Sleep problems in women can occur across the life cycle. Subjective and objective data confirms

women A woman is an adult female human. Prior to adulthood, a female human is referred to as a girl (a female child or adolescent). The plural ''women'' is sometimes used in certain phrases such as "women's rights" to denote female humans regardl ...

's increased risk to suffer from

sleeping problems Dyssomnias are a broad classification of sleeping disorders involving difficulty getting to sleep, remaining asleep, or of excessive sleepiness. Dyssomnias are primary disorders of initiating or maintaining sleep or of excessive sleepiness and ar ...

of various kinds at different life stages. Subjective and objective evidence supports the notion that various factors such as

hormonal A hormone (from the Greek participle , "setting in motion") is a class of signaling molecules in multicellular organisms that are sent to distant organs by complex biological processes to regulate physiology and behavior. Hormones are required fo ...

changes, ageing, psycho-social, physical and psychological as well as the presence of sleeping disorders may disturb women's sleep. Evidence from both subjective and objective measurements support the presence of disturbed sleep during the

menstrual cycle The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that make pregnancy possible. The ovarian cycle controls the production and release of eg ...

pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ...

, the

postpartum period The postpartum (or postnatal) period begins after childbirth and is typically considered to end within 6 weeks as the mother's body, including hormone levels and uterus size, returns to a non-pregnant state. The terms puerperium, puerperal peri ...

and the

menopausal Menopause, also known as the climacteric, is the time in women's lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause usually occurs between the age of 47 and 54. Medical professionals often d ...

transition. The relationship between sleep and women's psychological well‐being suggests that underlying causes of sleep disturbances across a woman's lifespan are often multi‐factorial.

Sleep during menstrual cycle

Initial variations of sleep in women begin with the menstrual cycle. In subjective studies, women who report PMS or PMDD report increases in poor sleep quality. However, most objective laboratory-based PSG measures of young healthy women do not confirm irregular sleep patterns, neither in sleep duration nor sleep quality across the menstrual cycle. One exception is the reduction of

REM sleep Rapid eye movement sleep (REM sleep or REMS) is a unique phase of sleep in mammals and birds, characterized by random rapid movement of the eyes, accompanied by low muscle tone throughout the body, and the propensity of the sleeper to dream vi ...

and markedly more so the increase of Stage 2 sleep during the

luteal phase The corpus luteum (Latin for "yellow body"; plural corpora lutea) is a temporary endocrine structure in female ovaries involved in the production of relatively high levels of progesterone, and moderate levels of estradiol, and inhibin A. It is ...

of the menstrual cycle. Several studies attribute this to increased

estrogen Estrogen or oestrogen is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three major endogenous estrogens that have estrogenic hormonal a ...

and

progesterone Progesterone (P4) is an endogenous steroid and progestogen sex hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species. It belongs to a group of steroid hormones called the progestogens and is the ma ...

concentrations. One actigraphy study reports a modest decline in total sleep time of 25 min in late-reproductive woman during the premenstrual week. The measurement of subjectively reported sleep during the menstrual cycle differs. Seventy percent of women report a negative impact on their sleep. Furthermore, they report a decrease in sleep quality on 2.5 days each month. Poor sleep quality, connected with poor mood and menstrual pain, especially during the premenstrual week, are most likely to be reported. Psychological factors influencing sleep quality in women, related to hormonal fluctuations, such as

mood disorder A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where a disturbance in the person's mood is the main underlying feature. The classification is in the '' Diagnostic and Stati ...

s and sleep disorders, are often higher in women after the onset

menarche Menarche ( ; ) is the first menstrual cycle, or first menstrual bleeding, in female humans. From both social and medical perspectives, it is often considered the central event of female puberty, as it signals the possibility of fertility. G ...

Sleep during pregnancy

An estimated 46% of women experience subjectively poor sleep during pregnancy and this percentage increases progressively up to approximately 78% in the late stages of pregnancy. Reasons vary according to the trimester, relating to hormonal changes and physical discomfort: anatomic changes, sleep fragmentation, fragmentation of breathing, metabolic changes which might increase sleep disorders such as

restless leg syndrome Restless legs syndrome (RLS), also known as Willis-Ekbom disease (WED), is generally a long-term disorder that causes a strong urge to move one's legs. There is often an unpleasant feeling in the legs that improves somewhat by moving them. This ...

gastroesophageal reflux Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is one of the upper gastrointestinal chronic diseases where stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/ ...

, increase in overnight sodium excretion, changes in the musculoskeletal system, nocturnal uterine contractions, changes in iron and folate metabolism, and changes in the circadian and homeostatic regulation of sleep.

First trimester

Laboratory-based studies show that most women experience more disruption during night-time sleep and become sleepier. They sleep on average more during this time compared to pre-pregnancy sleep time. Total sleep time, however, decreases as the pregnancy progresses.

Nocturia Nocturia is defined by the International Continence Society (ICS) as “the complaint that the individual has to wake at night one or more times for voiding (''i.e. to urinate'').” The term is derived from Latin ''nox, night'', and Greek '' �αο ...

and musculoskeletal discomfort account for the physiological factors impacting sleep during the first trimester. Subjectively, women report an increase in night-time awakening and an increase in total sleep time. Pregnant women's main physiological complaints during the first trimester which disrupt the quality of sleep are

nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the ...

and

vomiting Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteri ...

