Understanding Sleep Disorders That Commonly Affect Women

Sleep is a fundamental aspect of health and well-being, yet many women struggle to get enough rest. Sleep disorders are prevalent, affecting millions of women worldwide, with significant consequences for physical and mental health. Sleep has a critical role in promoting health. Research over the past decade has documented that sleep disturbance has a powerful influence on the risk of infectious disease, the occurrence and progression of several major medical illnesses including cardiovascular disease and cancer, and the incidence of depression. Understanding the types of sleep disorders that commonly affect women and their causes, symptoms, and treatments can help manage and improve sleep health. (Irwin, M. R. 2015).

The Importance of Sleep

Sleep is not merely a period of rest; it's a vital process that supports cognitive function, emotional regulation, and physical health. Adequate sleep helps the body repair itself, regulate hormones, and consolidate memories. For women, sleep is especially crucial as it influences reproductive health, mood stability, and overall quality of life. Sleep is an important physiologic process, and lack of sleep is associated with a host of adverse outcomes.

Lack of sleep or poor sleep quality can lead to a range of health problems, including obesity, diabetes, cardiovascular diseases, and mental health disorders such as anxiety and depression. Women are particularly vulnerable to sleep disorders due to hormonal fluctuations throughout life, including menstrual cycles, pregnancy, and menopause. (Pisani, M. A et al., 2015)

Common Sleep Disorders in Women

Insomnia

Insomnia is one of the most common sleep disorders affecting women. Insomnia disorder is characterized by chronic dissatisfaction with sleep quantity or quality that is associated with difficulty falling asleep, frequent nighttime awakenings with difficulty returning to sleep, and/or awakening earlier in the morning than desired. Insomnia can be acute (short-term) or chronic (long-term), with chronic insomnia lasting for at least three nights per week over three months or longer. (Levenson, J. C et al., 2015)

Causes: (Levenson, J. C et al., 2015)

• Hormonal changes: Women often experience insomnia related to hormonal fluctuations during the menstrual cycle, pregnancy, and menopause. For example, the drop in estrogen and progesterone during menopause can lead to hot flashes and night sweats, disrupting sleep.
• Stress and anxiety: High levels of stress and anxiety are significant contributors to insomnia. Women are more likely to experience anxiety disorders, which can interfere with sleep.
• Lifestyle factors: Irregular sleep schedules, excessive caffeine or alcohol consumption, and lack of physical activity can also contribute to insomnia.

Symptoms (Van Someren, E. J. 2021)

• Difficulties initiating sleep
• Waking up from sleep during the night or earlier in the morning
• Not being able to resume sleep easily
• Daytime fatigue or sleepiness
• Irritability, depression, or anxiety
• Difficulty concentrating or remembering things

Treatment: (Riemann, D et al., 2017)

• Cognitive Behavioral Therapy for Insomnia (CBT-I): CBT-I is a highly effective treatment that helps identify and change thoughts and behaviors contributing to insomnia. Cognitive behavioral therapy for insomnia usually consists of psychoeducation/sleep hygiene, relaxation training, stimulus control therapy, sleep restriction therapy and cognitive therapy. Usually, CBT-I is applied face to face (either on an individual basis or in a group format) by a trained clinician in four to eight sessions.
• Medications: In some cases, doctors may prescribe sleep aids or sedative-hypnotic medications. However, these are typically recommended for short-term use due to potential side effects and dependency risks.
• Lifestyle changes: Maintaining a regular sleep schedule, practicing relaxation techniques, and creating a sleep-conducive environment can significantly improve sleep quality.

Sleep Apnea

Sleep apnea is a serious sleep disorder where breathing repeatedly stops and starts during sleep. The most common type, obstructive sleep apnea (OSA), occurs when the throat muscles intermittently relax and block the airway during sleep. Obstructive sleep apnea (OSA) affects 17% of women and 34% of men in the US and has a similar prevalence in other countries. Obstructive sleep apnea (OSA) is characterized by repetitive upper airway collapse during sleep, which causes sleep fragmentation, oxygen desaturation, and excessive daytime sleepiness. This disorder is also associated with increased all-cause mortality. (Chang, H. P et al., 2020) In addition to increased mortality, other adverse health outcomes associated with untreated OSA include cardiovascular disease, cerebrovascular events, diabetes, and cognitive impairment. Additionally, OSA is negatively associated with quality of life and positively associated with motor vehicle accident injuries. Women with sleep apnea often report symptoms like excessive daytime sleepiness, loud snoring, and morning headaches. (Gottlieb, D. J., & Punjabi, N. M. 2020)

