Jefferson University Hospitals

Phases of Sleep Changes in Women

Women tend to experience sleep problems more often than men as you go through three major life phases:

  • Beginning of your menstrual cycle
  • Pregnancy
  • Onset of menopause

Sleep Changes During Menstrual Cycle

Insomnia is broadly described as difficulty falling asleep, maintaining sleep, waking up too early in the morning and not feeling refreshed throughout the day. It often occurs with the onset of menses and can occur every month in some women who experience premenstrual syndrome and with increased severity in women who experience premenstrual dysphoria.

These repetitive bouts of insomnia every month can lead to severe mood changes, anxiety and have long-term consequences on day-to-day functioning and significantly impact an adolescent's functioning in school and a young woman's performance at work, at home and personal relationships.

Polycystic ovarian syndrome – a disorder associated with increased production of testosterone and manifested by menstrual irregularities, hirsutism, obesity, increased incidence of diabetes, heart disease and endometrial cancer – is also associated with an increased incidence of obstructive sleep apnea syndrome. Treatment of sleep apnea can have a significant impact on weight loss and diabetes and improve quality of life.

Sleep Changes During Pregnancy

During pregnancy, sleep is affected by hormonal changes and the physical discomfort of the enlarging uterus. Severe sleep deprivation has been associated with premature labor and a higher incidence of postpartum depression. Certain sleep disorders, such as restless leg syndrome, periodic leg movement disorder and obstructive sleep apnea syndrome (OSAS) are more prevalent and in fact may start during pregnancy. These sleep disorders can have significant adverse consequences during pregnancy.

Pregnancy-induced changes in the upper airway make women more prone to snoring, OSAS and reduced oxygen saturation during sleep. In the third trimester, oxygen stored in the lung is already reduced due to the enlarging uterus compressing the lungs. If OSAS with its associated oxygen desaturation remains undiagnosed during pregnancy, this can have a profound impact on the growing fetus. In addition, pregnant women who snore may be at risk for preeclampsia and pregnancy-induced hypertension, two conditions associated with adverse fetal outcomes.

Sleep Changes During Menopause

Many women (about 40 to 50 percent) complain of sleep problems during the menopausal transition, some of which is attributed to hot flashes and night sweats. Short-term hormonal replacement therapy, antidepressants and nonpharmacologic therapy have been shown to have a beneficial effect in improving subjective and objective sleep quality.

In addition, menopause is a significant risk factor for the development of OSAS and restless leg syndrome. Untreated sleep apnea has profound effects on day-to-day functioning and has long term consequences on the health of women with increased risk of heart disease, hypertension, depression, stroke and diabetes.

Other Sleep Changes in Women

Eighty percent of working women report fatigue and exhaustion and 60 percent have difficulty sleeping. Shift-working women have altered sleep and circadian rhythms and are at a higher risk of menstrual irregularities, infertility, miscarriage and low birth weight infants. Women are also the main caregivers at home for children and elderly family members.

All these responsibilities place an enormous burden on women and increases their risk of sleep deprivation and sleep disturbances with negative impacts on health and quality of life. Life events, such as the sudden death of a loved one, have been associated with development of posttraumatic symptoms, including sleep disturbances. Women who use alcohol to cope with the demands of work, family and social obligations are at an increased risk of alcohol-induced sleep disturbances.