effects can be direct, by changing sleep patterns, or indirect, by affecting mood and emotional state. As many as 80% of women report premenstrual symptoms.
- Decreasing menopausal estrogen levels may cause hot flashes that disturb sleep. About two thirds of menopausal women have sleep problems. Lower menopausal estrogen levels are linked with increased snoring risk and sleep-disordered breathing.
- In today's society, many women cope with the roles of wife, mother, caregiver for parents, and worker. With less time for themselves, they often reduce sleep. The sleep deprivation and stress are linked with long-term insomnia.
- Work and lifestyle can also contribute to primary sleep disorders. Women who work in rotating and night shifts are likely to experience sleep problems. Inactivity and lack of exercise can lead to trouble falling asleep. Women with erratic schedules or altered weekend sleep patterns are more likely to have trouble resetting their body clock to normal.
- Caffeine, nicotine, or other stimulating drugs near bedtime may prevent a woman from falling asleep. Alcohol may cause sleep fragmentation and nightmares.
- Depression and anxiety are more prevalent in women than in men and can contribute to sleep disorders. In some women, these are related to the menstrual cycle. Anxiety may impair falling asleep, and depression may cause early morning awakening.
- Sleep-disordered breathing is common in postmenopausal women. Multiple breathing cessations during sleep occur with sleep apnea. The resulting breathing difficulty disturbs sleep and may cause daytime fatigue. Sleep apnea is linked to high blood pressure and cardiovascular disease.
- Snoring often indicates partial airway obstruction. Snoring is linked with high blood pressure and increased risk for sleep apnea. Snoring increases during pregnancy, particularly during the last trimester. It is linked to pregnancy-related high blood pressure, pre-eclampsia, and low infant birth weight. Pregnant women do not have a higher risk of sleep-disordered breathing.
- Sleep disorders are more common in older women.
- Being overweight or obese increases a woman's risk of having a sleep disorder.
Sleep Disorders in Women Symptoms
There are 3 common sleep disorder symptoms. Overlap is common.
- Difficulty falling asleep: This problem is more common in younger women. It is often linked to anxiety disorders and a stressful lifestyle.
- Difficulties maintaining sleep: Multiple awakenings during sleep are more common in older women. This symptom may indicate periodic limb movement disorder (PLMD). Arthritis, pain, medications, and the last trimester of pregnancy may cause multiple awakenings during sleep.
- Excessive daytime sleepiness: In older postmenopausal women, PLMD and sleep-disordered breathing may cause excessive daytime sleepiness. Sleep deprivation and narcolepsy are more likely to cause severe sleepiness in younger women.
Exams and Tests fo Sleep Disorders in Women
If you are having sleeping problems, the first step is a detailed medical interview. You will be asked about your medical and psychological problems, physical symptoms, medications, family medical problems, menstrual and pregnancy history, work life, habits, and lifestyle. The next step is a physical examination.
- Polysomnography: Overnight sleep studies or polysomnograms may be done in a sleep disorders center, at home, or in a hospital. Depending on the type of testing performed, the machine records EEG (sleep patterns) breathing patterns, ECG, eye movements, and changes in muscle tone.
- Multiple sleep latency test (MSLT): MSLT measures the level of daytime sleepiness. It is performed during the day following a supervised overnight polysomnogram.
- Sleep log: A sleep log is a diary of your sleep-wake cycles. You will be asked to keep a 2-week diary of sleep and daytime sleepiness. This diary can be helpful in diagnosing circadian rhythm disorders as well as irregular sleep patterns.
Sleep Disorders in Women Treatment
Medication may help in some women, but often behavior and lifestyle changes best relieve sleep problems.
Self-Care at Home for Sleep Disorders in Women
Guidelines for better sleep hygiene
Sleep hygiene refers to habits and lifestyle that promote healthy sleep. Your health care provider will often recommend improved sleep hygiene.
- Try to wake up at the same time every day, regardless of the time you went to bed.
- Try to stay away from long daytime naps, but a brief regular daily nap may be helpful.
- Exercise daily but not in the hours before bedtime.
- Use the bed only for sleeping or sex.
- Do not read or watch television in bed.
- Do not use bedtime as worry time.
- Eat a balanced diet with regular mealtimes.
- Avoid heavy or spicy meals at bedtime.
- Avoid alcohol, caffeine, and nicotine before bedtime.
- Spend time right before bed relaxing and engaging is soothing activities.
- Develop a routine for getting ready for bed.
- Control the nighttime environment with comfortable temperature, noise, and light levels.
- Wear comfortable, loose-fitting clothes to bed.
- If unable to sleep within 30 minutes, get out of bed and perform a soothing activity, such as listening to soft music or reading. Avoid bright light exposure during these times.
- Get adequate exposure to bright light during the day.
Weight loss may help overweight, habitual, loud snorers. Alcohol and sedatives before bed may aggravate snoring. Also, avoid sleeping on your back. Taping a tennis ball to the back of your bedclothes may prevent you from sleeping on your back.