Causes: (Gottlieb, D. J., & Punjabi, N. M. 2020)

• Obesity: OSA is common and the prevalence is increasing with the increased prevalence of obesity. Excess weight, particularly around the neck, can increase the risk of sleep apnea by causing airway obstruction.
• Menopause: Hormonal changes during menopause can lead to a redistribution of fat, particularly in the upper body, increasing the risk of OSA.
• Anatomy: Structural abnormalities, such as a narrow airway, large tonsils, or a deviated septum, can also contribute to sleep apnea.

Symptoms: (Veasey, S. C., & Rosen, I. M. 2019)

• Loud snoring
• Gasping for air during sleep
• Waking up with a dry mouth or sore throat
• Morning headaches
• Difficulty staying asleep (insomnia)
• Excessive daytime sleepiness

Treatment: (Chang, H. P et al., 2020)

• Continuous Positive Airway Pressure (CPAP): CPAP is the most common treatment for OSA. The first-line treatment for OSA is nasal continuous positive airway pressure (CPAP), in which the upper airway is splinted open to improve patency during sleep. Appropriate regular use of CPAP effectively reduces symptoms of sleepiness and improves quality of life measures in moderate-to-severe OSA. The CPAP is considered the preferred treatment option for moderate-to-severe OSA and has a success rate of approximately 75%.

• Lifestyle changes: Weight loss, regular exercise, and avoiding alcohol and smoking can reduce the severity of sleep apnea.
• Surgery: In some cases, surgical options such as removing tonsils, correcting a deviated septum, or implanting devices to stimulate the airway muscles may be considered.

Restless Legs Syndrome (RLS) (Manconi, M et al., 2021)

Restless legs syndrome (RLS) is a common sensorimotor disorder characterized by an urge to move that appears during rest or is exacerbated by rest, that occurs in the evening or night and that disappears during movement or is improved by movement. Symptoms vary considerably in age at onset, frequency, and severity, with severe forms affecting sleep, quality of life, and mood. Patients with RLS often display periodic leg movements during sleep or resting wakefulness. RLS is considered to be a complex condition in which predisposing genetic factors, environmental factors and comorbidities contribute to the expression of the disorder. RLS occurs alone or with comorbidities, for example, iron deficiency and kidney disease, but also with cardiovascular diseases, diabetes mellitus, and neurological, rheumatologically, and respiratory disorders.

Causes: (Manconi, M et al., 2021)

• Genetics: RLS often runs in families, suggesting a genetic component.
• Iron deficiency: Low iron levels in the brain are thought to be a primary cause of RLS.
• Pregnancy: Many women experience RLS during pregnancy, particularly in the third trimester, likely due to hormonal changes and increased blood volume.
• Chronic diseases: Conditions such as diabetes, kidney disease, and Parkinson's disease are associated with a higher risk of RLS.

Symptoms: (Manconi, M et al., 2021)

• Unpleasant sensations in the legs (or arms), often described as tingling, crawling, or itching
• An irresistible urge to move the legs, especially when resting or lying down
• Temporary relief of symptoms by moving or stretching the legs
• Symptoms that worsen in the evening or night
• Difficulty falling or staying asleep due to discomfort

Treatment: (Manconi, M et al., 2021)

• Medications: Dopaminergic agents, anticonvulsants, and opioids are commonly prescribed to manage RLS symptoms.
• Iron supplements: If iron deficiency is detected, iron supplements can alleviate symptoms.
• Lifestyle changes: Regular exercise, maintaining a regular sleep schedule, and avoiding caffeine and alcohol can help manage RLS.

