Women and Sleep
There are many types of life cycles and changes that can have an effect on sleep for women. They don’t always mean a sleep disorder diagnosis is required and can be something to be aware of as changes in hormones occur. Some of the most common sleep disturbances are:
- Menstrual Cycle
- Specific Sleep Problems
Sleep and the Menstrual Cycle
Progesterone levels rise significantly after ovulation on days 13-14 of the menstrual cycle and peak on days 19-21. As levels fall during the premenstrual phase of days 22-28, women frequently experience insomnia. Poorer quality sleep can also occur during the menstrual period itself.
Sleep and Pregnancy
High progesterone levels in the first trimester may lend to hypersomnia or excessive sleepiness. During the third trimester, sleep problems are almost universal due to leg cramps, reflux (or regurgitation at night), nocturia (or the need to go to the bathroom frequently) and nasal congestion. Approximately one-third of women who have never snored begin to snore during pregnancy. Some of these women may develop sleep apnea.
Pregnancy-related sleep disturbances range from mild to serious. As many as 15 percent of women develop the creepy-crawling sensations of restless legs in their calves and thighs during pregnancy. The majority of cases improve after delivery. Hypertension (high blood pressure) at night may occur in 50 percent of women during pregnancy but is much more common in women with pre-eclampsia (a serious condition). Severe sleep apnea can decrease oxygen levels and negatively affect fetal growth.
Pregnant women with sleep disorders need to be aware of the potential risks to the fetus from drug therapies they may receive for sleep disorders.
Sleep and Menopause
Hot flashes can frequently occur at night, resulting either in insomnia or poor quality of sleep due to frequent waking. If symptoms are severe enough, hormone replacement therapy is an option, as long as the patient is not already at risk for breast cancer or coronary heart disease.
The incidence of sleep apnea in women increases significantly after menopause. With it brings increased risks for hypertension (high blood pressure), heart attacks, strokes and excessive daytime sleepiness.
Sleep and Aging
As we age, the quality and quantity of our sleep often deteriorates. Difficulty falling asleep and staying asleep becomes a greater problem, and waking up early is common. Chronic illnesses and the medications used to treat them can affect the quality or quantity of sleep. Both sleep apnea and restless leg syndrome also increase with age.
Specific Sleep Problems
Nocturia is when you wake up two or more times at night to urinate, due to a combination of low bladder capacity and a normal increase in nighttime urine production. Nocturia occurs in nine percent of women ages 19-39 and in 63 percent of women ages 50-90. In postmenopausal women, it can be relieved in 50 percent of cases with hormone replacement therapy. Nocturia is associated with increased mortality rates due to falls and fractures as a result of nighttime waking.
Sleep deprivation (due to poor quality of sleep) can be associated with fibromyalgia and interstitial cystitis. In both conditions, the maintenance of strict sleep hygiene and a mild hypnotic can improve sleep continuity.