| Women
and Sleep
Introduction
In recent years
the problems with sleep that women may experience have been better
appreciated. Women are among the most chronically sleep deprived
members of society, with women from age 30-60 averaging just under
7 hours of sleep per night during the week. This is contributed
to by a combination of factors, including the multiple roles many
women have as wage earner, homemaker and mother. In addition of
course, physiological differences due to changing hormone levels
add unique issues for women with what we now recognize as an important
effect on sleep quality.
Sleep and
Menstrual Cycle
Studies have
shown that hormonal changes in the menstrual cycle can and do
interfere with sleep for an average 2-3 days per monthly cycle.
The interference with sleep appears due to a bloated feeling but
clearly contributed to by other factors. The most marked disturbance
occurs during the first few days of
|
Studies
have shown that hormonal changes in the
menstrual cycle can and do interfere with sleep for
an average 2-3 days per monthly cycle.
|
|
menstruation.
An second time of disrupted sleep occurs as progesterone levels
fall towards the end of the menstrual cycle. There may be difficulty
falling asleep in this time period. The premenstrual period, the
last few days before menstruation commences, is also associated
with poorer sleep with insomnia common but sometimes hypersomnia
or increased daytime sleepiness may also occur. While no specific
solutions exist for these problems, careful attention to good
sleep hygiene can help.
Sleep and
Pregnancy
Pregnancy
is associated with a host of physical and emotional changes. Physical
changes include morning sickness, body aches including back pain,
heartburn and of course fetal movement. Emotional changes include
a huge range including anxiety, fear and depression. Emotions
can swing wildly. According to a National Sleep Foundation poll
as well as other research, 78% of women experience more disruption
of sleep than they normally experience. These changes vary with
the stage of pregnancy:
In the first
trimester there are high levels of progesterone. This may
be associated with increased sleepiness. Some of the physical
changes may also disrupt nighttime sleep, leading to further increases
in daytime sleepiness.
The second
trimester usually has less severe disruption of sleep than
earlier or later stages, but still not normal quality sleep.
The third
trimester is associated with the most significant changes
in sleep. The physical changes of pregnancy are their greatest
and include general discomfort, increased nocturnal urination,
heartburn, back pain and nasal congestion. Studies have suggested
that virtually all women have some disruption of their sleep in
the third trimester. Again, there are no perfect solutions to
these problems. Taking naps may help to at least relieve some
of the daytime sleepiness.
Pregnancy and Other Sleep Disorders
In addition
to the disruption of sleep that is a consequence of the physical
and hormonal changes, certain specific sleep problems may also
occur in pregnancy.
Because of
the increased weight and the swelling of tissues that occurs in
pregnancy, many women have the onset of snoring for the first
time in pregnancy. If the airway obstruction is significant enough
and in particular if there is a predisposition due to genetic
factors, obstructive sleep apnea may also
occur. This condition is not only characterized by loud snoring
but by obstruction of airflow which in turn leads to significant
interruptions of sleep and drops in oxygen level. The interrupted
sleep can lead to marked daytime sleepiness. If daytime sleepiness
does occur and is more severe than might be reasonably expected
from hormonal changes alone, the diagnosis of sleep apnea should
be considered.
In the third
trimester as many as 15% of woman may also experience a sensation
of discomfort, often described as a "creepy crawly"
sensation in the legs which leads to a need to move, kick or even
get out of bed and walk. This condition also occurs commonly in
non-pregnant men and women but there seems to be an increase due
to pregnancy. The consequence can range from being slightly annoying
to severely disruptive of sleep. The condition can be treated
with medication but some of these can be harmful to the fetus.
Menopause
and Sleep
Menopause
occurs on average at age 51 and is associated with a variety of
symptoms due to the hormonal changes that occur. There is a gradual
decrease in estrogen levels that leads to hot flashes. These sensations
are often associated with intense sweating. A National Sleep Foundation
poll revealed that 36% of menopausal women experience hot flashes
in sleep. The result was poorer quality sleep for an average of
5 days per month with hot flashes persisting for an average of
5 years. The result is daytime fatigue. Treatment involves hormone
replacement therapy but there remains some controversy over the
potential side effects of this. Treatment decisions must therefore
be made by the woman and her physician. Alternative therapies
including some herbal medications and soy products have also been
suggested.
Other Sleep
Disorders in Women
Insomnia
Insomnia
is common in the population as a whole. It seems, however, to
be more common in women than men. The percentage of women with
insomnia averages over 50% and increases with age. Many women
who try and juggle multiple roles as mother, wage earners and
home makers are particularly prone to problems. Treatment options
include behavioral changes and sometimes medication. The first
step is usually to be sure you are following good sleep hygiene
practices. If these do not help, then you may need an evaluation
by your physician or a sleep specialist.
Obstructive
Sleep Apnea
For many years
it was believed that obstructive sleep apnea
(OSA) was unusual in women. More recently we have discovered
that while it is less common than in men it is non-the-less common
in women, occurring in as many as 2% of all adults. The condition
is often marked by serious snoring and daytime sleepiness. Of
even greater concern, it is associated with an increased risk
of cardiovascular diseases, including high blood pressure and
stroke. So, identification is not just about curing a socially
unpleasant snore, but about your health and well being. Fortunately,
once identified, treatment for sleep apnea
is available.
|
