According to a 1998 Women and Sleep Poll, a middle aged woman sleeps an average of 6 hours and 41 minutes. This falls short of the recommended 7- to 9 hours of sleep. Women (more than men) are more likely to suffer from poor sleep quality such as insomnia, disrupted sleep, “light sleep” and wake up feeling un-refreshed. Menstruation, menopause and pregnancy cause hormonal changes that affect a woman’s sleep at different stages of her life. Other factors such as life’s stresses and demands (marital, family, financial, work, aging parents, children) add to sleep problems. Poor sleep quality and quantity lead to daytime fatigue, decreased concentration, mood changes and possibly weight gain.

Sleep disturbances do not always stem from hormonal changes. They can be caused by depression, the change of life and its transitions, medical problems such as pain (migraines, arthritis) or sleep disorders like sleep apnea and restless legs syndrome. Women are more likely to suffer from pain than men. Migraines, arthritis, fibromyalgia are more common in women. Pain causes arousals and awakenings during sleep.

Sleep apnea is more common in adult men than women. However, menopausal women catch up with their male counterparts. Women with sleep apnea tend to have their diagnosis delayed because they present with atypical sleep apnea symptoms such as insomnia and daytime fatigue rather than the typical symptoms of snoring and witnessed apneas. Sleep apnea should definitely be considered in women in this age group. A 2004 October study published in the issue of Diabetes, nutrition and metabolism found that postmenopausal women have higher prevalence of sleep apnea compared to premenopausal women.

Restless legs syndrome (RLS) is common among women. It is an unpleasant urge to move the legs in the evening and nighttime and relieved by movements; it causes insomnia. Sometimes, it is associated with leg jerks during sleep, known as periodic limb movements of sleep. Pregnant women commonly suffer from RLS. RLS is believed to be due to low iron and dopamine in the brain.

Pregnancy is a common time for sleep problems. Excessive daytime sleepiness is due to poor sleep quality and the increase in progesterone. It becomes more difficult to find a comfortable position. Insomnia, which is due to hormonal changes, frequent urination, nausea, back pain, movements of the fetus and stress (anticipation of labor and delivery) and possible sleep apnea and restless leg is also common. Sleep apnea and snoring can emerge in pregnancy because of weight gain and hormonal changes; It carried a risk of low birth weight and pre-eclampsia. Nighttime gastroesophageal reflux (GERD) or heartburn is a common complain.

Recommendation on managing sleep problems in women

  • Keep good sleep habits
  • Maintain regular bed and wake times even if you suffer from insomnia
  • Avoid caffeine, alcohol and smoking- especially close to bedtime
  • Eat a low-fat diet. Choose foods that are low in fat, saturated fat and cholesterol
  • Work on reducing stress through stress reduction techniques such as yoga and exercise
  • If you experience hot flashes, keep your bedroom on the cooler side. Consider wearing light-fitting clothes that breathe, and possibly using a fan.
  • Talk to your doctor about the risk of sleep apnea syndrome. Pay attention to symptoms such as snoring, gasping at night and frequent awakenings (insomnia).
  • Do things that increase serotonin levels in the brain are prayer, meditation, music, exercise.
  • Try aromatherapy with lavender for example
  • If you suffer from chronic pain and it is affecting your sleep, consider biofeedback, relaxation techniques such as breathing exercises, massages and yoga to supplement your medication regime. At times, individuals with chronis pain requires a sleeping pill to allow them a good night sleep, which can by itself diminish the daytime pain. Talk to your doctor.
  • Few medications might be needed to help you if you continue to struggle with your sleep.
    • A recent 2012 study in the March issue of Menopause concluded that “Among healthy perimenopausal and postmenopausal women with hot flashes, escitalopram at 10 to 20 mg/day compared with placebo reduced insomnia symptoms and improved subjective quality at 8 weeks of follow-up.”
    • Another October issue of 2004 study published in Clinical Therapeutics found that Zolpidem (Ambien) was effective in the treatment of menopause-related insomnia in perimenopausal and postmenopausal women in that it increased total sleep time, decreased awakenings and improved daytime functioning.
    • Eszopiclone (Lunesta) was also found to be very helpful in this population according to a December 2006 study in Obstetrics and Gynecology; it “provided significant improvements in sleepand positively impacted mood, quality of life, and menopause-related symptoms in perimenopausal and early postmenopausal women with insomnia.”

Tips on managing sleep issues during pregnancy

  1. Make sleep a priority.
  2. Naps: Schedule a daily nap during the day if you are not getting a good night sleep.
  3. Medications: Avoid sleeping pills for insomnia since many of them carry risks for the fetus. Restless legs medications are also not indicated during pregnancy because of the potential harm on the fetus.
  4. Restless legs: If you suffer from restless legs, get evaluated for anemia and low folate levels during pregnancy. Prenatal vitamins should help. Avoid coffee.
  5. Routine: Maintain a routine sleep and wake schedule.
  6. Exercise: Get daily gentle exercise as permitted by your doctor. Along with drinking plenty of water during the day, it improves circulation and reduces leg cramps at night.
  7. Comfortable position: Sleep on your left side to allow the best blood flow to the fetus. Avoid sleeping on your back for too long. Use a pillow under you knee and perhaps another under your abdomen. You can use regular pillows or purchase special pregnancy pillow.
  8. Sleep apnea: If you have pauses in breathing or your snoring is severe, talk to your doctor to get tested with a sleep study. Particular attention should be paid to overweight women who gained more weight during pregnancy or those who developed swelling in their feet or hypertension (pre-eclampsia) since they are at higher risk for sleep apnea. Treatment is with CPAP therapy which involves the use of face mask connected to a devise that delivers pressurized room air to maintain an open airway. It is a safe treatment of sleep apnea for pregnant women.
  9. Reflux: Avoid heavy meals close to bedtime to decrease the chance for getting heartburn at night. Avoid fluids close to bedtime. However, drink plenty of water during the day. If heartburn continues to be a problem use a couple of pillows to elevate your head. Avoid food that is spicy, acidic or fried.