Women and
Sleep
Does any of these sound familiar?
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Night time sleep a lost skill
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Fibromyalgia by day--- useless sleep
by night
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Menopause + 15 pounds =
snoring yourself awake
Women are susceptible to sleep
disturbances in each phase of life. During the early adult years,
there are hormonal variations that make certain times in the month,
generally just before or at the start of menses, a time for excess
sleepiness. Assuming multiple roles, the average working woman with
a family is sleeping less than 7 hours on most weekday nights,
compared to 19th century women who slept 9 hours or more a night.
Thus, the commonest sleep disorder in younger women, experienced by
nearly half, is insufficient sleep.
During and after menopause, women
increasingly notice they are not sleeping well. Problems of getting
to sleep and staying asleep occur in 15% of younger adults of either
gender, but only women undergo a drastic increase in insomnia as
midlife proceeds, peaking at 30% by retirement time. Use of hormone
replacement therapy (HRT), which helped to eliminate hot flashes and
thus restored the sleep in some affected women, has dropped
significantly in recent years after two major studies, the Women’s
Health Initiative and the Heart and Estrogen/Progestin Replacement
Study, showed no cardiac benefit and a greater risk of breast cancer
from use of HRT. After eliminating psychologic and medical reasons
for sleep difficulties, the treatment of insomnia symptoms involves
cognitive and pharmacologic approaches.
Fibromyalgia, a multiple system syndrome
involving soft tissue pain, irritable bowel symptoms, depression and
fatigue, is much more common in women than men by a ratio of 7 to 1.
The syndrome has come to be regarded as a legitimate rheumatologic
condition. Part of what has established its legitimacy is the
discovery of a bona fide brain wave abnormality interrupting the
sleep of many persons with fibromyalgia. This pattern lessens the
effectiveness of the sleep and results in a generalized feeling of
fatigue in the fibromyalgia sufferer during the day. Treatment of
the sleep helps the fibromyagia symptoms and vice versa: less pain
means better sleep.
Weight gain is common in menopause, and
added weight along with its redistribution may cause circumferential
narrowing in the pharynx that is associated with obstructive sleep
apnea (OSA). While OSA is much more common in men than women during
middle age (24% vs 9%), after menopause, the incidence in women
almost catches up with men in its frequency. Snoring is quite common
in association with sleep apnea but its absence does not guarantee
there is no breathing disturbance. Nearly 50% of men and women snore
by the age of 65, and a large portion of snorers have sleep apnea.
There is new awareness that roughly half
of stroke survivors and heart failure patients have sleep apnea, and
many medical investigators recommend that the sleep apnea should be
treated under these conditions. Research has demonstrated that
treating the apnea leads to lowering of elevated blood pressure,
lessening of care dependency after a major stroke, and improved
quality of life in heart failure patients.
Recent research on sleep in women has
led to important discoveries about why more women than men suffer
with sleep disorders. The effects of the female hormones and their
absence during and after menopause, societal trends, and much
improved survival after treatment for cardiac problems has exposed
longer living women to common but treatable sleep disturbances. The
insomnia experience of older women can be addressed. If you are a
woman with a sleep disturbance, you shouldn’t have to endure chronic
fatigue. Address your quality of life shortfall by seeing your
primary physician or a sleep specialist to determine the cause and
treat it.
References
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National Sleep Foundation, Women
& Sleep, CFC# 2697, 2004
Javaheri S, Parker TJ, Liming JD
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