While sleep issues can impact anyone, women experience sleep disorders differently and at higher rates than their male counterparts. Certain disorders, like insomnia and restless legs syndrome, are much more common in women than in men.
Below, we’ll look at why sleep disorders are more common in women, review the most common sleep disorders, and provide tips for treating your sleep issues so you can have a more restful night.
Why Are Sleep Disorders More Common in Women?
There are a variety of reasons that sleep disorders are more common in women, including biological drivers — like hormone fluctuations and mental health challenges — as well as lifestyle factors like caregiving responsibilities.
Hormonal Fluctuations
Beginning in puberty, female reproductive hormones start impacting a woman’s ability to get quality sleep. Both estrogen and progesterone interact with the sleep-wake cycle to help promote sleep. When they fluctuate, everything from a woman’s ability to fall and stay asleep to her moods is impacted.
Hormonal fluctuations affect sleep at various stages throughout a woman’s life.
- Menstrual cycle: Sleep quality tends to decline in the week before a woman's period, and menstrual symptoms like cramps can also make it harder to sleep.
- Pregnancy: During pregnancy, hormonal fluctuations can lead to sleep disorders like insomnia, restless leg syndrome, and sleep apnea. Physical discomfort can also make it difficult to sleep, leading to nearly 80% of women struggling with sleep during their third trimester.
- Perimenopause and menopause: Perimenopause and menopause are marked by hormone levels that fluctuate and eventually drop, so sleep can be particularly hard to come by for women in midlife. Symptoms like hot flashes and mood changes can lead to insomnia.
Anxiety and Depression
Women experience higher rates of anxiety and depression than men, and both are strongly linked to insomnia. There’s also a bidirectional relationship between mental health and sleep, meaning that anxiety and depression make it more difficult to fall asleep and stay asleep, and impaired sleep can worsen anxiety and depression.
Caregiver Responsibilities
Caregiving greatly interferes with sleep for anyone who tends to children and aging adults during the night, and despite shifting gender roles, women still take on more caregiving responsibilities than men. In fact, the largest gap between recorded sleep time for men and women occurs during the caregiving years.
Waking to care for others during the night not only reduces total sleep time but also disrupts the natural sleep cycle by directly affecting sleep stages, which can impair memory and cognition.
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The Most Common Sleep Disorders in Women
Between 50 and 70 million Americans have some sort of sleep disorder, and research shows that lack of sleep impacts women to a greater degree than men. Below, we’ll review the primary sleep disorders that impact women.
Insomnia
Insomnia is the most common sleep disorder found in women, and women are 40% more likely to develop insomnia than men. Insomnia is characterized by trouble falling asleep, staying asleep, or getting quality sleep, and there are two main types:
- Acute insomnia: Insomnia is classified as acute when symptoms last for fewer than three months.
- Chronic insomnia: A person has chronic insomnia if their symptoms occur three or more nights per week and persist for more than three months. Insomnia can last for years for some individuals.
Insomnia is common in women for a few different reasons. In general, when hormone levels drop, women experience more trouble falling and staying asleep. This is particularly pronounced during perimenopause and menopause, as women are kept awake by symptoms like hot flashes.
Women are more likely than men to experience anxiety and depression, both of which are strongly linked to insomnia. Sometimes women develop anxiety about falling asleep, and their subsequent lack of sleep worsens their insomnia symptoms.
Insomnia is common, but it’s also treatable. Cognitive behavioral therapy for insomnia (CBT-I) is an effective option that involves working with a therapist to identify and change thoughts and behaviors that may be contributing to sleep issues.
Focusing on good sleep hygiene practices, such as maintaining a bedtime routine and avoiding alcohol and caffeine, can also help. Women in menopause may also benefit from sleep supplements, but care needs to be taken with interactions of supplements with other medications, dosing, and frequency.
Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is a sleep disorder that causes people to either stop breathing or experience shallow breathing during sleep.
OSA affects women differently than men, and for that reason, it often goes undiagnosed. While men are more likely to report symptoms like loud snoring or daytime sleepiness, women are more likely to experience symptoms like depression, fatigue, and morning headaches. Women are more likely to be diagnosed with insomnia without identifying that OSA is the underlying cause.
OSA is more common in men than women, but a woman’s risk increases after menopause. In fact, about 9% of young-to-middle-aged women experience OSA while 56% of older women develop it.
A continuous positive airway pressure (CPAP) machine is the most common and effective treatment for OSA. It works by sending a steady stream of air through a mask to keep a person’s airway open while they sleep. Sometimes, doctors will also recommend lifestyle changes.
Restless Legs Syndrome (RLS)
People with restless legs syndrome (RLS) experience an overwhelming urge to move their legs while resting, often accompanied by tingling or burning sensations. RLS is about twice as common in women as it is in men. Other risk factors include the following.
