Women report poor sleep despite a good night's rest, while men overestimate their own sleep quality

From medicalxpress.com

by Torbjörn Åkerstedt, The Conversation

edited by Gaby Clark, reviewed by Andrew Zinin 

Disturbed sleep is a common problem—and one that has many serious consequences beyond feeling tired the next day. Research has linked insomnia and poor sleep to early mortality and diseases including diabetes and cardiovascular disease.

Women often report experiencing disturbed sleep more frequently than men. They also constitute the majority of patients in sleep clinics. Yet, strangely, some studies show worse objective sleep quality in men—a bit of a paradox.

To understand what might explain the paradox, my colleagues and I conducted a study that directly compared sleep quality ratings and objective sleep measures between men and women.

We found that women complained more of sleep problems—but slept objectively much better than men. We think this paradox can probably be explained by men overestimating their sleep quality because they are less able to perceive how often they wake up at night.

A total of 238 randomly selected women participated in the study, plus 238 men who were matched on age and BMI with the women to ensure similar participants were compared with each other.

Sleep was recorded in each participant's home using a recorder that measured brain waves (electroencephalography—EEG), muscle tension (electromyography—EMG) and eye movements (electrooculography—EOG). These devices tracked what stage of sleep a participant was in and for how long, how much time they spent awake and how quickly they fell asleep.

A researcher visited the participant's home in the evening, mounted the recording equipment and left. The participant went to bed and awoke at their usual time.

In the morning, the participant rated the degree of difficulty they had falling asleep, whether their sleep was restless, whether they woke up early, how often they thought they had woken up, how long it took them to fall asleep, how long they slept and their overall sleep quality.

The sleep recording was scored by a sleep technician based on visual inspection of the EEG, EOG and EMG recordings. The data was then analysed to understand the objective quality of each participant's sleep and its relation to gender and age.

Analyses were also adjusted for factors such as gender, age, alcohol consumption and smoking, which may affect sleep.

                                                                                                            Credit: CC0 Public Domain

Sleep quality

The results show that women subjectively reported significantly lower sleep quality than men. Yet women actually had considerably fewer night-time awakenings, less stage one (superficial) sleep and higher sleep efficiency (they spent more time asleep while in bed). Women also experienced more stage three (deep) sleep and slept longer (400 minutes versus 382 minutes for men).

The results suggest that women objectively had a good night's sleep, compared with men. The only variable that suggests worse sleep in women was that when they did wake up at night, they spent more time awake than men did—around nine minutes each time for women versus just under seven minutes each time for men.

It only takes around five minutes of being awake at night for a person to remember it the next morning. This may explain why women were better able to remember whether they had woken up the night before and estimate how many times they had. Men, on the other hand, grossly underestimated their number of awakenings (by 72% compared with women's 37%).

For other quantitative measures, like time to fall asleep, sleep duration and time awake, men and women were equally good at estimating their objective values. And they were relatively correct.

We took this further and found that men who woke up only for a short period during the night (around eight minutes or so each time they woke up) often didn't remember they had.

When this group of men was removed, no gender difference in subjective sleep quality remained. This suggests that men with short night-time awakenings report better sleep quality than would be expected from their objective sleep measures because they didn't remember they had woken up.

It's also noteworthy that men's objective sleep deteriorated faster with age than women's. This was particularly obvious for stage three sleep. While women older than 65 got around 80 minutes of stage three sleep each night, men had only 53 minutes. Among those between 30 and 50 years of age, the amount was similar for men and women (around 70 minutes).

Sleep and well-being

A key reason women may complain of having a worse night's sleep than they objectively had may therefore be the amount of time they spent awake when they woke up, making it easier for them to notice. Likewise, men may overestimate their sleep quality because they spend less time awake when they wake up, so they don't remember it happening.

Both findings would work toward reducing subjective sleep quality in women and increasing it in men. We assume, then, that the experience of awakenings has an important influence on subjective sleep quality.

As our study was conducted over only one night, it will be important for future research to investigate whether these findings remain when participants are studied over longer periods.

Future studies may also want to explore the reasons for poor sleep in men—especially since common sources of disturbed sleep, such as alcohol, smoking and BMI, were all adjusted for in our analysis. Researchers may also want to investigate why men's sleep becomes objectively worse as they get older.

Our research illustrates how sleep quality doesn't just involve the physiological aspects of sleep. It also includes our own subjective experiences, which can affect our well-being and how rested we feel.

It also suggests that because many men overestimate their sleep quality, they may overlook any sleep problems they are experiencing. This could mean that some men aren't getting help for conditions that could be affecting their health and well-being.

https://medicalxpress.com/news/2026-06-women-poor-good-night-rest.html

Sleep patterns & disorders differ between women and men

From washingtonpost.com 

Women are more likely to suffer from insomnia and say they have lower sleep quality. Men are more likely to have sleep apnoea.

Women’s circadian rhythms run earlier than men, and such disruptions have been associated with worse health outcomes. Men tend to overeat, and male shift workers have a higher risk of Type 2 diabetes, when sleep deprived.

