Posted by Brigham and Women's Hospital July 25, 2013
Today’s post is written by Dr. Sandra Horowitz, a neurologist who specializes in sleep disorders at Brigham and Women’s Hospital.
Women lead busy lives: we work, have babies, raise families, and take care of our sick and elderly family members. Juggling these numerous roles, combined with hormonal changes due to menarche, menopause, and pregnancy, as well as other health conditions, can affect a woman’s ability to fall asleep and stay asleep. Despite these challenges, there are things women of all ages can do to get a good night’s sleep.
Changes in sleep can occur during all stages of pregnancy. In the first trimester, we are often sleepier due to hormone changes; however, nausea, frequent bathroom trips, and anxiety may keep us awake. During the second trimester, fetal movement can wake us, and in the third trimester, women may find it difficult to find a comfortable position for sleep. Nightmares are also more frequent during pregnancy and may persist after the baby is born.
To improve sleep during pregnancy, include a consistent wake and bed time along with regular exercise during the day. Slightly elevating the head of your bed may decrease an upset stomach, and sleeping in the lateral position with a pillow between your legs may help you get more comfortable. Nausea may also respond to a small snack of crackers before bed or your doctor may recommend an over-the-counter medication if it is severe. Restless legs in the evening may respond to stretching before bed. Prenatal vitamins containing iron may also help with restless legs.
The hallmark symptom of menopause is the hot flash, caused by dilation of blood vessels. Hot flashes often occur at night and disrupt a woman’s sleep. Hormone replacement therapy may improve symptoms such as hot flashes, but there is controversy about taking estrogen and progesterone for a long time. The good news is that sleep symptoms may respond rapidly to hormone replacement therapy and a short course may be helpful. There also are other medications and supplements that may improve sleep during menopause. Your doctor is your best source of information. As time passes, the symptoms of menopause tend to lessen and sleep disruptions may occur less frequently.
Over two million women have sleep apnea in the US. It can take twice as long to diagnose sleep apnea in women because, unlike men, it can present with vague symptoms such as general fatigue, depression, or lack of interest and energy. After menopause, the incidence of sleep apnea in men and women is equal.
An overnight sleep study is necessary to make the diagnosis of sleep apnea. Weight loss, side sleeping, a breathing mask attached to a CPAP (continuous positive airway pressure) machine , dental appliances, and surgery are effective therapies for sleep apnea. A sleep physician can help you choose the most appropriate therapy. Treating sleep apnea protects women from high blood pressure, heart attacks, strokes, and possibly dementia. Women with untreated sleep apnea have more illness in general and use more medical services so it’s important to contact your doctor if you have concerns.
Restless legs syndrome (RLS) is an irresistible urge to move your legs in the evening, in bed, or if sitting still for long periods of time. RLS may happen nightly or just a few times per month. It occurs in about 10 percent of all women and up to 25 percent of pregnant women. The need to move may result in sensations of tingling or pain, and often must be satisfied before you can return to sleep. Anemia, especially due to iron deficiency, and a family history of restless legs may increase the likelihood of RLS.
Stretching before bed, yoga, and taking iron supplements may help. Some people find ibuprofen useful, and prescription medicines are also available. All medications may have side effects so discuss any therapy with your doctor.
Establishing Good Sleep Habits
In general, creating good sleep habits is the first step in addressing a woman’s sleep problems. Follow these tips to improve your sleep time and quality:
- Go to bed and wake up the same time each day, even on weekends.
- Do not watch TV or use electronic devices in the two hours before you go to bed.
- Keep your room dark and quiet, without distractions.
- Do not look at a clock during the night; it’s a reminder you’re awake and this can provoke anxiety.
- Do not have coffee after 3pm.
- Refrain from smoking before bed; both the activity and the nicotine can impair your sleep.
- Exercise regularly, but do so early in the day.
- Leave your worries outside the bedroom; remember, you cannot solve problems from your bed.
- Do not let your children control you sleep times; establish regular sleep times for them.
- If you are a night shift worker (up to 20 percent of women work some night shifts), go to bed at the same time on workdays and days off; wear sunglasses on the way home to protect from morning light.
Your doctor also can prescribe medications called hypnotics. Even a small dose may affect you, so take these medications early in the evening. Furthermore, women and older patients can be susceptible to residual drowsiness. Never drive if you are drowsy, and always take the lowest dose possible of a sleeping medicine. Your doctor can help you weigh the benefits and risks of these medications.
In closing, when something disrupts your sleep, don’t wait, discuss it with your doctor. With so many people depending on you, a good night’s sleep is essential.
Learn more about sleep:
- Brigham and Women’s Hospital Sleep Disorders Service
- Video: Exploring Sleep Across a Woman’s Lifespan
- Sleep and Productivity: A Delicate Balance
- Wake Up America! – We’re Not Getting Enough Sleep
- Why Can’t We Stay Asleep as We Get Older?
- Sleep Research: Is the Night Shift Bad for Your Health?