Medical Treatment for Sleep Disorders in Women
Why doesn't your health care provider prescribe a sleeping pill for you? One reason is that sleeping pills may cause dependency and abuse. Also, sleeping pills may cause side effects and complications, such as confusion, dizziness, imbalance, falls, and a daytime "hangover." These medications are only a short-term solution. The dose for prescription sleeping pills was recently changed for women because of significant side effects.
Your health care provider may treat medical or psychological sleep disorders or refer you to a specialist. Your health care provider may also change or discontinue medications to improve sleep. The treatment for sleep-disordered breathing is continuous positive airway pressure (CPAP). A mask is worn over the nose or mouth while you sleep, and gentle steady air pressure from the mask keeps your airway open. CPAP often provides immediate relief. Patients feel more rested at night and are more alert during the day.
Medications for Sleep Disorders in Women
Health care providers use short-term and long-term drug treatment to treat sleep disorders. Sleep medications are a short-term drug treatment for insomnia. Other names for sleeping medications are hypnotics or sedatives. The goal is to reduce insomnia without sacrificing daytime alertness. Short-term treatment lasts 2-4 weeks. The health care provider treats the underlying cause of the sleep disorder during this period.
The most widely used sleep medications are the benzodiazepine and nonbenzodiazepine drugs. These medications are safe because they are difficult to overdose. Tolerance develops quickly, and over time, a higher dose is required to get the same effect as the initial dose. The risk of becoming dependent on these medications is high. These medications may cause withdrawal symptoms. These are the reasons for using sleep medications on a short-term basis. Examples are the benzodiazepines lorazepam (Ativan), triazolam (Halcion), and temazepam (Restoril) and the nonbenzodiazepines zolpidem (Ambien) and zaleplon (Sonata).Ramelteon (Rozerem) is a prescription drug that stimulates melatonin receptors. A newer classification of medications for treating insomnia includes Suvorexant (Belsomra).
Melatonin is a hormone produced by the pineal gland during the dark hours of the day-night cycle (circadian rhythm). Melatonin levels in the body are low during daylight hours. The pineal gland (located in the brain) responds to darkness by increasing melatonin levels in the body. This process is thought to be integral to maintaining circadian rhythm. Ramelteon promotes the onset of sleep and helps normalize circadian rhythm disorders. Ramelteon is approved by the Food and Drug Administration (FDA) for insomnia characterized by difficulty falling asleep. Long-term treatment consists of treating medical and psychological conditions that underlie sleep disorders. In some cases, the sleep disorder is treated directly.
Hormone replacement therapy (HRT) improves sleep in menopausal women. HRT reduces hot flashes that disturb sleep. HRT may also improve sleep-related breathing disorders. HRT may be estrogen alone, or estrogen with progesterone. HRT is not for every woman, but it can markedly improve menopause symptoms. Long-term use of HRT involves risks. Make sure you understand the risks and benefits before you start HRT. Antidepressant drugs are sometimes used for women with chronic (long-term) insomnia. These drugs usually work, even in people who have no other depression. They also help some premenstrual sleep problems, postpartum depression, anxiety-related sleep disorders, and clinical depression. They alter brain chemicals called neurotransmitters, such as serotonin and norepinephrine. These drugs do not cause dependency. Examples are sertraline (Zoloft), fluoxetine (Sarafem or Prozac), and mirtazapine (Remeron). Stimulants are sometimes used to treat narcolepsy. These drugs promote wakefulness. An example is modafinil (Provigil). Dopamine agonists are drugs that promote release of the neurotransmitter dopamine in the brain. These drugs may improve restless legs syndrome. An example is pramipexole (Mirapex).
For more information, see Understanding Insomnia Medications.
Surgery for Sleep Disorders in Women
Uvulopalatopharyngoplasty (UPPP) is one operation that eliminates loud snoring and obstruction in some cases. The surgeon repositions tissues to enlarge and stabilize the throat opening and prevent airflow obstruction. Other procedures may be considered as well if an examination reveals an appropriate indication.
Sleep Disorders in Women Follow-up
Your health care provider will ask you to return in a few weeks to see if treatment is effective. Regular visits are necessary if you take medication or receive sleep apnea treatment.
Prevention of Sleep Disorders in Women
Good sleep habits will improve insomnia and frequent sleep awakenings. Managing stress and maintaining a healthy weight help women sleep better and prevent more serious sleep problems.
Outlook for Sleep Disorders in Women
Persistent insomnia may cause daytime fatigue, decreased daytime function, memory and concentration problems, depression, and injuries and accidents. Women with persistent insomnia tend to have more psychological and medical problems. The outlook for persistent insomnia is good if the underlying problem is treated. Untreated or undertreated sleep apnea may cause heart rhythm problems, high blood pressure, and congestive heart failure. Daytime fatigue from sleep apnea increases the risk of accidents and injuries. Effectively treated sleep apnea has an excellent prognosis. CPAP treatment improves alertness, nocturnal awakenings, and sense of well-being.
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Medically reviewed by Peter O'Connor, MD; American Board of Otolaryngology with subspecialty in Sleep Medicine
"Classification of sleep disorders"