There are more than 60 million insomnia sufferers in the USA, costing the healthcare industry billions of dollars. Too often people dismiss insomnia, not realizing just how severe the problem is. In fact, some may say it’s an epidemic. Although insomnia affects both men and women, women tend to suffer from this debilitating sleep condition far more.
Why is that? Is there really such a thing as gender-related insomnia?
First, it’s essential to understand that there are two types of insomnia that women can suffer from – primary and secondary. How do the two differ?
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The most significant reason why women have insomnia are hormonal changes, and that really shouldn’t be that big a surprise. After all, a woman’s body goes through many things during the course of a lifetime. Hormonal changes begin at puberty, continue through adulthood (and childbearing years), and happen again at menopause. The other reasons why women (and men too) have insomnia can relate to any one of the following conditions:
- acid reflux
- breathing problems (sleep apnea)
- prescription medications
- restless leg syndrome
- thyroid disorders
There are all kinds of reasons for women to suffer from insomnia. A number of them are due to the hormonal changes they go through. A woman is said to have secondary insomnia if she has difficulty sleeping due to an underlying condition, be it medical, social, or mental. What are some of the common reasons why a woman may have secondary insomnia?
- Insomnia tends to begin around the time a girl reaches puberty, yet the exact biological cause is not known.
- Menstrual cycles can affect how well a woman sleeps due to the hormonal changes that go on during this time. A number of women have reported sleep disturbances during the week before their periods and during the week of the periods, which is believed to be the result of bloating, cramps, and headaches that occur.
- Women who suffer from PMS (premenstrual syndrome) also report a high rate of insomnia. A recent study reported that women who suffer from PMS have poorer sleep quality (unrelaxing sleep).
- Pregnancy is another major reason why many expectant mothers don’t get a lot of sleep. Since women share their bodies with their growing babies, they experience the need to urinate more often, vomiting/nausea, restless leg syndrome, the baby’s movements, changes in the body temperature, and difficulty to get comfortable.
- Lactation is another potential cause for insomnia. Firstly due to frequent feedings of a newborn, secondly due to the increase in breast size thanks to milk production. It’s not uncommon for a new mother to feel uncomfortable trying to breastfeed her child, as she’s trying to match her body up to the baby’s feeding schedule. Until the two are synced she could leak breast milk and have pain.
- Perimenopausal, menopausal, and postmenopausal women also experience insomnia. Up to 60 percent of perimenopausal women have insomnia due to night sweats and hot flushes. Hormone levels fluctuate in menopause, which can lead to insomnia. For postmenopausal women there is a rise in both the RLS (restless leg syndrome) and obstructive sleep apnea. It’s important to note that insomnia at one stage doesn’t always indicate insomnia at subsequent stages.
- Women who work night or split shifts can also suffer from insomnia as well as infertility, breast cancer, menstrual changes, and miscarriages.
Other possible causes of insomnia in women include but are not limited to:
- acid reflux
- breathing disorders (asthma)
- thyroid conditions
- Alzheimer’s disease
- Parkinson’s disease
- post-traumatic stress disorder.
Common symptoms of insomnia in women
Women’s symptoms are pretty much the same as men’s and include:
- problems with falling asleep
- problems with staying asleep (waking up at night)
- waking up earlier than wanted.
When you’re trying to figure out what’s stopping you from getting a good night’s rest, it can include anything that keeps you from sleeping. This will vary for each person and can be different for each gender.
How does insomnia affect women’s health?
Short-term insomnia can produce irritability, anxiety, and excessive tiredness. If the trend continues with no relief, it can lead to serious health problems such as high blood pressure and diabetes. Insomnia can also lead to accidents such as falls (usually seen in older women), obesity, heart disease, stroke, and mood swings.
Menopause and sleep
Menopausal insomnia can start during perimenopause – women experience perimenopause in their late 30s or 40s. It typically lasts four years and ends when women do not have a period for one full year.
Hormonal changes happen during perimenopause and menopause, usually coinciding with other critical lifestyle situations – empty nesting, retirement, etc. In perimenopause the ovaries start to produce less progesterone and estrogen. Progesterone is known to promote sleep while estrogen can help take care of the woman’s emotional wellbeing.
A decrease in the hormonal levels makes it emotionally harder to get a grip on the stresses that menopause puts on the body. Add lifestyle changes, and it’s easy to see why women can experience insomnia during this time.
About 20 percent of menopausal women suffer from depression – perhaps due to loss of estrogen or changes in lifestyle or a combination of the two. Depression often coincides with insomnia as do anxiety and stress.
Menopause also produces bodily changes – one such notable experience is hot flushes, which 75 percent of women suffer from. Hot flushes cause a woman’s body temperature to rise, which also leads to night sweats. Both of these things can make it difficult to fall and stay asleep.