- Pregnancy: Pregnant women are two to three times more likely to develop RLS than the general population. Researchers aren’t entirely sure why, but it may be linked to low levels of iron or vitamin D.
- Iron deficiency: Many people with RLS also have low iron levels.
- Family history: There’s a genetic component to RLS, meaning women are more likely to develop it if a family member has it.
RLS typically responds well to medication, and doctors usually recommend iron replacement for those with iron deficiency.
Circadian Rhythm Disorders
Normally, circadian rhythms make humans sleepy at night and alert during the day, but in circadian rhythm disorders, a person’s body clock becomes misaligned with their lifestyle or environment.
- Shift work disorder: This disorder can affect anyone who works during typical sleeping hours, such as those on overnight or rotating schedules, and is characterized by insomnia (when they finally have the opportunity to sleep) and excessive sleepiness (during waking or working hours).
- Delayed sleep-wake phase: Most common in adolescents, it involves sleep and wake times that are substantially later than conventional timing.
- Advanced sleep phase in older adults: Advanced sleep phase occurs when a person’s sleep and wake times are two or more hours earlier than desired or typical. It’s most common in older adults who have trouble sleeping past a certain time in the morning and become drowsy in the afternoon.
Parasomnias
Parasomnias are a group of sleep disorders that involve unusual or undesirable behaviors, movements, or emotions that happen during sleep or upon waking up. Some parasomnias are more common during pregnancy or times of stress because disturbed sleep can act as a trigger.
- Sleepwalking: Sleepwalking involves moving around or trying to perform tasks while asleep.
- Night terrors: These are episodes of intense fear or panic during sleep that can cause a person to scream or thrash.
- REM sleep behavior disorder: In this disorder, people act out their dreams by moving around or talking.
- Sleep paralysis: Sleep paralysis is when a person can’t move right after falling asleep or waking up. They’re usually conscious and can feel panicked or suffocated.
Narcolepsy and Hypersomnia
Narcolepsy and hypersomnia are both sleep disorders with a defining symptom of excessive daytime sleepiness, but there are distinct differences.
- Narcolepsy: Narcolepsy is caused by the lack of a chemical in the brain that helps regulate the sleep-wake cycle. Symptoms can include cataplexy (loss of muscle control), sleep disruptions, sleep paralysis, and hallucinations.
- Hypersomnia: Those with hypersomnia tend to sleep much longer than average at night and still feel excessively sleepy during the day.
Because it can be difficult to pinpoint symptoms, diagnosis is often delayed and can sometimes take years. Both disorders are highly disruptive to work and caregiving, so it’s important to track symptoms and talk to your doctor if you are struggling with excessive sleepiness during the day.
Treatment for Sleep Disorders in Women
Sleep disorders can very negatively impact your quality of life, but the good news is that there are a variety of treatment options available.
Lifestyle Changes
- Sleep hygiene: Improving your sleep hygiene — or behaviors that influence sleep — is a great first step in tackling most sleep issues. Changes like having regular sleep and wake times, avoiding blue light in the evening, and cutting out afternoon caffeine can go a long way.
- Exercise: Daily exercise is good for your mental health and can help you feel tired and ready for sleep when bedtime comes along. Just be sure to exercise at least four hours before bed.
- Stress reduction: Stress is a major contributor to sleep disorders like insomnia. Depending on your circumstances, something as small as a daily yoga ritual might help, or you may find you need to make more drastic shifts, such as improving your work-life balance.
Therapy
- CBT-I: Cognitive behavioral therapy for insomnia (CBT-I) is a type of therapy focused on identifying and changing beliefs and behaviors linked to sleep.
- Light therapy: Light therapy involves sitting in front of a bright light box every morning for 10 to 60 minutes and can help regulate a disrupted sleep-wake cycle.
Medical Interventions
- PAP therapy: Positive airway pressure (PAP) therapy is the gold standard for treating OSA. It involves delivering a steady stream of pressurized air through a mask to keep the airway open during sleep.
- Medications: There are a variety of over-the-counter and prescription sleep medications that can be helpful. Always consult your doctor before taking any medication or natural remedy.
- Iron supplementation (for RLS): If your doctor finds that your RLS is due to iron deficiency, you’ll likely be prescribed an iron supplement.
- Hormone therapy (when appropriate): If your sleep issues are due to hormone fluctuations — especially if you’re in perimenopause or menopause — talk to your doctor about the possibility of hormone therapy.
- Treatment of underlying conditions: Sometimes sleep issues stem from an underlying condition, such as a chronic disease or a mental health disorder. Treating the underlying condition can help you get the rest you need.
When to Talk to Your Doctor
If you experience sleep issues that impact your everyday life, it’s time to talk to your doctor. Pay extra attention to the following:
- Trouble falling or staying asleep for multiple nights
- Fatigue and/or morning headaches
- Excessive daytime sleepiness
- An urge to move your legs when resting
