What does insomnia mean? By definition, insomnia is when a person has one or more of the following symptoms: has trouble initiating sleep, staying asleep and/or waking up early than expected and not being able to go back to sleep and feeling tired upon waking.
Some people report having difficulty with one or all of these conditions. According to the Centers for Disease Control and Prevention (CDC), sleep disorders affect one-third of all adults in the United States.
Insomnia can become a chronic problem and may be a symptom of a more serious disease or disorder.
The National Sleep Foundation categorizes insomnia in the following way:
- Acute Insomnia: short periods of time with lack of proper amount of sleep, usually caused by life events (Travel, work, relationships). It’s often resolved without treatment.
- Chronic Insomnia: long-term sleep disturbances demonstrated by difficulty falling asleep or staying asleep, at least three nights per week for at least three months.
- Comorbid Insomnia: this insomnia occurs at the same time as another medical or mental health problem. Some of these conditions can include back pain, frequent urination, depression or anxiety. This can also be referred to as secondary insomnia.
- Onset Insomnia: trouble falling asleep.
- Maintenance Insomnia: trouble staying asleep.
The number one category for sleeplessness among women is related to hormonal changes. When you look at the different things that happen to a female’s body during the course of a lifetime, it is tremendous! Females begin to experience hormonal changes with the onset of puberty. These changes continue throughout adulthood and reduce again following menopause.
The other causes of sleep insomnia are common among men and women. They can include:
- sleep apnea and other breathing issues
- restless leg syndrome
- stress, anxiety, depression
- thyroid disorders
- acid reflux
- medications, caffeine, alcohol
Women have their own unique set of reasons for insomnia. Many of them are related to hormonal changes. Secondary insomnia refers to the fact that you are having difficulty sleeping because of another condition. This could be related to another medical, mental or social condition that is keeping from getting a good night’s sleep. The following are some common causes of secondary insomnia in women:
- The risk of insomnia among females emerges with the onset of menses, yet the exact biological cause is unknown.
- Sleep in women is impacted by hormonal effects during the menstrual cycle. Many women report sleep disturbances during their premenstrual week and during their period with cramps, bloating, and headaches as the possible causes.
- There is an increased occurrence of insomnia among women with premenstrual syndrome (PMS). A recent study has reported that women with PMS had poorer sleep quality, a higher perception of unrefreshing sleep. During pregnancy, you are “sharing space” with a little one. During this time woman may experience nausea/vomiting, frequent urination, body temperature changes, difficulty finding a comfortable position, movement of the baby, and restless leg syndrome (RLS).
- Lactation can cause insomnia. First and foremost, because of the need to frequently feed a newborn and secondly because of the increase in breast size due to milk production. With initial breastfeeding, the new mom may be uncomfortable while her body regulates with the baby’s feeding schedule. She may experience pain and leaking of breast milk until this happens.
- During perimenopause, menopause, and post-menopause, insomnia is very common. Perimenopausal insomnia is reportedly present in 40–60% of women. The majority of the time, this is due to hot flashes/night sweats. During menopause, insomnia tends to be linked more to hormonal levels. Postmenopausal women may have insomnia, with an increased incidence of obstructive sleep apnea (OSA) and restless legs syndrome (RLS) among others. Interestingly, poor sleep in one stage does not predict poor sleep in a later phase.
- Women who work a non-traditional shift (nights or split shift) have an increased risk of menstrual changes, infertility, miscarriages, and breast cancer.
Other medical conditions can cause insomnia. They can include but are not limited to acute pain, chronic pain (arthritis), hypertension, diabetes, post-traumatic stress disorder (PTSD), Alzheimer’s disease, Parkinson’s disease, asthma and other breathing disorders, acid reflux, thyroid conditions, and cancer.
- difficulty falling asleep
- staying asleep and/or having frequent episodes of waking earlier than desired with an inability to fall back to sleep
- feeling tired upon waking
According to the American College of Physicians, older adults tend to have different insomnia symptoms than younger individuals. Older adults complain of sleeping difficulties related to maintaining sleep. This means that they experience frequent awakenings or difficulty staying asleep. Younger individuals frequently report having difficulty falling asleep.
Chronic insomnia can cause clinically significant distress or impairment in important areas of functioning. If you feel that you meet the criteria to be diagnosed with chronic insomnia, it is important to seek medical advice. This sleep disorder could be an indication of another medical condition.
Unfortunately, the answer is yes. Women tend to have a higher incidence of insomnia and depression related to poor sleep. The types of symptoms differ significantly between men and women. Women are more likely to report insomnia, headache, irritability, and fatigue, unlike the male symptoms of loud snoring and breathing cessation during sleep.
