Sleep Disorders in Women: Identifying the Root Causes and Solutions

Women take longer to fall asleep and suffer from sleep disorders more frequently than men. Stress and hormonal fluctuations are the main causes of sleep disorders in women. Do you also often experience restless nights? Here is what you can do about it.

What Are Sleep Disorders?

When we have trouble falling asleep or staying asleep, or when we feel constantly tired during the day, these are signs of a sleep disorder (insomnia). These symptoms can occur individually or simultaneously. If sleep disturbances occur only on a few occasions, it’s not a cause for concern. However, if sleep disorders persist for more than four weeks, we should seek medical help to determine the underlying causes, as chronic insomnia or another medical condition might be the root of the problem.

Women Are More Likely To Suffer From Sleeplessness

According to a German study by the Medical Faculty of the University of Leipzig in 2017, women (42 per cent) are more likely to suffer from sleep disorders than men (29 per cent). This study analysed data from over 9,200 participants from Leipzig in Germany. According to the study, 36 per cent of those surveyed had trouble falling asleep.

These Are the Most Common Sleep Disorders in Women

For decades, sleep research primarily focused on men. As a result, specific female sleep problems were much less explored. Although the causes of sleep disorders in men overlap with those in women in many areas, there is a significant difference: female hormones. Fortunately, studies are now increasingly examining the sleep problems and needs of women specifically, which have shown to change with age. The most common sleep disorders in women include:

• Chronic insomnia: Those affected are unable to fall asleep or stay asleep. Waking up too early in the morning is another symptom. Persistent sleep deprivation often leads to high blood pressure, cardiovascular diseases, diabetes, or impaired immune function.
• Restless legs syndrome: The uncontrollable urge to move the legs is often accompanied by stabbing or cramping sensations in the legs.
• Sleep apnoea: The cessation of breathing for at least 10 seconds, accompanied by loud and irregular snoring and audible pauses in breathing, is unfortunately not just a male problem.
• Circadian rhythm disorder: The internal clock is disrupted, leading to difficulties in falling asleep at regular times, such as due to shift work. As a result, you may feel tired and exhausted when you should be awake.

Younger Women Are Less Likely to Suffer From Sleep Disorders

Women, especially from middle age onwards, often struggle with sleep disorders. A Swedish study has shown that 20 per cent of women aged 38 suffered from sleep disorders. By the age of 85, this figure increased to 45 to 50 per cent.

Causes of Sleep Disorders in Young Women

Menstruation, pregnancy, and motherhood are common reasons for disrupted sleep or a poor sleep quality in young women. A lack of sleep can lead to long-term exhaustion and daytime sleepiness.

Sleep Disorders in Middle-Aged Women

In middle-aged women, age-related hormonal fluctuations are responsible for poor sleep quality, particularly changes in the hormonal balance due to menopause. In addition to hormonal changes, physical factors such as hot flushes, breathing difficulties, or arthritis negatively affect sleep. Stress, depression, and anxiety are other negative factors that are often accompanied by sleeplessness.

Hormones as Hidden Sleep Disruptors

Female hormone levels fluctuate significantly during the menstrual cycle, pregnancy, and breastfeeding, as well as during menopause and the periods leading up to and following it. These hormonal changes can be profound enough to cause sleep disorders. In a study by the National Sleep Foundation, 23 per cent of women reported experiencing sleep disturbances before menstruation, and 30% reported poorer sleep during their period. Various periods in a woman's life can disrupt hormonal balance to such an extent that it triggers sleep disorders:

• Monthly cycle
• Pregnancy
• Breastfeeding
• Menopause

The Influence of the Menstrual Cycle

A study by Rush University in Chicago identified specific days in the menstrual cycle when women experience reduced sleep quality. This is particularly evident before and after menstruation, on days with significantly lower hormone production, especially when the FSH level (FSH = follicle-stimulating hormone) is particularly low.

FSH plays a crucial role in ovulation and the regulation of the menstrual cycle. The hormones oestrogen and progesterone, which also govern the menstrual cycle, have a similar impact on the circadian rhythm and sleep.

Sleep Disorders During Menstruation

The Rush University study confirms that many women experience significantly worse sleep during their periods. During this time, REM sleep phases (the dream sleep phases) are shortened. As oestrogen levels stabilise post-menstruation, hormonal balance improves, and REM sleep phases return to normal.

