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Why Missing Sleep Is Worse for Women Than Men

Not only do females get less sleep than males, their health suffers more from it


spinner image close up of a sad woman with sleep deprivation resting her head on her arms while lying on her bed
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Although roughly one-third of all adults don’t get as much sleep as they should, women seem to suffer disproportionately from not getting enough zzz’s.

A new study in Diabetes Care finds chronic insufficient sleep — even getting about six hours of sleep instead of the seven to nine recommended — increases insulin resistance, raising risk for diabetes in otherwise healthy women. This adds to past research that finds women are more likely than men to not get the recommended amount of shuteye, increasing their risk for everything from heart disease to depression.

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To make matters worse, sleep deprivation and the negative health effects from it can be even more pronounced for women who’ve gone through menopause, researchers found in the Diabetes Care study and previous research published in the journal Hypertension. That study found that pushing back bedtime by an hour and a half, while waking up at the same time, led to an increase in blood pressure. Again, the effect was more pronounced for those who had gone through menopause.

In general, irrespective of age and other factors, “women tend to report poorer sleep quality overall,” says Marie-Pierre St-Onge, director of the Center of Excellence for Sleep & Circadian Research in the Columbia Irving Medical Center. St-Onge, who was a coauthor on the Diabetes Care and Hypertension studies, explains that hormonal changes, like those women experience during menopause, can further disrupt sleep. But that’s only one piece of a complex puzzle. Experts still don’t know all the answers for why women have a more fitful relationship with sleep than men – who, to be sure, also have significant issues getting the rest they need. One thing is certain: Sleep quality declines with age for both sexes.

Understanding women’s sleep struggles

Getting to the root of your unrested development, or an emerging sleep problem, isn’t so easy. But experts say understanding, at least in part, what’s contributing to sleep loss is critical to adequately address the problem before it gets worse and torpedoes your health.

“Whenever we don’t sleep well, it literally makes every other component of our life and health worse,” says Marjorie Soltis, M.D., a neurologist and sleep medicine specialist at Duke Health in Durham, North Carolina. “It makes pain worse, it makes anxiety worse, it makes depression worse,” she says, to name a few examples.

Soltis adds that sleep deprivation causes medical conditions to progress more rapidly as well. The Centers for Disease Control and Prevention (CDC) notes that insufficient sleep contributes to or worsens mental health issues, brain disorders and chronic diseases.

Research finds women are more likely to experience insomnia, and the CDC reports that 17 percent of women have trouble falling asleep most nights, if not every night (when surveyed about the last 30 days), compared with almost 12 percent of men.

“There are so many different reasons, I think, why women tend to be more sleep-deprived than men,” Soltis says. “A lot of that can relate directly to the hormones that are involved in making us female, allowing us to have children – and, of course, having children and caring for children also definitely impacts the degree of sleep deprivation that women experience.” Frequently, sleep loss continues into later life as well, Soltis says, as women continue to take on a disproportionate share of family caregiving.

Women are also slightly more likely to be diagnosed with depression or anxiety, which can contribute to insomnia and insufficient sleep, she adds. Women commonly experience sleep problems during perimenopause and menopause when hormone levels become irregular and symptoms such as hot flashes, which tend to be worse at night, and night sweats make it especially difficult to get a good night’s rest.

The relationship between sleep and mental health is complex, and the effect of one on the other goes both ways, complicating diagnosis. So in the space of a quick visit with a primary care doctor, sleep-related problems can easily be overlooked. More pointedly, when “women seek care for various conditions, it may be written off as anxiety or depression when it may not actually be the case,” Soltis says. In cases where those issues are actually present, an underlying sleep problem that’s contributing could also be missed.

Getting to the root cause of restless nights

The first step to getting a better night’s rest involves taking sleep concerns seriously. As common as short sleep might be, experts say women and men often don’t think of it as a health issue at all.

But a problem like sleep apnea — a common and potentially dangerous sleep disorder where a person’s breathing stops and starts many times overnight — can have dire cardiovascular consequences, causing heart rate and blood pressure to elevate. Although it’s most common in overweight men, sleep specialists emphasize that the disorder affects women, too, and people of all sizes and shapes.

For persistent sleep issues, it’s important to see a health professional who can help.

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“Starting with a primary care physician [PCP] is good, but I don’t want patients to jump [right] to medications,” says Safia Khan, M.D., a sleep medicine specialist and program director of the Sleep Medicine Fellowship Program at UT Southwestern in Dallas, who coedited A Clinical Casebook of Sleep Disorders in Women. “If that’s what their PCP is offering, then they should request referral to a sleep specialist.”

