Insomnia is common in women due to a combination of biological and social factors. A sleep specialist can offer medication and non-drug options to help people with insomnia.
Insomnia is a sleep disorder in which a person has difficulty falling asleep or staying asleep. It affects about 1 in 3 adults in the United States each year.
Most people have short-lived symptoms, but about 1 in 10 have chronic insomnia. This is defined as the occurrence of distressing symptoms of insomnia for at least 3 nights a week for at least 3 months.
Although insomnia can affect anyone, a 2020 meta-analysis shows that it affects women 58% more often than men. This can have serious health consequences for women. Insomnia is linked to many health effects, including an increased risk of heart disease and stroke.
The female sex hormones estrogen and progesterone are involved in a variety of processes that regulate sleep. Fluctuating values during menstruation, pregnancy, and perimenopause can lead to insomnia. Stress and mood disorders such as anxiety and depression can also increase the risk of insomnia in women.
“There are several factors – both biological and social – that are responsible for higher rates of insomnia in women compared to men,” said Dr. Jennifer L. Martin, Ph.D ..
Dr. Martin is a clinical psychologist and behavioral sleep medicine specialist at the University of California, Los Angeles and spokesperson for the American Academy of Sleep Medicine (AASM).
Learn more about some of the reasons women are more likely to experience insomnia than men, including the role hormones play in regulating sleep.
Differences in sleep behavior occur early in life. “Even with young children, there are differences in some aspects of sleep between boys and girls,” said Dr. Martin.
When exactly the differences begin is unclear. Some research has found no major differences in sleep patterns between children of either sex assigned at birth. Other studies have found differences in the quality of sleep in young adults.
Sleep is a dynamic process that is regulated by a variety of internal and external factors. These vary over the course of a woman’s life and can profoundly affect sleep from childhood through to the postmenopausal phase of life.
The role of hormones in insomnia
The body uses hormones to send messages across the body quickly. Among other things, hormones are regulators of sexual function and reproduction.
They also perform a variety of other important functions, including regulating:
- Growth and development
Two of the most important female sex hormones, estrogen and progesterone, act heavily in the areas of the brain that regulate sleep. Studies suggest that these molecules have two primary sleep-related functions:
- Hypnotic Effects: By regulating brain waves and sleep-wake cycles, estrogen and progesterone can directly affect sleep patterns.
- Respiratory effects: Progesterone in particular is a powerful breath stimulant and supports airway function and breathing during sleep.
Estrogen and progesterone levels change over the course of a woman’s life, including puberty, menstruation, pregnancy, and perimenopause. Studies of insomnia in women have often found that sleep problems overlap with these events.
Sleep during pregnancy and after childbirth
Pregnancy is a challenging time to get a good night’s sleep. Not only does hormone levels change, but a lot of energy is required to support a growing fetus.
Both the amount and quality of sleep generally decrease as pregnancy progresses, with symptoms tending to peak in the third trimester. Some research suggests that more than 3 in 4 people have trouble sleeping during pregnancy, with most having difficulty falling or staying asleep.
Lack of sleep is normal even after the baby is born. Caring for a newborn is a round-the-clock job. However, for many new parents and caregivers, sleep problems can last longer than expected.
A 2015 study of 1,480 women found that 60% had insomnia 8 weeks after giving birth and 41% still had sleep problems 2 years after giving birth. Although postpartum depression is common and has been linked to insomnia, a diagnosis of depression failed to explain the study’s results.
The study authors suggest that these results are due to hormonal changes and changes in work and sleep schedules. They also suggest that pregnancy could be a trigger for long-term chronic sleep problems.
Sleep during perimenopause
About 40–60% of women experience poor sleep during perimenopause or menopause. Perimenopause is the period of physical changes that occur in the 4-8 years leading up to menopause. Rapid fluctuations in hormone levels are characteristic of this change in menopause. Because of their role in maintaining sleep, these changes can lead to some levels of insomnia.
“During the menopause, many women also have difficulty sleeping because of hot flashes,” explains Dr. Martin. “This improves over time, but some women struggle to recover after menopause.”
For some women, research suggests that hormone therapy during menopause can improve the quality of sleep in those with hot flashes. Other research has found no link, suggesting that lifestyle and diagnoses of anxiety and depression during this time may play a more important role in sleep.
Dr. Martin added that the benefits and risks of hormone replacement therapy are different for every woman. “An in-depth conversation between a woman and her doctor [is] necessary to make an informed decision. “
Stress, depression, anxiety and sleep
Stress and mood disorders are important factors that can contribute to insomnia in women too.
“There are also differences in the daily life of men and women, and these factors can affect sleep,” said Dr. Martin. “Today, for example, women still have more responsibility in childcare and household chores than men. This also applies when women work outside the home. “
She also stated that women are at increased risk for mood disorders that can affect sleep, such as anxiety and depression.
According to the Agency for Substance Abuse and Mental Health, the prevalence of depression in women is over 50% higher than that of men. Women are also almost twice as likely as men to have an anxiety disorder. These differences can be due to both biological factors and external psychological stressors.
Stress, depression, and anxiety are major causes of insomnia in transgender women as well. In fact, almost 80% report significant sleep problems.
Dr. Martin emphasized the importance of prioritizing healthy sleeping habits.
“Find a bedtime and wake-up time that suits you and stick with it [them]”She said.” Most people know the basics, like limiting caffeine and alcohol and having a comfortable sleeping environment. If you haven’t checked these things off, see if you can make a small improvement in any of these areas. “
People who have made these changes and haven’t seen any improvement within 3 months may experience chronic insomnia. “Now is the time to seek help from your doctor or sleep specialist. Some people with insomnia also have other sleep disorders, so a specialist exam can be very helpful, “explains Dr. Martin.
The AASM provides information on its website about the search for a sleep specialist.
“There are effective, safe, non-drug treatments,” noted Dr. Martin. The recommended first-line treatment is called cognitive behavioral therapy for insomnia (CBT-I).
CBT-I involves studying how thoughts, feelings, and behaviors contribute to the symptoms of insomnia. It provides participants with healthy strategies for relaxing and developing good sleeping habits. A person can request CBT-I from a trained healthcare professional or through a digital app.
A 2020 study found that using a digital CBT-I program improved sleep and reduced the use of both prescription and non-prescription sleep aids.
In some people, insomnia treatment may also require medication.
Studies also suggest that yoga and Pilates can aid sleep health and improve symptoms of insomnia.
Insomnia is common in women and can appear and walk at different stages of life including pregnancy and menopause. A combination of biological and social factors increases the risk of insomnia in this group. These factors include hormonal changes and short-term or chronic stressors.
Developing healthy sleeping habits can help some women. However, people who have slept poorly – especially if symptoms persist for more than 3 months – should consider contacting a doctor.
Chronic insomnia may require the assistance of a sleep specialist who can provide both drug and non-drug treatment if necessary.