Women and Sleep Problems

Introduction

All women may experience problems sleeping from time to time, but hormonal changes during specific times of life, such as with premenstrual syndrome, pregnancy, perimenopause, and menopause may create an ongoing problem.  Certain medical conditions and lifestyle factors can contribute to sleep problems as well.  You should talk to your doctor if you experience problems with falling asleep, staying asleep, or awakening too early in the morning.  In many cases, the symptoms of sleep disorders can be relieved.

Anatomy

Sleep is vital for life, just like eating and breathing.  Sleep allows your body to rest.  It is believed that during sleep your brain performs important functions, such as storing memory and processing brain chemicals. 

In a way, your body goes on “auto-pilot” while you sleep.  Your brain regulates automatic functions for you, such as breathing, heart rate, and blood pressure.  The average adult needs about eight hours of healthy sleep.  Although sleep is a complex process that is not fully understood, it is known that a good night’s sleep is important for optimal health and functioning.

Causes

Everyone may experience difficulty sleeping from time to time, but women may be especially apt to experience sleep problems during certain periods of their lives.  Premenstrual syndrome, pregnancy, perimenopause, and menopause are associated with hormone changes that can contribute to sleep problems.  Further, some existing sleep disorders may become worse because of hormone changes.

Hormonal changes can contribute to insomnia, a sleep disorder that makes it difficult to fall asleep or remain asleep.  The incidence of insomnia may increase with premenstrual syndrome, pregnancy, perimenopause, and menopause.  Hot flashes during perimenopause or menopause may compound the issue.

Women that are overweight, obese, or pregnant may develop sleep apnea, a sleep disorder that causes a person to stop breathing during the night and then gasp for air.  Women with sleep apnea may awaken several hundred times during the night and not realize it.  Sleep apnea can lead to daytime drowsiness and serious medical consequences, including stroke, heart attack, or death.

Some women develop restless legs syndrome while they are pregnant or if they have anemia or low levels of iron in their blood.  Restless Legs Syndrome (RLS) is defined as an unpleasant sensation, primarily in the legs, that occurs during rest and is typically the worst in the evening.  Those who suffer from RLS feel an urgent need to move the legs and find that movement relieves the unpleasant sensations.  RLS can make it difficult to fall asleep.  For many women that develop the condition during pregnancy, RLS usually disappears after childbirth.  Pregnancy may also cause frequent urination during the night, which can temporarily disrupt sleep until childbirth.

Symptoms

Sleep problems may cause you to have difficulty falling asleep or remaining asleep.  You may wake too early in the morning.  The lack of sleep may cause you to feel tired during the day, moody, and irritable.  You may have a harder time concentrating, performing your usual tasks, solving problems, and remembering things.

Diagnosis

You should talk to your doctor if you experience trouble sleeping at night.  Your doctor will review your medical history, medication list, and conduct evaluations as necessary.  Lab tests may be used to test your hormone levels and thyroid function.  Depending on the suspected cause of your sleep problem, you may be referred to other specialists, such as a sleep medicine doctor, gynecologist, or psychiatrist.

Treatment

The type of treatment that you receive depends on the type and cause of your sleep disorder.  Simple lifestyle changes, such as regular exercise and avoiding stimulants, may be all that some women need.  Treatment for an underlying condition, such as sleep apnea, depression, anxiety, or acid reflux, can help reduce symptoms.  Low-dose birth control pills may be an option to treat some women with premenstrual syndrome.  Prescription or over-the-counter sleep medications may help as well. Improvement in sleep hygiene can also ensure a better healthier night's sleep. 

Prescription and over-the-counter sleep aids may not be suitable for pregnant women because they may pose a risk to a developing baby.  The same is true for prescription medication for restless legs syndrome.  Fortunately, sleep disorders that develop during pregnancy usually improve or resolve after childbirth.

In the past, hormone replacement therapy (HRT) was used to treat symptoms of menopause and prevent osteoporosis.  However, a major research study by the Women’s Health Initiative found that the risks of HRT greatly outweighed the benefits.  HRT was found to increase the risk of heart attack, strokes, breast cancer, and blood clots.  You should carefully discuss the appropriateness of HRT with your doctor.  In some cases, low dose HRT is used for the shortest time possible.  It is also important to discuss the vast array of herbal supplements on the market and their safety and efficacy before you take them.

Sleep Apnea can be diagnosed with an overnight test both in clinic or at home Sleep study or Polysomnography.  it measures your sleep, heart rate, activity and episodes of oxygen deprivation (gasp for air).  If diagnosed, using a CPAP or Continuous Positive Airway Pressure device can help correct this to improve sleep and reduce risk of heart disease.  Better sleep can lead to weight loss by decreasing cortisol levels.  Newer devices are extremely quiet and not perceptible and easier to use.  

Prevention

You may prevent insomnia by reducing the risk factors that you can control.  It can be helpful to eat healthy, exercise regularly, and practice relaxation techniques.  Counseling may help as well.  Establish a regular bedtime routine and use your bedroom only for sleep and sexual activity.  It is helpful to not use alcohol, cigarettes or nicotine products, caffeine products, illegal drugs, or other stimulants.  If you are diagnosed with a psychiatric disorder such as anxiety or depression, follow your psychiatrist’s recommendations for taking your medication.

Am I at Risk

Common risk factors for sleep problems in women:

_____ Hormone changes related to premenstrual syndrome, pregnancy, perimenopause, and menopause could contribute to sleep problems.
_____ Pregnancy and obesity can contribute to sleep apnea, a type of sleep disorder.
_____ Pregnancy can increase the need to urinate during the night, resulting in frequent awakenings that disrupt sleep.
_____ Restless legs syndrome is a condition that can impair sleep. Some women develop it during pregnancy or it may occur with aging.
_____ Hot flashes can cause night sweats and awakening at night. Women may experience hot flashes during perimenopause and menopause.
_____ Certain medical conditions, such as chronic pain from arthritis, thyroid conditions, or acid reflux increase the risk of sleep problems.
_____ Short-term stressful events increase the risk of sleep problems.
_____ Depression, anxiety, and long-term stress can contribute to sleep problems.
_____ Alcoholism or substance abuse increases the risk of sleep disorders.
_____ Caffeine products, such as coffee, tea, and soda pop, are stimulants and may make it difficult to fall asleep if you drink them too close to bedtime.
_____ Smoking cigarettes and using tobacco products can interfere with sleep because these products are stimulants and may increase alertness.

Complications

Over time, sleep loss can lead to daytime drowsiness and decreased functioning.  Recent research suggests that sleep loss may contribute to a more prolonged labor during childbirth.  Research has also linked sleep loss with an increase in car crashes, injuries, and accidents.

Advancements

Sleep disorders are more common among women who are pregnant or post-menopausal.  Studies have shown an increase in snoring and obstructive sleep apnea during pregnancy.  The drop in blood oxygen levels caused by sleep apnea may affect the health of the fetus.  In post-menopausal women, who have higher rates of sleep apnea, hormone replacement therapy resulted in a reduction in the severity of sleep apnea.  Women who suspect they have sleep apnea should consult with their physician to discuss treatment options.