Sleeping Problems, Sleep Difficulty and Insomnia in Women

Women are more likely to suffer from sleep disturbances than men and with age such problems may become more frequent and troublesome. Sleep disturbances may include trouble falling asleep, maintaining a good night’s sleep, difficulty in going back to sleep once woken, or excessive daytime sleepiness. There are many factors involved that may affect a woman’s sleep, the most important being underlying depression and hormonal changes that occur in different phases of a woman’s life such as during menstruation, pregnancy, and menopause. Sleep disorders can lead to excessive fatigue and inability to perform well at work. It can interfere with daily activities and impair one’s quality of life. Different conditions need different treatment hence it is of utmost importance to identify the cause of the sleeping problem.

Types of Sleep Problems

  • Insomnia is difficulty in falling asleep, going back to sleep once woken, or waking up too early. It is one of the most common sleeping problems, especially in elderly women. Stress, anxiety, and depression can also cause insomnia.
  • Excessive daytime sleepiness or narcolepsy may be a sequel to insomnia, or insomnia may occur as a result of daytime sleeping.
  • Restless leg syndrome and periodic limb movement disorder are types of sleep disorders there is restlessness and periodic leg movement which may cause difficulty in falling asleep or may awaken a person from sleep.
  • Sleep apnea are periods of  interrupted breathing (apnea) during sleep. It is associated with snoring and daytime sleepiness. It is common in elderly women. Obesity increases the risk.
  • Parasomnia  includes nightmares and night terrors, sleepwalking, bedwetting, talking in one’s sleep, and teeth grinding.

Causes of Sleep Disturbances in Women

  • Depression.
  • Stress.
  • Anxiety.
  • Reaction to significant life events.
  • Physical discomfort or pain, as in arthritis.
  • Changes in hormonal levels affect the sleeping pattern in various stages of a woman’s life since it is known that sex hormones modulate sleep-wake behaviors in women. Insomnia is often associated with premenstrual syndrome. Sleeplessness is common during pregnancy, which may be aggravated by acid reflux, low back pain, leg pain, or urinary frequency. Night sweats and hot flushes associated with menopause can interfere with sleep in older women.
  • After childbirth, taking care of the newborn baby may deprive the mother of adequate sleep.
  • Disturbed sleeping pattern may be work-related, such as working in different shifts.
  • Lifestyle factors – late nights and irregular sleeping patterns due to social activities.
  • Illness.
  • Medication.
  • Intake of stimulants such as caffeine or nicotine near bedtime.
  • Drug misuse.
  • Alcohol abuse.

Treatment of Sleep Disturbances

Quite often, simple lifestyle changes and maintaining a regular pattern of sleep can take care of the problem. Specific illnesses can be treated. Sedatives may be given for a short period of time in selected cases, keeping in mind the dangers of drug dependence, tolerance to the drug, and development of withdrawal symptoms. The sedatives normally used are lorazepam, triazolam, temazepam, zolpidem, and zaleplon. Ramelteon is especially useful in sleep onset problems and in normalizing circadian rhythm (day-night cycle) disorders.

Psychological stress and depression need appropriate treatment. Antidepressants may be useful not only in clinical depression but also in women with premenstrual sleep disturbances, postpartum depression, and anxiety states. The drugs normally used are sertraline and fluoxetine. Stimulants such as modafinil may be used in narcolepsy. Restless leg syndrome may be treated with pramipexole. Surgery (uvulopalatopharyngoplasty) may help to stop loud snoring.

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