When sleep eludes…

Published in Apollo Life (April-June 2006)

The quality of women’s sleep is an important component of the quality of her life. Many women in today’s fast paced world cut back too often on their sleep and ignore signs of fatigue, daytime sleepiness and other effects of insufficient sleep. Medical research confirms that are twice as likely as men to have difficulties in falling asleep or staying asleep. Yet, physicians often overlook women’s complaints about sleep!

In general, sleep is less prone to disturbances during young adulthood; however, some women are prone to sleep problems during their reproductive years. Hormonal fluctuations associated with menstrual cycle and pregnancy may affect sleep rhythms and stress reactivity, thereby rendering women more vulnerable to emotional stress and to concomitant sleep disturbances. As a women ages, physical and hormonal changes affect her sleep quality. Older women get less deep sleep and are more likely to wake up at night. Physical factors such as arthritis, disorders of breathing, or hot flashes may also disturb sleep.

Emotional issues continue to impact sleep in women of all age groups. Insomnia is one of the most common symptoms of depression at any age. Women who are depressed are tend to fall asleep fairly quickly but often awaken in the middle of the night, unable to go back to sleep. Although, most of us are in a state of denial when it comes to accepting a diagnosis of depression, it is important to note that getting professional help and treatment for the depression can often solve many of the related problems including insomnia. Some women wake up in the middle of the night and feel that they are unable to go back to sleep until they eat. This ‘nocturnal (night) eating syndrome’ is typically associated with dieting during the day and emotional disturbances.

Sleep Cycle

Changes in women’s bodies occur at different times in the menstrual cycle and may affect sleep. Distinct changes in sleep patterns accompany the changing phases of the menstrual cycle and I couldn’t think of any better term than to call this ‘the sleep cycle’. An increased number of awakenings, vivid dreams and more sleep disturbances occur during the period just before menstruation (pre-premenstrual period) in some women. Some women report excessive daytime sleepiness and fatigue, and longer sleeping hours during the premenstrual period. These sleep problems generally disappear a few days after menstruation begins. For women who finds these changes particularly disturbing, increased tension and irritability can result in lingering, long-term sleep problems.

Women who experience menstrual-related sleep disorders should pay careful attention to their sleep needs, maintain a regular sleep/ wake schedule, eat a healthy diet and try to reduce stress. If sleep problem interfere with daily functioning, medical advice should be sought.

Pregnancy: Sleeping for two!

Early in pregnancy, most women report feeling fatigued during the day and sleeping longer hours at night. Increasing levels of the progesterone hormone during pregnancy probably causes this almost universal change in sleep requirement.

Later in pregnancy, particularly during the last trimester, women often note poor sleep quality, which may be due to reduced slow wave sleep (deep stage of sleep) and frequent awakenings. Women may find it difficult to sleep in certain positions. There is many causes for sleep disruption in the late stages of pregnancy: leg cramps, backache, heartburn, movements of foetus, general discomforts of pregnancy and increased frequency of urination. It is important to report any significant symptoms to the doctor.

Throughout pregnancy, women need to make sure they are getting enough sleep, maintaining regular sleep/wake schedules and avoiding stress much as possible. Because sleeping pills and alcohol should be avoided during pregnancy, other measures to improve sleep should be considered. Muscles relaxation techniques may be effective in promoting better sleep and reducing the discomforts of pregnancy. Maintaining a balanced diet and avoiding heavy meals and spicy foods within 2 or 3 hours of bedtime will help avoid provoking heartburn.

After the baby is born, the physical stress of pregnancy on sleep may be replaced by the demands of the baby’s feeding schedule and frequent awakenings at night. After delivery, getting enough rest continues to be very important, as severely disturbed sleep can be tied to postpartum depression.

Sleepless with menopause?

Some natural changes in sleep accompany the inevitable menopause and ageing process in women. The amount of deep sleep decreases, sleep becomes lighter, and more awakenings occur during the night.

In the year surrounding menopause, gradual changes in sex hormone levels impact sleep directly and indirectly by affecting other important hormones that are related to sleep. Hot flashes and night sweats-associated with decreased level of estrogen-may cause repeated awakenings associated with sensation of heat and sweating, increased heart rate and feeling of anxiety. Although hot flashes usually last only a few minutes, in severe cases a woman may wake up hundreds of time a night. The sleep disturbances and resultant sleep deprivation generated by these hot flashes may result in daytime fatigue, irritability and depression.

• Control the bedroom temperature, use light and comfortable (preferable cotton) bed linen.
• Eliminate caffeine, sugar and alcohol from the diet. Increase vitamin E intake in the diet, or take a vitamin E supplement.
• Estrogen replacement therapy can be helpful in relieving severe hot flashes and resultant significant sleep loss. A physician can offer advice on this mode of treatment.

After the hormones

In the years following menopause, sleep grows lighter and more fragmented. It becomes more difficult to maintain long hours of uninterrupted sleep, and to maintain long hours of wakefulness during the day. An increase in daytime fatigue can be one result. Other physical factors can also disturb sleep such as arthritis and other painful conditions, chronic lung disease, certain medications, heartburn, and increased frequency of urination.

Some sleep disorders occur frequently in the postmenopausal years. For example, sleep disordered breathing (Sleep Apnea) which is common in young women is more common in postmenopausal women. This may be related to falling progesterone levels, since younger women who experience surgical menopause are also at increased risk of developing sleep disordered breathing. Signs of sleep-disordered breathing include loud snoring during sleep and excessive daytime sleepiness. It is important to remember that snoring can be warning symptom of underlying sleep apnea and not a sign of ‘sound sleep’!

Other factor also influence the quality of in sleep in postmenopausal women; psychological environment, physical health and emotional state. The connection between worry and insomnia may be obvious, but at times subtle signs and concerns can be less visible in their influence on tension and insomnia.

To promote better sleep during the postmenopausal years, women should follow these guidelines:

• Maintain a comfortable, safe environment in the bedroom; reducing disturbing noise and extreme temperature.
• Go to bed and get up at same time everyday.
• Avoiding staying in bed late in the morning to make up for sleep loss.
• Get up early in the morning and maintain structured daily activity.
• Consider an afternoon nap at regular time.
• Stay away from fatty, spicy foods that are likely to cause indigestion or heartburn.
• Seek Medical advice if following these measures does not alleviate excessive daytime sleepiness.

When to see a healthcare provider?

Women are particularly sensitive to sleep difficulties because they are affected by hormonal changes, family stresses and role conflicts, any of which can affect sleep quality. However, getting enough sleep is enormously important, as it is positively impacts concentration, job performance, social interaction and general well being. Occastional disturbance in sleep can happen to anyone and generally do not require medical intervention. Serious sleep problems, however, can affect a women’s daily functioning, her relationships and her general sense of well-being. When a sleep problem results in disruption in one of these areas, it may be wise to consult with a healthcare provider!