These and other major sleep differences are highlighted in a new review of ongoing research into sleep and gender and have implications for how women and men could be treated for sleep-related disorders. The review by researchers at the University of Southampton, Stanford University and Harvard University is published in Sleep Medicine Reviews.

“Depending on your gender, should you get a different kind of treatment or a different kind of medication or a different dosage of medication, for example,” said Renske Lok, a postdoctoral scholar in psychiatry and behavioural sciences at Stanford University who led the review.

An estimated 50 million to 70 million Americans have chronic or ongoing sleep disorders, according to the National Institutes of Health. And 1 in 3 adults in the United States experience sleep deprivation, according to the Centres for Disease Control and Prevention.

                                          Women say they have lower quality of sleep than men, a review found. (iStock)

Women say they have lower sleep quality

The review found that women are more prone than men to lower sleep quality, which is associated with anxiety and depressive disorders.

The quality of women’s sleep in terms of the amount of deep sleep and the time they’re sleeping, as measured by brain activity, is good. But women complain far more than men about insomnia, the researchers found.

“Women maybe are a bit more open about … psychological consequences and the fact that they have bad sleep, whereas men are more inclined to keep it to themselves,” Lok said.

A study in 2021, not included in the review, suggested a different reason. Researchers at Lausanne University Hospital examined the sleep patterns of women to try to understand why they complained of waking up throughout the night when the sleep metrics showed they’d had a good night’s sleep.

Researchers glued 256 electroencephalographic or EEG electrodes to the scalp and face to get a deeper read on brain activity during sleep. They then woke the women at different times of night and asked them if they felt they were asleep or awake.

They found that the women who felt they had been awake frequently during the night, even though they appeared to have been asleep, were experiencing a high-frequency almost wake-like brain activity in a small part of their brain, while the other 95 percent of their brain was resting. This activity is not detected in standard sleep studies where only a handful of electrodes are used.

“Now we know that we understand what they’re feeling, because we see that in this small part of the brain, they still have some activity that makes them aware of being here, even though 95 percent of the brain is resting,” said Raphael Heinzer, director of the Centre for Investigation and Research on Sleep at Lausanne University Hospital in Switzerland. “We never make fun of our patients, but we didn’t believe them.”

Women have an earlier circadian rhythm

Sleep disorders such as insomnia in women may also be because their circadian rhythm tends to run faster and begin a bit earlier in the day than that of men. A woman’s cycle is 24.09 hours, plus or minus 0.2 hours, while a man’s cycle is 24.19 hours, plus or minus 0.2 hours.

While the discrepancy may seem small, the cumulative effect over days, weeks or months could lead to a misalignment between the internal clock and external cues such as light and darkness, which may cause sleep disruptions.

The earlier cycle for women corresponds with an earlier timing in the secretion of melatonin and cortisol, researchers said. Melatonin is a natural hormone that signals to our bodies that it is time to sleep.

This finding relates to what earlier studies have found, said Christian Cajochen, head of the Center for Chronobiology at the University of Basel, who was not involved with the review. For instance, circadian rhythm differences — associated with hormones secreted during puberty — may explain sleep differences among younger men and women.

After they get their period, girls start going to sleep a cumulative 20 minutes later every year until they hit their early 20s, right about when puberty is ending.

Males experience a similar phenomenon in their teens, but it doesn’t end until their late 20s, said Cajochen, whose research includes age-related changes in the circadian regulation of sleep.

When children are sleeping and waking up “later, later, later, later, and then there is this tipping point, that’s the end of puberty. And this occurs later in men than in women,” Cajochen said. “When you see in your kids that they’re starting to get earlier again, so there is hope that puberty is over.”

Men’s risk of sleep apnoea and Type 2 diabetes

The review found that men, because of the way their upper airway is constructed, are three times more likely to develop sleep apnoea, making them more susceptible to health problems such as high blood pressure, diabetes, heart disease and stroke.

Also, men tend to overeat more than women when they are sleep deprived, the review found. And among shift workers, who are considered to be sleep deprived because of their unusual schedules and thus are out of alignment with their natural circadian rhythm, both men and women have a higher risk of Type 2 diabetes, but the risk was much higher in men, the researchers noted.

Gender differences are important

With such profound health implications, there is a need for better understanding about the gender differences in sleep and circadian biology, researchers said. And yet historically, biomedical research on sleep didn’t even include women, because it was thought that hormonal events such as menstruation and menopause presented so many confounding variables as to render the research unhelpful, Lok said.

If women were included, researchers typically only used women who were at the same spot in their menstrual cycle, or those who were taking oral contraceptives because they suppress the normal ovarian cycle.

The prevailing opinion was that sleep patterns were basically gender neutral, Lok said. But new studies have shown distinct differences in sleep quality, duration and latency between men and women and that these discrepancies may be caused by differences in the genders’ circadian rhythms, and the physiological changes that accompany them, such as core body temperature and melatonin levels, she said.

“In general, women have just been excluded,” Lok said. “And it’s been more or less assumed that results found in men translate to women, and we now more and more start to understand that that is not completely true.”

https://www.washingtonpost.com/wellness/2024/04/18/sleep-disorders-women-men-differences/