The Impact of Hormones on Women's Sleep

There are many ways in which women experience sleep differently from men. Women contending with distinct sleep challenges respond differently to sleep disorders, as well as sleep deprivation and deficiency, and face particular health outcomes as a result of poor sleep. Hormones play a crucial role in regulating sleep patterns, and women experience significant hormonal fluctuations throughout their lives, particularly during menstruation, pregnancy, and menopause. These changes can have a profound impact on sleep quality and contribute to the development or exacerbation of sleep disorders. Each phase of a woman’s life, from childhood to menopause, increases the risk of sleep disturbance in unique ways that may require distinct management. (Pengo, M. F et al., 2018)

Menstruation

Menstrual hormonal changes also seem to influence sleep architecture. The menstrual cycle affects sleep in several ways, primarily due to the rise and fall of estrogen and progesterone. Many women experience premenstrual syndrome (PMS), which can include sleep disturbances such as insomnia or hypersomnia. The discomfort and pain associated with menstruation, including cramps and headaches, can also interfere with sleep.

The most dramatic change in sleep across the menstrual cycle is increased EEG activity in the frequency range of sleep spindles (12-16 Hz) in NREM sleep in the postovulatory luteal phase of the menstrual cycle, when progesterone and estradiol are high, compared with the follicular phase when progesterone is low. (Pengo, M. F et al., 2018)

Pregnancy

Pregnancy is associated with dynamic physiological changes that affect sleep and sleep disorders. These changes range from anatomic changes that have the potential to affect sleep duration, sleep fragmentation, and breathing during sleep to metabolic changes that increase the risk of restless legs syndrome. (Pengo, M. F et al., 2018)

Menopause

Sleep disturbances are common in older women, affecting > 40% to 60% of perimenopausal or postmenopausal women. The 2005 National Institutes of Health State-of-the-Science Conference Statement cites sleep disturbance as a core symptom of menopause. Many recent studies support subjective sleep quality deterioration starting in the perimenopausal period. Perceived sleep changes mostly relate to sleep fragmentation, increased awakenings, and poor sleep quality. (Pengo, M. F et al., 2018), (Jehan, S et al., 2015)

Conclusion

Sleep is vital to overall health, yet many women experience sleep disorders like insomnia, sleep apnea, restless legs syndrome, and narcolepsy, often worsened by hormonal changes throughout life. Recognizing these disorders and seeking appropriate treatment, whether through lifestyle adjustments, therapy, or medication, can greatly improve sleep quality and well-being.

By prioritizing good sleep hygiene and understanding the unique challenges women face with sleep, it’s possible to enhance daily functioning and overall quality of life. Addressing sleep disorders is key to living a healthier, more balanced life.

References

Pisani, M. A., Friese, R. S., Gehlbach, B. K., Schwab, R. J., Weinhouse, G. L., & Jones, S. F. (2015). Sleep in the intensive care unit. American journal of respiratory and critical care medicine, 191(7), 731-738.

Irwin, M. R. (2015). Why sleep is important for health: a psychoneuroimmunology perspective. Annual review of psychology, 66(1), 143-172.

Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179-1192.

Van Someren, E. J. (2021). Brain mechanisms of insomnia: new perspectives on causes and consequences. Physiological reviews, 101(3), 995-1046.

Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., ... & Spiegelhalder, K. (2017). European guideline for the diagnosis and treatment of insomnia. Journal of sleep research, 26(6), 675-700.

Gottlieb, D. J., & Punjabi, N. M. (2020). Diagnosis and management of obstructive sleep apnea: a review. Jama, 323(14), 1389-1400.

Veasey, S. C., & Rosen, I. M. (2019). Obstructive sleep apnea in adults. New England Journal of Medicine, 380(15), 1442-1449.

Chang, H. P., Chen, Y. F., & Du, J. K. (2020). Obstructive sleep apnea treatment in adults. The Kaohsiung journal of medical sciences, 36(1), 7-12.

Manconi, M., Garcia-Borreguero, D., Schormair, B., Videnovic, A., Berger, K., Ferri, R., & Dauvilliers, Y. (2021). Restless legs syndrome. Nature reviews Disease primers, 7(1), 80.

Pengo, M. F., Won, C. H., & Bourjeily, G. (2018). Sleep in women across the life span. Chest, 154(1), 196-206.

Jehan, S., Masters-Isarilov, A., Salifu, I., Zizi, F., Jean-Louis, G., Pandi-Perumal, S. R., ... & McFarlane, S. I. (2015). Sleep disorders in postmenopausal women. Journal of sleep disorders & therapy, 4(5).