According to an article published in the Journal of Women’s Health “differences in sleep behavior and sleep disorders may not only be driven by biological factors but also by gender differences in the way women and men report symptoms”. The article was written after an expert panel of sleep clinicians and researchers were brought together by the Society for Women's Health Research, to address sleep disorders in women.
When this group compared sleep disturbances among men and women, they found the following:
- Women take a longer amount of time to fall asleep (latency)
- Women complain of poor sleep more often but during sleep studies, this was not supported.
- Women have twice the risk for restless leg syndrome (RLS) and this risk gradually increases with her number of pregnancies. Women with three or more pregnancies have three times the risk of developing RLS than a woman that has had no pregnancies.
- Weight gain among women under 50, increased their risk of developing obstructive sleep apnea (OSA). But women tend to report symptoms of OSA as unrefreshing sleep, fatigue, insomnia, and depression. This is compared to men that report snoring, snorting, gasping, and sleepiness. The possible due to what a partner is telling them.
- Midlife women tend to be caregivers of elderly parents and can lead to stress and anxiety.
- Overactive bladder (OAB) is more common in woman and the risk increases with age. 30% of women compared with 16.4% of men between 18 to 70 years of age.
The symptoms of insomnia can be either acute or chronic. Acute insomnia is limited to short periods of time or sleep disturbances that occur intermittently. Sleep disturbances that are acute usually are resolved without medication or other treatments. Chronic insomnia lasts for longer periods of time. Chronic insomnia is classified as sleep disturbances that occur at least 3 times per week or at 3 consecutive months. This type of insomnia most often requires some form of intervention, which may include medication or other forms of treatment.
The symptoms of insomnia are very straightforward for anyone experiencing sleep disturbances. They include:
- difficulties initiating sleep
- nocturnal awakenings, difficulty staying asleep (sleep maintenance problems)
- waking up too early, earlier than planned
However, when identifying the causes of insomnia, they can include anything that keeps you from sleeping. Obviously, this will vary from one person to another, and it is even different between the sexes.
Women have their own unique set of reasons for insomnia. Many of these reasons are related to hormonal changes.
There is an increased occurrence of insomnia among women with premenstrual syndrome (PMS). A recent study has reported that women with PMS had poorer sleep quality, a higher perception of unrefreshing sleep.
Insomnia during menopause
During perimenopause, menopause, and post-menopause, insomnia is very common. Perimenopausal insomnia is reportedly present in 40–60% of women. The majority of the time, this is due to hot flashes/night sweats. During menopause, insomnia tends to be linked more to hormonal levels and can be attributed to depression, and hot flashes/night sweats. Postmenopausal women may have insomnia, with an increased incidence of obstructive sleep apnea (OSA) and restless legs syndrome (RLS) among others.
Insomnia and other sleep disturbance need to be determined (diagnosed) by a medical professional. The reason for this is, that the effects of insomnia can be detrimental to your physical and mental health. When you see your health care professional they may ask you about the following:
- Time you go to bed and how many hours are you in bed
- What you do directly before going to bed
- The temperature of your bedroom
- Sleep partner or animal in bed with you
- Napping during the day
- Regular day prescribed medications
- Any new over-the-counter medications
- Any herbal supplements
- Changes in a relationship(s)
- Changes in employment or job responsibilities
- Moved or changed living conditions
Your health care provider may ask you to keep a diary of a week or two. This diary should include things such as time to bed, when you get up, how many times you were awake, if you took any naps, etc. They may even ask you to log any life events.
As part of the screening process, your health care provider will ask you about any new symptoms. They will most likely draw blood to run some tests. This is to determine if you have some underlying medical condition that may be causing your insomnia problems.
Finally, your health care provider may want to have you do a sleep study (polysomnogram). During this study, you will need to stay overnight at a sleep center or medical facility. Different body functions will be monitored during the night as you sleep. The monitors will be recording data about your brain activity, eye movement, breathing, blood pressure, heart rate, and oxygen levels. In addition to these, sensors will be placed to determine if you snore, to record chest movement and how much air moves through your nose. Once the night is over, a doctor will review the information that has been collected in order to discuss the findings with you.
Insomnia in women can be treated in several different ways. If you are experiencing acute (short-term) insomnia, it can usually be resolved without treatment. However, chronic insomnia in women can affect your ability to work, perform normal daily activities, and care for yourself or others. Chronic insomnia does need to be treated, but you have options. These options might include behavioral therapy, over-the-counter or prescription medications or complementary/alternative treatments.