A rise of the body temperature during a hot flush also causes the mind to reawaken. Keep in mind that cool temperatures make it easier to fall and stay asleep. When the body is winding down (in the circadian rhythm), it starts to cool down. Hot flushes, and night sweats, can hinder the body from cooling down and staying asleep.
As women go through menopause in their 40s and 50s, they also go through physical changes. Older adults may wake up more often with the need to urinate (reduced bladder control and incontinence). They also spend less time in restorative REM sleep and get up earlier than planned, which can lead to insomnia and daytime sleepiness.
Tips for sleeping better in menopause
Any man or woman who has insomnia can get relief by incorporating good sleep hygiene and following a regular sleep schedule. Women going through menopause and suffering from night sweats and hot flushes may find some additional tips helpful.
Turn the bedroom temperature down
You should have a cool bedroom to sleep in for your body to get a good rest. The ideal temperature is in the mid 60s Fahrenheit, but if you’re going through menopause, you may want to drop this temperature even more.
Have cool backups close by
Have a cold glass of water on your bedside table, or use a new pillowcase or pillow if yours have gotten too hot. If you need to change your pajamas, have an extra breathable set at hand. You can also place a washcloth in a bucket of ice to use when you get really hot.
Buy a temperature regulating mattress
There are mattresses designed to lock in heat, which can increase the effects of hot flushes. If you get hot when sleeping, consider buying an airbed or firm innerspring mattress.
Do relaxation exercises, acupuncture, or meditation
Meditating and breathing exercises can calm your mind before you go to bed. Acupuncture is also helpful in alleviating insomnia.
Control your diet and exercise
Do not drink alcohol or consume stimulants such as caffeine before you go to bed. These substances can affect your ability to go to sleep and cause peri- and postmenopausal women to have hot flushes. Dinner is best to have three to four hours before sleep. Exercise as early in the day as you can to avoid elevating your body temperature before sleep. Exercise will wear the body out, improve your mood, and refresh your mind, which will make it easier to go to sleep at night.
Use white noise
It’s not uncommon for people to use relaxing sounds to help them fall asleep – a fan, air conditioner, or a white noise device. White noise will induce a restful state of mind and cause it to feel sleepy. You can get a white noise machine or use a smartphone app to help you sleep better.
Talk to a doctor about other potential options
If you have severe hot flushes and night sweats, it may be a good idea to talk to a doctor about some other treatment options you can try. For example, s/he may suggest a HRT (hormone replacement therapy) or prescribe low doses of antidepressants such as Paxil or Prozac.
HRT is advised as a short-term solution because of the side effects it can cause:
- blood clots
- breast cancer
- heart disease
Women in perimenopause may find relief from using birth control pills to alleviate their symptoms of insomnia.
How your period can affect your sleep
Premenstrual syndrome (most commonly known as PMS) can cause insomnia as well as hypersomnia. Each woman is different and will experience different symptoms. Some women will experience cramps and bloating, which make sleeping harder. They can experience emotional issues such as fatigue, stress, and irritability – also leading to insomnia.
During the follicular phase (first part) of the menstrual cycle the body produces more estrogen so that ovulation can occur. In the luteal phase (second part) ovulation has occurred and progesterone increases, which produces a soporific effect. Right before the period is set to begin the levels of both hormones significantly drop, which can lead to insomnia.
A 2010 study shows that women in the luteal phase of their cycle experience less REM sleep, which could be a reason for insomnia during PMS. At this stage the body increases production of progesterone after ovulation, which increases the body’s core temperature by half a degree. REM sleep occurs at the lowest body temperatures during the night, which may be why REM sleep is elusive to women at this time.
Tips for controlling insomnia during PMS
Women who suffer from insomnia can alleviate the symptoms by keeping a regular sleep schedule and following good sleep hygiene.
Have a dark, cool bedroom
Set the temperature in your bedroom to the low to mid 60s Fahrenheit. Don’t use electronics an hour before you to go bed and steer clear of blue light.
Do relaxation and meditative exercises and try acupuncture
It’s been proven that acupuncture can help alleviate symptoms of insomnia. However, both meditation and breathing exercises can slow the mind down, making it easier to go to sleep.
Create a good diet and exercise routine
Don’t drink any alcohol or take stimulants right before you head to bed. Eat several hours before bedtime. Exercise in the early part of the day, as it will raise your body temperature. However, it will also help to tire your body and improve your mood – all things that make going to sleep easier.
Use white noise devices or apps
Some people need white noise to go to sleep. Rather than leaving the TV or radio on all night, consider using a smartphone app or white noise device to induce a restful state. You can easily find white noise machines in any store (although a fan can also serve as a great noise device that will also keep the room cool). Alternatively you can download a smartphone white noise app.