Generally, sleep problems are most prevalent at the beginning of menstruation and tend to decrease afterwards. However, it's important to note that menstrual-related tension could potentially lead to chronic insomnia.

Common sleep disorders in healthy women before ovulation include:

• Night waking
• Increased sleepiness
• Heightened daytime sleepiness
• Fatigue
• More frequent and intense dreams

Sleep disorders may even cause premenstrual symptoms, such as:

• Stomach cramps
• Irritability
• Mood swings
• Sudden, intense hunger

Sleep Disorders During Pregnancy

For many women, the need for sleep increases at the beginning of pregnancy due to the heightened production of progesterone. However, during the later stages, especially in the last trimester, many women suffer from significantly poor sleep quality.

This is confirmed by a recent study from Taiwan: 300 non-pregnant women were compared with 150 women in the second and third trimesters of pregnancy. 60 per cent of pregnant women reported significant sleep disturbances. Among non-pregnant women, this figure was 48 per cent.

Altered Sleep During Pregnancy

Studies have shown that during pregnancy, deep sleep, which is essential for physical and mental recovery, decreases, while nighttime awakenings increase. Some women also have difficulty sleeping in certain positions. Sleep disorders in the last trimester of pregnancy often result from:

• Back pain
• Leg cramps
• Heartburn
• Movements of the unborn child
• General discomfort
• Increased need to urinate
• Breathing difficulties during sleep such as snoring and short periods of apnoea

Sleep Disorders in Women Aged 40 and Above

From the age of 40 to 45, women typically enter menopause: fertility declines, menstrual periods often become irregular, and eventually cease with menopause.

Are Increased Sleep Disorders During Menopause Normal?

Yes! 54 per cent of women suffer from sleep disorders during the postmenopausal period. This is largely due to altered hormone production, which directly impacts sleep. Other hormones critical to sleep are also negatively affected.

How Hot Flushes Affect Sleep

Hot flushes, severe night sweats, and palpitations are caused by decreased estrogen levels. These symptoms, although short-lived, can occur frequently enough to significantly disrupt sleep.

A recent study of 149 women aged 40 to 59 (of whom 33.6 per cent were in menopause) shows that more than 40 per cent of the participants struggled with hot flushes at night, with 33 per cent experiencing pathologically increased daytime sleepiness.

Tips for a Healthy Sleep in Women

Whether we sleep well and restfully depends on several factors. A good start is to make sure we are sufficiently comfortable. A mattress tailored to your needs, suitable pillows and, for example, a weighted duvet from CURA of Sweden, which exerts a pleasant pressure on the body, can help. This is because the weight of a weighted duvet or weighted blanket stimulates the body to release the so-called feel-good hormone serotonin and reduces levels of the stress hormone cortisol. At the same time, the weight boosts the production of our sleep hormone melatonin.

Additionally, the following tips can help to ensure a good night's sleep:

• Stick to a regular sleep schedule by going to bed and waking up at the same time each day.
• Only go to bed when you feel genuinely tired.
• Establish bedtime rituals, such as a warm bath, gentle yoga, soft music, or a ten-minute read to help you wind down and relax.
• Avoid intense exercise sessions in the last four to six hours before bed; opt for easy walks or stretching exercises instead.
• Limit caffeine intake, particularly in the six hours before bedtime.
• Avoid alcohol and nicotine before bed.
• If possible, refrain from using sleeping pills.
• Ensure your bedroom is cool, well-ventilated, and free from distractions like noisy alarm clocks, tvs, or light sources.
• Consider separate sleeping arrangements if your partner's snoring disrupts your sleep, or try using earplugs.

A Positive Note to End On: Sleep Disturbances in Women Can Be Alleviated

Both men and women often struggle with sleep disorders and difficulties falling asleep. Although many symptoms are similar, women frequently face additional responsibilities on top of work-related stress. Even today, a significant portion of the responsibility for children and household chores still falls on women. Furthermore, hormonal fluctuations—triggered by menstruation, pregnancy, breastfeeding, or menopause—affect the well-being and sleep quality of many women.

These fluctuations can lead to insufficient production of melatonin and serotonin, which are crucial for the sleep-wake cycle and its proper functioning. During menstruation, estrogen and progesterone levels drop, potentially causing physical and emotional issues throughout the month that can severely disrupt nighttime sleep. However, significant relief can be achieved through exercise, relaxation techniques, and proper sleep hygiene.