, urinary frequency, backaches, and feeling uncomfortable and fatigued; as well as tender breasts, headache, vaginal discharge, flatulence, constipation, shortness of breath, and heartburn. Other contributing factors for sleep quality are age, parity, mood disorders,

anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil Turmoil may refer to: * ''Turmoil'' (1984 video game), a 1984 video game released by Bug-Byte * ''Turmoil'' (2016 video game), a 2016 indie oil tycoon video ...

and primary sleep disorders.

Second trimester

Laboratory based measures during the second trimester show a further decrease in total sleep time,

slow-wave sleep Slow-wave sleep (SWS), often referred to as deep sleep, consists of stage three of non-rapid eye movement sleep. It usually lasts between 70 and 90 minutes and takes place during the first hours of the night. Initially, SWS consisted of both St ...

and sleep quality. No changes in REM sleep have been observed. Fetal movements, uterine contractions, musculoskeletal discomfort and

rhinitis Rhinitis, also known as coryza, is irritation and inflammation of the mucous membrane inside the nose. Common symptoms are a stuffy nose, runny nose, sneezing, and post-nasal drip. The inflammation is caused by viruses, bacteria, irritant ...

and nasal congestion account for the physiological factors which influence sleep. Self-reported total sleep time and quality decreases during the second trimester. Reported contributing factors are fetal movements,

heartburn Heartburn, also known as pyrosis, cardialgia or acid indigestion, is a burning sensation in the central chest or upper central abdomen. Heartburn is usually due to regurgitation of gastric acid (gastric reflux) into the esophagus. It is the ma ...

, cramps or tingling in the legs, breathing problems, and anxiety.

Third trimester

Objectively, slow-wave sleep and total sleep time as well as general sleep quality decreases further progressively during the third trimester. More night-time awakenings are common.

Sleep onset latency In sleep science, sleep onset latency (SOL) is the length of time that it takes to accomplish the transition from full wakefulness to sleep, normally to the lightest of the non-REM sleep stages. Sleep latency studies Pioneering Stanford Univers ...

problems and napping becomes more frequent. Physiological factors impacting sleep at this stage during the pregnancy are nocturia, fetal movement, uterine contractions, heartburn,

orthopnea Orthopnea or orthopnoea is shortness of breath (dyspnea) that occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair. It is commonly seen as a late manifestation of heart failure, resulting from fluid ...

, leg cramps, rhinitis, nasal congestion, and sleeping position. Women at the third trimester report progressively reduced Total Sleep Time, and similarly to the second trimester, being uncomfortable, feeling fetal movements, heartburn, frequent urination, cramps and respiratory difficulties. The last weeks before delivery influence sleep quality reportedly most markedly. It is, however, curious that in spite of virtually all women experiencing poor sleep, only one third consider themselves to have current sleep problems.

Postpartum

Total sleep time is objectively the lowest during the 1 month postpartum though it steadily increases toward normal. Main contributing factors influencing sleep during the postpartum period are infant behaviours such as infant sleep and feeding patterns, bed-sharing and infant temperament. It appears that slow-wave sleep is preserved during the first weeks postpartum in spite and because of chronic sleep deprivation. Frequent napping occurs. Recent studies suggest additionally a myriad of further contributing factors influencing postpartum sleep. It has been found that

multipara In biology and human medicine, gravidity and parity are the number of times a woman is or has been pregnant (gravidity) and carried the pregnancies to a viable gestational age (parity). These terms are usually coupled, sometimes with additional t ...

s sleep remained relatively stable while first time mothers experienced a decline in sleep efficiency. Furthermore, mothers of bottle-fed babies experienced less night-time awakening than breast feeding mothers. Parents general physical and psychological health should be considered as well; however, by three months postpartum, mothers' and infants' sleep tend to stabilise and mothers' sleep becomes more regular.

Menopausal transition

Poor sleep quality, sleep fragmentation and increased awakenings are common complaints during the menopausal transition. Reportedly, 31% to 42% of women suffer from chronic insomnia during their menopausal transition. However, some objective PSG studies have not shown significant differences in sleep architecture in pre‐, peri‐, and postmenopausal women. Nonetheless, quantitative and qualitative studies report elevated beta activity, resulting objectively and subjectively in a consistent coupling of sleep disturbances such as sleep fragmentation, increased waking after sleep onset and poor sleep efficiency with vasomotor symptoms such as hot flashes. Besides vasomotor symptoms are changes in hormone levels such as

, affective disorders, stress and perceived health, urinary problems, obesity, gastrointestinal problems, endocrine problems, and cardiovascular problems contributing factors to menopause' associated sleeping problems and insomnia. Sleep during the menopausal transition is furthermore influenced by pain disorders and specifically by comorbid physical and psychiatric conditions. Other proposed causes for sleep problems during menopause are increased incidences{{verify spelling, date=September 2022, reason=''incidence'' is normally used only in the singular form, perhaps ''incidence'', ''incidents'', or ''instances'' was intended of obstructive

sleep apnea Sleep apnea, also spelled sleep apnoea, is a sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal. Each pause can last for a few seconds to a few minutes and they happen many tim ...

, increased sleep disordered breathing, and inadequate sleep hygiene. Another important factor contributing to changed sleep patterns in ageing women in general is the circadian disruption, showing in disturbed regulation of body temperature at sleep onset and early morning

cortisol Cortisol is a steroid hormone, in the glucocorticoid class of hormones. When used as a medication, it is known as hydrocortisone. It is produced in many animals, mainly by the '' zona fasciculata'' of the adrenal cortex in the adrenal g ...

levels. Postmenopausal women tend to express a morning chronotype. These changes in chronotype compared to premenopausal women require a different sleep hygiene.

References

Sleep disorders Women's health