Females and insomnia: How hormones impact sleep at every stage of life

From medicalnewstoday.com

Insomnia is common in females due to a combination of biological and social factors. A sleep specialist can provide medication and non-medication options to support those with insomnia

Insomnia is a sleep disorder wherein a person has difficulty falling or staying asleep. It affects about 1 in 3 adults in the United States every year.

Most people have short-lived symptoms, but about 1 in 10 have chronic insomnia disorder. This is defined as experiencing distressing insomnia symptoms on at least 3 nights per week for at least 3 months.

Although insomnia can affect anyone, a 2020 meta-analysis suggests that females are 58% more likely to experience it than males. This can have important health consequences for females. Insomnia is associated with many health effects, including an increased risk of heart disease and stroke.

The female sex hormones oestrogen and progesterone are involved in a variety of processes that regulate sleep. Fluctuating levels during menstruation, pregnancy, and perimenopause can cause insomnia. Stress and mood disorders, such as anxiety and depression, can also increase the risk of insomnia in females.

“There are multiple factors — both biological and social — that account for higher rates of insomnia in women compared with men,” Dr. Jennifer L. Martin, Ph.D., told us.

Dr. Martin is a clinical psychologist and behavioural sleep medicine specialist at the University of California, Los Angeles and a spokesperson for the American Academy of Sleep Medicine (AASM).

Learn more about some of the reasons that females are more likely than males to experience insomnia, including the role that hormones play in regulating sleep, here.

Why do more females than males have insomnia?

Differences in sleep patterns emerge early in life. “Even in young children, there are differences in some aspects of sleep between boys and girls,” said Dr. Martin.

It is unclear exactly when differences begin. Some researchTrusted Source has found no major differences in sleep patterns between children of either sex assigned at birth. Other studies have noted differences in sleep quality among young adults.

Sleep is a dynamic process regulated by a variety of internal and external factors. These vary throughout a female’s life and can have profound impacts on sleep from childhood all the way to the postmenopausal phase of life.

The role of hormones in insomnia

The body uses hormones to quickly send messages throughout the body. Among other things, hormones are regulators of sexual function and reproduction.

They also perform a variety of other important roles, including the regulation of:

• growth and development
• metabolism
• mood
• sleep

Two of the main female sex hormones, oestrogen and progesterone, work heavily in the areas of the brain that regulate sleep. Studies suggest that these molecules have two primary sleep-related functions:

• Hypnotic effects: By regulating brain waves and sleep-wake cycles, oestrogen and progesterone can directly affect sleep patterns.
• Breathing effects: Progesterone, in particular, is a strong respiratory stimulant and supports airway function and breathing during sleep.

Oestrogen and progesterone levels change throughout the course of a female's lifeTrusted Source, including during puberty, menstruation, pregnancy, and perimenopause. Studies of insomnia in females often find that sleep problems tend to overlap with these events.

Sleep in pregnancy and postpartum

Pregnancy is a challenging time for quality sleep. Not only do hormone levels change, but substantial energy is needed to support a growing foetus.

Both the amount and quality of sleep generally declineTrusted Source over the course of pregnancy, with symptoms tending to peak in the third trimester. Some research suggests more than 3 in 4 peopleTrusted Source experience sleep problems during pregnancy, with most having difficulty falling or staying asleep.

Lack of sleep is also normal after the baby arrives. Caring for a newborn is around-the-clock work. However, for many new parents and caregivers, sleep problems can last for longer than they expected.

A 2015 studyTrusted Source involving 1,480 females found that 60% still experienced insomnia at 8 weeks postpartum and that 41% still had sleep problems 2 years after giving birth. Although depression is quite commonTrusted Source following birth and has been linked to insomnia, a diagnosis of depression could not explain the study’s findings.

The study authors suggest that these findings may be due to hormonal changes and changes in work and sleep schedules. They also note that pregnancy could be a trigger for longer-term chronic sleep problems.

Sleep during perimenopause

Around 40-60% of femalesTrusted Source experience poor sleep during perimenopause or menopause. Perimenopause is the period of physical changes that occur in the 4-8 years leading up to menopause. Rapid fluctuations in hormone levels are characteristic of this menopausal transition. Given their role in sleep maintenance, these changes may result in some level of insomnia.

“During menopause, many women also have trouble sleeping due to hot flashes,” Dr. Martin explained. “This tends to improve over time, but some women have trouble getting their sleep back on track after menopause.”

For some females, research suggestsTrusted Source that hormone therapy during menopause in those experiencing hot flashes can improve sleep quality. Other researchTrusted Source has found no link, suggesting that lifestyle and anxiety and depression diagnoses during this period may play more important roles in sleep.

Dr. Martin added that the benefits and risks of hormone replacement therapy are different for each female. “A detailed discussion between a woman and her doctor [is] needed to make an informed choice.”

Stress, depression, anxiety, and sleep

Stress and mood disorders are important factors that can also contribute to insomnia in females.

“There are also differences in how daily life differs for men and women, and these factors may impact sleep,” Dr. Martin said. “For example, even today, women still have more responsibilities related to childcare and household tasks than men. This is true even if women are working outside the home.”

She also explained that females are at increased risk of mood disorders that can affect sleep, such as anxiety and depression.

According to data from the Substance Abuse and Mental Health Services Administration, the prevalence of depression is over 50% higherTrusted Source in females than in males. Females are also nearly twice as likelyTrusted Source as males to have an anxiety disorder. These differences may be due to both biological factors and external psychological stressors.

Stress, depression, and anxiety are significant drivers of insomnia in transgender women as well. In fact, almost 80%Trusted Source report significant sleep issues.

How can females get better sleep?

Dr. Martin emphasized the importance of prioritising healthy sleep habits.

“Find a bedtime and rise time that work for you and stick to [them],” she said. “Most people know the basics, like limiting caffeine and alcohol and having a comfortable sleep environment. If you haven’t checked these things off yet, see if you can do one small improvement in one of these areas.”

People who have made these changes and haven’t seen any improvement within 3 months may have chronic insomnia. “This is the time to reach out to your doctor or a sleep specialist for help. Some people with insomnia also have other sleep disorders, so getting an evaluation from a specialist can be very helpful,” explained Dr. Martin.

The AASM  has information about how to find a sleep specialist on its website.

“There are effective, safe non-medication treatments out there,” Dr. Martin noted. The recommended first-line treatment is called cognitive behavioural therapy for insomnia (CBT-I).

CBT-I involves exploring examining how thoughts, feelings, and behaviours contribute to symptoms of insomnia. It provides participants with healthy strategies to relax and establish good sleep habits. A person can seek CBT-I from a trained healthcare professional or through a digital app.

One 2020 studyTrusted Source found that the use of a digital CBT-I program improved sleep and reduced the use of both prescription and non-prescription sleep medications.

For some people, treatment for insomnia may also require medication.

Studies also suggest that yoga and PilatesTrusted Source Trusted Sourcecan support sleep health and improve symptoms of insomnia.

The takeaway

Insomnia is common among females and may come and go throughout different phases of life, including pregnancy and menopause. A combination of biological and social factors increases the risk of insomnia in this group. These factors include hormonal changes and short-term or chronic stressors.

Developing healthy sleep habits can help some females. However, people who have been sleeping poorly — particularly if the symptoms have lasted for longer than 3 months — should consider connecting with a healthcare professional.

Chronic insomnia may require support from a sleep specialist, who can provide both medication and non-medication treatment as needed.

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