A lifetime of female sleep
So what about women’s sleep? There has been plenty of focus on aspects of female health over recent years. From menstruation to menopause there are resources and information available across various media platforms, science, medicine and health outlets. However, what’s not always commented on is the impact of sleep during a women’s life. This is slightly shocking given sleep and sleep disturbances are increasingly recognised as determinants of a women’s health and wellbeing, particularly in the context of the menstrual cycle, pregnancy, and menopause, all times of major hormone transition (Kloss, 2015).
Whilst these phases of hormone transition are significant in the context of female sleep, there are other causes of poor sleep in women too, such as shift work, pain and care giving. That’s not to say men don’t have sleep issues too, but there is an overarching difference in male and female sleep over the course of a lifetime and this article will hopefully provide a little insight, understanding and advice on sleep health specific to women.
Poor sleep in women is well reported. In 2022, The Sleep Charity, a UK Charity focused on improving the nations sleep, reported over 70% of calls to their national sleep helpline were from women. A significant number of women report poor sleep later in life, be it, for example, from the symptoms associated with the menopause or other age-related factors. The good news is we can combat a lot of the issues with some practical strategies for good sleep health, or signposting to clinical intervention where necessary, and some of these are outlined in this article.
Menstrual cycle and sleep
With little difference in sleep between the genders in childhood, once puberty sets in there is a marked difference in male and female sleep. The onset of puberty means menstruation begins (periods), which can cause sleep issues through a variety of symptoms such as pain, anxiety or premenstrual syndrome, where a whole host of symptoms can interact with a woman’s sleep. Symptoms may change in severity too. Keeping a track of your cycle and symptoms can often be helpful, particularly when seeking medical advice.
Pregnancy and sleep
In her relationship with sleep, a significant stage of a woman’s life is pregnancy. During which time a woman’s sleep quality and quantity is affected to relative degrees. Whether experiencing nausea, foetal football as baby likes a kick, or the general feelings of discomfort in the latter stages of pregnancy, all link to an accumulated sleep debt during pregnancy. Not ideal for what follows with a new born baby, when female sleep is yet again challenged as nursing and caring for baby take priority, whilst also experiencing the roller coaster of emotions and hormone changes after having given birth!
Some women may experience very little effect on their sleep for the first few months of pregnancy and only in the latter stages, as baby has grown significantly and sleep becomes more uncomfortable, do they notice a difference. However, poor sleep in the first and third trimesters is quite common due to the body’s responses to pregnancy during these stages. Frequent symptoms bridging trimesters can include nausea, night time urination (nocturia), musculoskeletal pain, Rhinitis (blocked nose) and uterine contractions. The second trimester is typically the time to gain as much sleep as possible ahead of the uncomfortable third trimester where symptoms such as uterine contractions, heartburn and leg cramps may upset sleep patterns.
The majority of pregnant women (8 out of 10) will experience some form of nausea and for most this will improve and completely stop around 16-20 weeks, although for some women it can last longer. Some pregnant women experience very bad nausea and vomiting. They might be sick many times a day and be unable to keep food or drink down, which can impact on their daily life and of course their sleep. In severe cases a woman may suffer from hyperemesis gravidarum, excessive nausea and vomiting that often needs hospital treatment (NHS guidelines 2022). In this case you need to seek advice from your GP and midwife team.
Whilst symptoms causing poor sleep during pregnancy can vary, unfortunately for some, poor sleep in pregnancy can be all consuming and the associated fatigue quite debilitating throughout the whole pregnancy. If this is the case for you do seek advice from your GP.
Menopause and sleep
Every woman goes through the menopause, a natural event and expected phase in a woman’s lifetime when your ovaries cease to work and you stop producing the usual amount of the female hormones; oestrogen and progesterone. It is defined as the final time you have a period (menses), after twelve months without any menstrual bleeding, typically due to age. Yet it is much more than this. It is a major life transition phase culminating in the end of biological function.
Usually menopause occurs in a woman’s early 50’s (in the UK at approximately 52 years of age), but in some circumstances it can be earlier due to certain medical interventions (for example, chemotherapy) or impaired ovarian function (Nawakowski, 2021).
Perimenopause is the phase prior to menopause when hormone levels decline but menses is still present. Given perimenopause typically starts in a woman’s 40’s (but can start in her 30’s or even earlier), and menopause itself typically occurs in early 50’s, the entire process can last anywhere between two to ten years. Combined with this is the fact that the impact of menopause can linger for some years after the event. So a woman’s perimenopausal and menopausal state can last for up to a third of her life and consequently the effects of menopause on sleep can be chronic and life debilitating given the longevity of the menopause process.
There are approximately 48 symptoms (and counting!) of the menopause with sleep disturbance being an overarching symptom. Sleep changes usually manifest at first as sleep fragmentation (restlessness), increased awakenings, and poor sleep quality, but as time goes on there can be an increase in insomnia (a regular inability to fall asleep or persistent night wakening’s over several weeks), along with associated depression and anxiety and use of prescription sleeping aids (Nawakowski, 2021).
Hot flushes are another leading cause of sleep upset during this phase of a woman’s life. They can last a few minutes and occur several times a night leading to a restless night’s sleep and consequently daytime sleepiness the following day. Hormone replacement therapies can have a positive effect on a woman’s sleep during the menopause if symptoms become unbearable. Seek advice from your GP on this.
Sleep disorders and women
Woman are 40% more likely to suffer from the global leading sleep disorder, insomnia (National Sleep Foundation, 2022), particularly during mid to later life. If this persists for three times a week, over a period of at least three months then this can be classed as chronic insomnia and can be a real threat to quality of life and needs clinical referral. Other sleep disorders common in women can be restless leg syndrome (RLS) where uncomfortable sensations in the legs, such as itching, prickling, pulling, or crawling create an overwhelming urge to move the legs and periodic limb movement (PLM), which involves repetitive jerking, cramping, or twitching of their lower limbs during sleep, usually occurring every five to ninety seconds and for up to an hour (National Sleep Foundation, 2022). In later life women are more likely to experience sleep disordered breathing from conditions such as sleep apnoea, an ailment where disordered breathing causes a lack of oxygen and so you wake up repeatedly during the night, rarely getting into a deep sleep and thus causing excessive daytime sleepiness. The list goes on.
Other factors affecting women’s sleep
Women make up the majority of health and social care roles, the fastest growing industry in the UK, many of which involve shift work which can also affect sleep. All this, coupled with the fact that on the whole, women take on the brunt of family and domestic tasks, often alongside paid employment. Caring is of course also work – if unpaid. This can include caring for children or elderly relatives and all the emotional labour of running a home: remembering everything from birthday parties to dustbin day, packing lunches and gym kits and ensuring domestic supplies never run short! Juggling the juggle can certainly impact on sleep.