Khan says PCPs are perfectly capable of assessing patients’ sleep problems. The issue is typically one of time: If a patient has multiple conditions they’re seeing the doctor for, it’s unlikely the doctor is going to have enough time to dig deep into evaluating why they can’t sleep. Khan suggests that patients schedule an appointment specifically to see their doctor about sleep issues – so there’s time to do more than prescribe a sleep aid, and they can deeply evaluate the causes of sleep woes.

Solutions to help women sleep better

Treatments for sleep problems are as varied as the issues, or disorders, themselves. But for specific symptoms related to menopause or hormonal changes, some women turn to hormone replacement therapy (HRT).

“There have been studies showing improvement with sleep and other vasomotor symptoms (like night sweats) with hormone replacement therapy,” Soltis says. “That being said, some studies have shown hormone replacement therapy to be associated with an increased risk of heart disease, stroke, certain cancers and blood clots.”

Ultimately, Soltis says, the decision to pursue HRT has to be made on an individual basis with your doctor. When having that conversation, it’s important to assess the potential risks versus benefits of HRT, which, she notes, may vary based on age, duration of treatment and other medical conditions.

If hot flashes are disturbing your sleep, there are some strategies that help, such as limiting alcohol, caffeine and spicy foods. Also, the FDA approved a new pill this year, Veozah, to treat hot flashes, so talk to your doctor about whether this new medication may help. 

For more intractable and deeper cultural or societal issues, such as women often taking on a greater share of caregiving, experts say help from others — family, friends, medical professionals and support groups — is key. Sharing caregiving responsibilities is critical to support the health and sleep of caregivers as well as those they’re supporting.

Soltis stresses that every situation is different and needs to be approached accordingly. For example, for more complicated situations, such as a spouse with dementia or other serious health concerns, part of the solution could involve having outside caregivers come into the home to take shifts overnight, she says, so the partner can get much-needed rest.

How to choose a sleep specialist

If you are thinking about seeing a specialist, just know that there’s no cookie-cutter sleep doctor. Rather: With sleep medicine, physicians may come from all different backgrounds, Soltis says. A sleep medicine provider could be a neurologist, like Soltis, or a pulmonologist, anesthesiologist, family doctor or have a background in behavioral health, psychology or psychiatry.

If a person has chronic obstructive pulmonary disorder (COPD) or other significant breathing issues that affect sleep, a pulmonologist may be a good fit. If you are having abnormal behaviors like kicking, punching or acting out dreams at night, or have an issue that you think might be restless leg syndrome or narcolepsy? Maybe a neurologist is a good choice. Longstanding history of anxiety or depression that’s hard to control? A sleep psychiatrist might be the right professional for you.

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Sara Nowakowski, an associate professor at Baylor College of Medicine in Houston who has studied the impact of sleep issues on women’s health and a licensed clinical psychologist board-certified in behavioral sleep medicine, says many people aren’t even aware that sleep professionals like her exist. She helps people make behavior changes, like recommending that patients get out of bed when they can’t sleep and creating a sleep schedule – and employs cognitive behavioral therapy for insomnia.

Nowakowski notes that around half – or more – of all postmenopausal women report sleep issues. “But it doesn’t mean it has to be that way,” she says.

Getting help can turn sleep troubles around.

But if you’re still not sure where to start, besides a recommendation from your primary care doctor, Soltis points out that many doctors have online bios detailing their areas of interest and conditions they see frequently.

Improving your sleep hygiene

Even the most inspired sleuthing to get to the root cause of your sleep woes with help from a professional can’t overcome bad sleep habits. You still have to prioritize getting rest.

That includes making time for sleep – but not too much. Don’t sleep less than six hours or more than 10. If you can’t fall asleep, do your best to not stress or worry about it, which could make the problem get worse. Get out of bed, do something calming like reading, then go back to bed when your eyes get heavy.

Also, ensure your bedroom is conducive to sleep by keeping it cool and dark. Dim lights before bedtime – and give your smartphone the side-eye. 

“Phones are a huge distraction,” Khan reminds. Get an old-fashioned alarm clock if it’s disrupting your sleep and you’re scrolling your feed every time you should be dozing off. She says she often asks her patients about their screen time.

She recommends starting your cellphone diet by breaking away from that screen during the day and doing more physical activity. Both time away from the cellphone and being more active during the day can help you ease into a more restful night.

Because ultimately what happens in the middle of the night will follow you around for the rest of the day – if not the rest your life.

“Disrupted sleep affects us in a lot of different ways, and affects a lot of different body systems,” Soltis says, reiterating just how important it is for overall health.

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