How Women’s Sleep Changes Across the Lifespan

Throughout a woman’s life, biological changes can wreak havoc on sleep. Hormonal changes during menopause can trigger significant, lasting changes in sleep quality. Menstruation and pregnancy also affect sleep and increase the risk of sleep disorders.

“There are biological differences in men and women that are impactful to sleep,” says University Hospitals sleep medicine specialist Sally Ibrahim, MD. “Women generally have more changes in sleep patterns due to their changing biology when compared with men. They also have higher rates of insomnia and mood disturbance, which can play a role in sleep.”

Dr. Ibrahim and women’s health nurse practitioner Jean Marino, CNP, share more about the complex relationship between a woman’s biology and sleep.

Menstrual Cycle

Many women notice sleep-related changes during their menstrual cycles, especially during the pre-menstrual phase. The days before a period are often when sleep problems occur.

“Women often experience differences in their sleep and may see a difference in their fatigue patterns in the days approaching their period,” Dr. Ibrahim says. “Some women are really sensitive to hormonal changes and they may have more insomnia and sleep quality changes.”

Certain menstrual disorders can affect circadian rhythms, breathing and sleep. In particular, polycystic ovary syndrome (PCOS), which causes irregular periods, may increase the risk of sleep-disordered breathing.

Pregnancy

During pregnancy, women often experience insomnia and other sleep challenges. “As the belly grows, it pushes on your bladder, so you have to get up and go to the bathroom during the night,” Dr. Ibrahim says. “Weight also puts strain on your back, which may cause pain and trouble getting comfortable at night. This is especially true as the pregnancy progresses. I don’t think I’ve ever met a woman in the third trimester who stays asleep all night, every night.”

Beyond the typical pregnancy-related sleep challenges, pregnancy can increase a woman’s risk for other sleep disorders:

• Women in pregnancy are more likely to develop sleep-disordered breathing, including obstructive sleep apnea, especially as the pregnancy progress. These breathing issues heighten risk of complications, including preeclampsia and gestational diabetes. There are other serious health consequences of untreated sleep apnea during pregnancy.
• Pregnancy increases risk of restless legs syndrome and insomnia.
• Post-partum sleep issues are common due to frequent awakenings, caring for a new baby during the night and mood changes.

Pregnancy-related sleep disorders often go unrecognized. Dr. Ibrahim says women having sleep issues should see a medical professional. Remedies for insomnia include cognitive behavioral therapy (CBT) and treatment of underlying problems such as back pain with massage therapy. For sleep apnea, there are a variety of options such as continuous positive airway pressure (CPAP).

Menopause

“Sleep difficulties get worse as women get older,” says Marino. “Menopause is a huge factor for worsening sleep.” Decreases in estrogen and progesterone are the primary cause.

“Women going through menopause have a hard time falling asleep and then staying asleep. Waking in the middle of the night and then being unable to fall back asleep is the most common problem I see,” Ms. Marino says. During menopause, hot flashes, night sweats, mood changes and anxiety often disturb sleep.

Post-menopausal women are at increased risk for sleep disorders like sleep apnea, because estrogen and progesterone help stabilize the airway. That protection disappears after menopause.

“Premenopausal women are relatively protected from sleep apnea compared to men,” Dr. Ibrahim says. “After menopause, women have nearly the same rates of sleep apnea as men. They lose the hormones that stabilize the airway, giving them more risk for airway collapse.”

Sleep also helps with appetite-regulating hormones, so poor quality or too little sleep is a factor in weight gain during and after menopause.

When to Seek Help

Dr. Ibrahim says women should seek help if:

• You have a persistent problem falling asleep or staying asleep, which causes fatigue or other problems.
• You experience persistent problems with excessive daytime sleepiness, low energy and difficulty functioning the next day despite sleeping the night before.
• You experience biological changes that negatively impact sleep.

Treatments are available for sleep disorders and for underlying problems such as hot flashes and mood disorders.

Related Links

The women’s health experts at University Hospitals offer comprehensive services to help women manage their menopause symptoms, including integrative health therapies, weight management strategies and nutritional counseling.