Talk to a doctor about medical treatments
Sleep restriction has been determined to help in reducing depression related to menstruation, as has bright light therapy for insomnia. Premenstrual dysphoric disorder (or PMDD) has been linked to insomnia, but doctors usually tackle the anxiety issues associated with PMDD instead of insomnia. Your doctor may suggest taking antidepressants to help with your PMS or PMDD symptoms, which could also work on your insomnia and other sleep issues.
Why do pregnant women have insomnia?
Pregnancy can cause insomnia in many women because of the physical discomfort they experience (typically seen in the first trimester). This is the time when the body undergoes physical, emotional, and mental changes associated with pregnancy. During the third trimester the percentage of women who have pregnancy-induced insomnia climbs to 75. There are several reasons for this:
- hormonal changes
- inability to control the bladder
- leg cramps
Tips for better sleep when pregnant
Pregnant women can alleviate insomnia by practicing good sleep hygiene and sticking to a regular sleep schedule. What are some other things pregnant women can do to help them overcome insomnia?
Darken and keep the bedroom cool
Keep the temperature in your bedroom in the mid 60s Fahrenheit and avoid using electronics an hour before going to bed. Don’t use a smartphone in the middle of the night if you wake up.
Buy maternity pillows
Pregnancy will cause physical discomfort, which is why you need to consider investing in maternity pillows. While sleeping on your left side, place a pillow behind you (at your back), and give additional support to your legs and arms.
Do breathing and stretching exercises or meditation
Your mind is constantly on the go during the day, so when it’s time to wind down, it’s not so easy to shut it off and relax. Learn different breathing exercises and meditation techniques to relieve the mind and get comfortable. You can also get a prenatal massage or do stretches to ease the discomfort of pregnancy and fall sleep.
Create a manageable exercise and diet plan
Reduce how often you need to get up for the bathroom by decreasing the amount of liquids before bed. Don’t consume any products that contain stimulants (like caffeine) or alcohol, and eat dinner three hours before bed.
Exercise as early in the day as you can. The key is not to increase the body temperature before you go to bed. When you exercise, you also improve your mood and tire the body, which allows you to get to sleep more easily.
Buy a white noise machine or download an app
People often use white noise to help them go to sleep. You can buy a white noise machine or use a fan (which will also lower the room temperature). Alternatively you can use an app that includes white noise or nature sounds to help you fall asleep.
Treating women’s insomnia with cognitive behavioral therapy
Doctors and patients often go with this treatment before a prescription is written. Why? Behavioral therapy can help with an array of mental and medical health disorders. And it’s preferred over medications because of how successful it can be. There’s also no risk of intolerances or side effects, as against prescribed medications.
This therapy includes an initial evaluation and weekly sessions to find the culprit of the insomnia. By discussing the issues you can get a better handle on them and find ways to eliminate them and implement better sleeping habits. Your therapist will talk to you about negative thoughts and find ways to override them with positive ones.
A study about CBT in the Sleep Medicine Reviews journal found it beneficial for treating people with chronic insomnia. It allowed patients better sleep quality, improved their ability to go to sleep, stay asleep, and sleep longer. The participants saw benefits in the followup appointments.
Over-the-counter medicines to combat insomnia in women
There are all kinds of over-the-counter sleep aids on the market. But are they safe?
Valerian root – you can easily find this herbal remedy on the market. Used to treat insomnia since the Roman and Greek times, it comes from the root of the Valeriana officinalis plant. Marketed as a sleeping aid, the supplement has a mild sedating effect.
Melatonin – the body naturally produces melatonin to control our wake-sleep cycle. However, people are advised to use melatonin if they suffer from jet lag or have problems sleeping. There are mild side effects of melatonin supplements, such as headaches or daytime sleepiness.
Antihistamines – these medications are wonderful in treating an allergic reaction, and many of them also contain ingredients that can make you sleepy (much like cold and flu products). However, antihistamines should not be used for long-term insomnia, and have side effects such as daytime drowsiness, constipation, and dry mouth.
Even though OTC medicines do have mild side effects, they have the potential to interact negatively with medicines you take. Talk to a doctor before using any OTC medication for any condition.
Prescription medicines for insomnia in women
If you talk to a doctor about your sleeping problems, s/he may give you a medication to help improve your sleep quality. If this happens, you may need to visit the doctor more often so that s/he can monitor the side effects you might experience. It’s possible that the first dosage won’t be right, but don’t give up and let the doctor know what’s happening.
No matter what treatment you go with, talk to a doctor about the positives and negatives. There are two primary goals of treating insomnia – improving sleep quality and quantity and decreasing the impairments you feel during the day.