Sleep: there’s a fairly good chance you’re not getting enough. Whether due to the likes of stress, caffeine or late-night doom-scrolling, 1 in 3 people are reportedly not getting enough sleep, according to US figures.
Some of these people will have insomnia, a clinical condition with an exact definition: a sleep disorder that affects a person’s performance the next day – for two to three nights every week, for more than three months.
Anyone can get insomnia, but women are more at risk than men – according to one study, they have a 58 per cent higher prevalence rate.
Why? Although studying sleep is complex – and the causes of sleep disturbance are multifactorial – hormonal fluctuations throughout a woman’s lifespan significantly impact the quality and quantity of a woman's sleep.
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Women who have a menstrual cycle experience cyclical changes in a multitude of hormones. In the days leading up to their period, this shows itself through a variety of symptoms, collectively known as pre-menstrual syndrome (PMS) or pre-menstrual dysphoric disorder (PMDD), due to the declining levels of oestrogen and progesterone.
This can cause disturbances such as difficulty getting to sleep, frequent awakenings, non-restorative sleep and nightmares.
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Poor sleep and pregnancy go hand in hand and reports of difficulty sleeping begin at the start of pregnancy, worsening throughout. Studies monitoring sleep patterns in women in their first trimester show increased waking and poorer sleep quality compared to pre-pregnancy.
In the third trimester, the number of wakings in the night increases typically to five per night. During this time, women experience more disturbing dreams, and the quality and quantity of sleep are so poor it is consistent with a clinical diagnosis of insomnia.
This then leads to a significant impact on daytime functionality, with decreased alertness and increased need for daytime sleeping. Poor sleep during pregnancy puts women at increased risk of maternal and fetal poor health – this includes an increased inflammatory state for women and increased risk of fetal growth problems.
Then there's menopause. As you'll probably know, this major hormonal transition – when the ovaries reduce in function and ultimately periods stop altogether – has a significant impact on a woman’s body. Although not spoken about much, these changes include sleep disturbance. In fact, the prevalence of insomnia reported in studies as high as 60 per cent of women aged 40 years and older.
In this instance, sleep is affected by a multitude of hormone-induced symptoms. The most common reported by women are night sweats due to the hypothalamic temperature control centre in the brain being affected by the fluctuating levels of oestrogen.
These episodes are very disruptive, often accompanied by severe fear as well as extreme sweating through bedclothes and sheets, making it difficult for a woman to get back to sleep. And on average, women experience these for at least four or five years throughout perimenopause.
Also prevalent throughout the perimenopause phase in part due to the fluctuating and decreasing levels of hormones, notably oestrogen and progesterone. We now know that the female brain is dense with oestrogen receptors and that density changes during the menopausal transition, which is associated with changes in memory and mood.
But also, the emotional and psychological impact of menopause symptoms can in turn lead to anxiety, which can make it difficult for people to fall and stay asleep, whilst also leading to early morning waking. So, in fact, this particular hormonal fluctuation throughout perimenopause, due to its length of duration and breadth and intensity of symptoms, brings about a double blow to sleep quality and quantity.
Although sleep issues affect everyone, women face specific challenges throughout their lives that significantly impact sleep quality and quantity. Recognising these gender-specific issues is crucial for both women and healthcare providers in developing effective strategies to improve sleep health and overall well-being.
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