Women & Insomnia: What Else Could it Be?

Here’s a not-too-surprising finding: A 2007 study front the National Sleep Foundation found that 3 out of every 10 women admit to taking a sleeping pill at least a few nights a week. Prescription sleep aids peak amongst women aged 40 to 59. Many women also report that their sleep has never been the same ever since that last pregnancy. Even with older children, being able to either fall asleep or stay asleep can be challenging for many women. 

Beyond the obvious reasons for poor quality sleep in women (nighttime feedings, stresses of modern life, hormonal changes, etc.), there’s one important additional factor that wasn’t mentioned in a recent New York Times article on this subject: increasing problems breathing at night.

I’ve written numerous times about how pregnancy predisposes women to obstructive sleep apnea, but due to rising levels of progesterone, their airways are protected (as an upper airway muscle stimulant). But after delivery, progesterone drops, but you still have all that weight. Now you’re narrowed your upper airway, but without the protective benefits of progesterone. Add to this the initial sleep deprivation from routine awakenings at night, and the problem is compounded even further.

Notice also that sleeping pill use peaks around peri-menopause. This is also a period when progesterone levels slowly drop, leading to even more breathing pauses while sleeping. Add to this the typical few more pounds that women gain during menopause, and this can lead to worsening obstructive sleep apnea. No wonder women begin to catch up to men when it comes to rates of obstructive sleep apnea and cardiovascular disease as they go past menopause.

You’ll notice that most women who have chronic insomnia prefer not to sleep on their backs, since that’s then the tongue falls back the most due to gravity. Having smaller jaws create less room for the tongue, making them more prone to sleep-breathing problems. Many of these women will have one or two parents that snore heavily. 

It’s also important to realize that you don’t have to have true apneas to have disrupted breathing during sleep. You can have very short obstructions and arousals that don’t count as being apneas if you did a formal sleep study. Younger and thinner women (and men) can have these more subtle events, which can manifest as upper airway resistance syndrome. You can also have different combinations of all these breathing pauses and arousals. The bottom line is that you just can’t sustain deep, continuous sleep. Waking up after 4-5 hours of sleep would be expected when you begin to enter longer periods of REM sleep in the later parts of the night. This is when your throat muscles are most relaxed, and most susceptible to obstructions and arousals.

I’m not discounting all the other reasons why women have so many sleep issues, but untreated sleep-breathing problems is is major source of poor sleep that can frequently masquerade as insomnia, especially in women. 

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