Of sleepless nights

Inability to sleep well is a problem more common in women than in men. Read on to know what keeps women awake through the dark hours

sleepless womanWhen you spend a restless night, the whole world comes to know about it the next day by the way you look. You might think to yourself, “I did everything right before turning in: had a light dinner, took a warm shower, drank a glass of milk, played soothing music. Then, why couldn’t I sleep well?”

Unfortunately, this is not enough to lull you into the blissful oblivion for the required 7-8 hours. Women often find sleeping soundly more difficult than men. Let’s explore the reasons for the same.

Sleep snatchers

Normal sleep varies with age and sex. To begin with, men and women have different sleep patterns. What is normal for a man is definitely not so for a woman. Men do not have much variation in their hormonal levels in a month. Women, on the other hand, undergo several dramatic changes that affect their sleep pattern. This is also the reason that sleep studies use more men as subjects than women. But in the case of women, it’s not just the hormones; there are other factors influencing their sleep as well. These fall into three major groups: biological factors that involve fluctuations in hormones and temperature and genetic factors; psychological factors like expectations, stress responses and mood; and socio-cultural factors like child rearing, work and family commitments.To determine a proper sleep pattern for women one needs to know the complete menstrual cycle.

Sleep in women

Women’s sleep patterns have some typical highlights.

  • Increased percentage of slow-wave sleep that tends to decay more slowly than men. [Slow-wave sleep is the stage of deepest sleep characterised by absence of eye movements, decreased body temperature, and involuntary body movements.]
  • Young women have shorter sleep latency and higher sleep efficiency compared to young men. [Sleep latency is the amount of time it takes to fall asleep after the lights have been turned off.]
  • Older women have a higher sleep efficiency [Sleep efficiency is the ratio of time spent asleep—total sleep time—to the amount of time spent in bed]. Elderly males, on the other hand, spend more time in bed.

Monthly cycles

Sleep in women gets affected due to the menstrual cycle. The changing landscape of sex hormones during the cycle appears to be associated with changes in overall structure of sleep [sleep architecture in medical terms]. Levels of melatonin, cortisol, thyroid stimulating hormone, and prolactin impact sleep.

Even during the menstrual cycle the characteristics of sleep differ as per the two phases of the cycle: follicular and luteal.

In general, sleep appears better [few arousals] in the early luteal phase when progesterone hormones are increasing. As those hormones recede, the number of arousals increases leading to a disturbed sleep. In the luteal phase, there is a higher percentage of NREM [non-rapid eye movement sleep] as compared with the follicular phases. The follicular phase also has more UARS [Upper airway resistance syndrome] as compared to the luteal phase. Upper airway resistance syndrome is a sleep-disordered breathing syndrome characterized by complaints of daytime fatigue and/or sleepiness, increased upper airway resistance during sleep, frequent transient arousals, and no significant hypoxemia.

During your menstrual cycle, there are chances of you suffering from menstrual related hypersomnia. [Usually hypersomnia is characterised recurring episodes of excessive daytime sleepiness {EDS} or prolonged night-time sleep] Though this is not common, it is a possibly treatable condition.

Menstrual related Hypersomnia can be characterised by:

  • Recurrent episodes of sleepiness in association with menstrual cycle.
  • The disorder begins within the first month of menarche [beginning of menstruation].
  • Episodes last approximately a week.
  • Rapid resolution at the time of menses.

Pregnancy patterns

Sleep patterns vary during pregnancy. The changes are trimester specific. An increase rate of sleep disorder is seen during pregnancy. Here how sleep gets affected when you are carrying.

First trimester

  • Increased total sleep time, possibly due to the relative properties of progesterone.
  • Sleep disruption.
  • Nausea/vomiting, frequent urination.

Second trimester

  • Many report improved sleep and daytime alertness
  • Decreased nausea
  • Normalisation of total sleep time

Third trimester

  • Decreased total sleep time
  • Increased insomnia/nocturnal awakening
  • Increased daytime sleepiness
  • General physical discomfort, frequent urination, back/front pains, nasal congestion, leg cramps, foetal movement and contractions

If you are pregnant, your sleep pattern can actually predict the lengthy labour and type of delivery you will have. Your WASO or Wake After Sleep Onset can tell you the probability of having a C-section. WASO is the total time spent awake during the night after having initially fallen asleep. A WASO of 15 per cent plus indicates 5.2 per cent odds of having a C-section, WASO of 10-14 per cent means 1.9 per cent odds of a C-section. If your total sleep time [TST] is less than six hours you have 4.5 per cent odds of assisted delivery. If your TST is over seven hours, you have 1.0 per cent odds of a C-section.

Several other sleep disorders can co-exist during pregnancy, which include: sleep disordered breathing; insomnia; restless leg syndrome [RLS] and parasomnia.

Pregnancy is a dynamic time of changing physiological and psychological state which can affect sleep. There is an alteration in sleep architecture. The changing sleep affects physiological symptoms. Medications to treat sleep disorder are often considered unsafe during this time, but a sleep specialist can relieve the problem with non-invasive recommendations.

10 Tips to Sleep Better

It’s important to make an overall commitment to healthy, restorative sleep. Here are some tips for maintaining a healthy sleep cycle and ensuring the best night’s rest:

  1. Make sleep a priority by keeping a consistent sleep [bedtime] and wake schedule, including weekends.
  2. Create a bedtime routine that is relaxing. Experts recommend reading a book, listening to soothing music or soaking in a hot bath.
  3. Transform your bedroom into a haven of comfort. Create a room that is dark, quiet, comfortable and cool for the best possible sleep.
  4. Evaluate your mattress and pillow to ensure proper comfort and support. If your mattress is five to seven years old, it may be time for a new one. In general, pillows should be replaced every year.
  5. Keep work materials, computers and televisions out of the bedroom; it should be used for sleep and sex only.
  6. Exercise regularly, but complete workouts at least two hours before bedtime.
  7. If you sleep with a partner, your mattress should allow each of you enough space to move easily. Couples who’ve been sleeping on a “double” [full size] may think they have enough room, until they learn that each person has only as much sleeping space as a baby’s crib.
  8. Avoid nicotine [e.g., cigarettes, tobacco products]. Used close to bedtime, it can lead to poor sleep.
  9. Avoid caffeine and alcohol [e.g., coffee, tea, soft drinks, chocolate] close to bedtime. It can keep you awake.
  10. Finish eating at least two to three hours before bedtime.

Source: The Better Sleep Council

Preeti Devnani
Dr Preeti Devnani, MD, DASM is Certified by tha American Board of Neurology and American Board of Sleep Medicine. She manages the Sleep laboratory and Sleep Disorders Clinic in the Department of Neurology at the Jaslok Hospital and Research Center.


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