What women need to know about sleep problems

September 23, 2020 Providence Women's Health Team

Women may chalk poor sleep up to lifestyle habits, but there could be an underlying medical issue.

Women should talk to a health care provider to determine if sleep apnea, insomnia, restless leg syndrome or another condition is causing the problem.

It’s important to prepare to go to sleep — and that means unplugging and relaxing.

If you’re a woman, you may be grappling with the expectation of having to do it all, whether building a career, raising a family, maintaining relationships with a partner or friends, caring for aging parents, or some combination of all of the above.

It may often feel like there aren’t enough hours in the day, which is why many women stay up late to get it all done, losing out on sleep in the process. However, that may be masking an actual sleep issue, says Andrea Matsumura, MD, a sleep medicine specialist at Providence Sleep Disorders Centers and The Oregon Clinic-Pulmonary Critical Care & Sleep Medicine East in Portland, Oregon.

“Oftentimes there is a delay in women seeking help from a sleep medicine specialist because they are told by friends, family or a health care provider that they can’t get the sleep they need because it’s secondary to those lifestyle factors,” Dr. Matsumura says. “But in fact there may be something else underlying their inability to fall asleep.”

When women have trouble sleeping, Dr. Matsumura focuses on whether they have trouble getting to sleep, staying asleep or whether they feel their sleep is quality sleep. She will then dig deeper to see if they are experiencing symptoms of insomnia, sleep apnea (problems breathing during sleep) or excessive movement such as restless leg syndrome.

For instance, postmenopausal women have the same risk of obstructive sleep apnea as men, but they sometimes don’t have the same symptoms — men tend to snore loudly, but not all women do. Dr. Matsumura says a few studies have noted that while women are observant of their male partner’s sleep behaviors, men are not as in tune. Without those noticeable symptoms or feedback from a partner, women often don’t know why they feel tired during the day.

“They naturally accept the fact that they are chronically sleep deprived,” Dr. Matsumura says. “When a woman comes in and talks about sleep, she may not say she snores loudly, but she may say she feels fatigued, has fragmented sleep or is starting to feel depressed.”

She adds that women who are still menstruating and premenopausal usually are prone to sleep apnea if they are morbidly obese. Otherwise, their sleep problem is usually caused by insomnia or a sleep phase issue — say, a night owl is going to bed too early, when her body and brain aren’t ready to shut down.

Other women may lack sleep because of a movement issue such as restless leg syndrome. This intense urge to move the limbs can keep women up through the night and prevent them from getting to sleep. Some women may also have narcolepsy that manifested earlier in life and can lead to excessive daytime sleepiness or fragmented nighttime sleep.

Another big factor for women is hormones. When women are menstruating, there will be a couple of days late in the cycle when some women may experience a little trouble sleeping. Other women going through perimenopause and post-menopause can experience hormonal changes that can cause night sweats or fragmented sleep. Dr. Matsumura recommends those women talk with their gynecologists about potential treatments.

Dr. Matsumura also points out that the recent #MeToo movement has brought to light that women may be at disproportionate risk for forms of abuse that are unrecognized as affecting sleep. Perhaps there was childhood trauma or an interaction with a boss or partner that made them feel uncomfortable or put them at risk verbally, physically or emotionally and that impaired their ability to fall asleep. That is a real issue that should be investigated, says Dr. Matsumura.

She urges women who are experiencing sleep issues to talk to their health care provider, giving specifics about the trouble they have getting to sleep. “Are they having a lot of trouble getting to sleep, spending a lot of time in bed unable to sleep, waking up too many times in the middle of the night,” Dr. Matsumura says. “They should focus on what time they go to bed, what time they actually fall asleep and what time they wake up.”

There are other things women can try to do on their own to improve their quality of sleep. That includes preparing themselves for sleep.

“Many people stay busy up until the minute they go to bed, but we should all be trying to wind down for the evening, ideally an hour before we go to bed and go to sleep,” Dr. Matsumura says. “That means not using any electronics or working. The key is to set the stage for good sleep. Also, it’s important for people to not take their worries to bed. They need to allow themselves permission to relax and get to sleep.”

Women can also try to keep a sleep diary to track their nighttime patterns if they are having sleep issues. Dr. Matsumura says many devices that track sleep are good at indicating if something may be wrong but aren’t precise or accurate enough to give a complete picture of sleep habits. In fact, Dr. Matusmura notes that the devices may cause anxiety in some people who are over-reliant on them.

It also helps to not drink too much caffeine at least six hours before bed, and also be mindful about not drinking too much alcohol, as both can affect sleep. Dr. Matsumura says she can’t overstate the importance of unplugging from electronics at night.

“We live in a sleep-deprived society at this point in time,” she says.

Because sleep affects so many areas of our health — everything from mood to the immune system — it’s crucial to get the necessary seven to nine hours of rest. “I always say to patients that sleep is food for the brain — don’t starve it.”

Having trouble sleeping?  Take our free sleep assessment or contact a clinic near you:

Oregon: Providence Sleep Disorders Centers

Washington: Kathryn Severyns Dement Sleep Disorders Center; Swedish Sleep Medicine

Montana: Sleep Center at Providence St. Patrick Hospital

Alaska: Providence Medical Group Primary Care

California: Providence Health & Services Primary Care; St. Joseph Health Medical Group Sleep Medicine; St. Joseph Hospital Sleep Disorders Center

KPTV Health Watch news story about treating sleep apnea featuring Dr. Candace Meinen from Providence Sleep Disorders Center in Portland, Oregon:

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

About the Author

The Providence Women's Health team is committed to providing useful and actionable insights, tips and advice to ensure women of all types can live their healthiest lives.

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