Many patients as well as health providers, may opt for this form of treatment first before prescribing a medication. Behavioral therapy is used to treat various types of medical/mental health disorders for years and is the first choice because of its success. This therapy can be used without the risk of tolerance and the lack of adverse side effects that you see with prescription drugs.
This type of therapy usually requires an initial evaluation, followed by weekly sessions in order to identify unhealthy/unhelpful thoughts. By discussion these thoughts you will be better prepared to address them, decrease or eliminated them and improve your sleep habits. The therapist will work with you to get rid of the negative thoughts and replace them with positive ones.
A recent study published in Sleep Medicine Reviews found that cognitive behavioral therapy (CBT) was highly effective for the treatment of chronic insomnia. The treatment improved sleep quality for individuals that experienced difficulty falling asleep, staying asleep and those who woke early. At their follow-up appointments, these individuals continued to report to have continued success.
If your health care provider decides to prescribe medication to treat your insomnia, you may have frequent follow-up appointments for monitoring of possible side effects and for dose regulation. It could take a few tries to get a medication and/or dose that works best for you, but don’t get discouraged.
There are numerous over-the-counter sleep aids on the market these days.
- Antihistamines. These medications are used for treating allergic reactions and is included in many of the over-the-counter cold and flu medications as well. The clever thing about antihistamines is that they make you very drowsy. They're not intended for regular use, however. The side effects can include dry mouth, constipation, daytime drowsiness, and difficulty urinating.
- Melatonin. Melatonin is a naturally occurring hormone in the body that controls our wake-sleep cycle. Studies have shown that this has been an effective sleep aid for individuals that have jet lag or if you have difficulty falling asleep. Melatonin may have mild side effects that can include daytime sleepiness or headache.
- Valerian Root. Valerian is one of many herbal remedies that are available to the general public. It comes from the root of Valeriana officinalis plant and has been used to treat insomnia since Greek and Roman times. This dietary supplement is sold as a sleep aid because it has a mildly sedating effect.
One thing that you should keep in mind is that even though many of these over-the-counter medications have mild side effects, they can interact with other medications you are taking. Always check with your healthcare provider before starting any new medication. Regardless of the type of therapy that you and/or your healthcare provider choose, the treatment of chronic insomnia has two primary objectives: to improve sleep quality and quantity and to reduce or eliminate any daytime impairments you are currently experiencing.
Albert, S. M., Roth, T., Toscani, M., Vitiello, M. V., & Zee, P. (2015). Sleep health and appropriate use of OTC sleep aids in older adults—recommendations of a Gerontological Society of America workgroup. The Gerontologist, 57(2), 163-170. https://doi.org/10.1093/geront/gnv139
American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA. American Psychiatric Association.
Baker, F. C., Willoughby, A. R., Sassoon, S. A., Colrain, I. M., & de Zambotti, M. (2015). Insomnia in women approaching menopause: beyond perception. Psychoneuroendocrinology, 60, 96-104. https://doi.org/10.1016/j.psyneuen.2015.06.005
Centers for Disease Control and Prevention. (2018). Sleep and sleep disorders. Retrieved from https://www.cdc.gov/sleep/index.html.
Daugherty, J. L., Hendricks, L., & Simpson, C. (2014). Sleep Aids: Sedative-Hypnotic Drugs in America. Sleep, 3(1). Retrieved from http://www.nationalforum.com/Electronic%20Journal%20Volumes/Daugherty,%20Jason%20L%20Sleep%20Aids%20NFJCA%20V1%20N1%202014.pdf.
de Zambotti, M., Goldstone, A., Colrain, I. M., & Baker, F. C. (2017). Insomnia disorder in adolescence: Diagnosis, impact, and treatment. Sleep Medicine Reviews, 39, 12-24. doi.org/10.1016/j.smrv.2017.06.009
Indira, M., & Kasikrishnaraja, P. (2018). Sleep, Insomnia, Menopause, Post-Menopause, Pittsburgh Sleep Quality Index. Patterns of sleep impairments in an epidemiological cohort of postmenopausal women in Perundurai. Journal of Evolution of Medical and Dental Sciences, 7(16), 1955-1961. DOI: 10.14260/jemds/2018/440
Koffel, E. A., Koffel, J. B., & Gehrman, P. R. (2015). A meta-analysis of group cognitive behavioral therapy for insomnia. Sleep Medicine Reviews, 19, 6-16.
Mallampalli, M. P., & Carter, C. L. (2014). Exploring sex and gender differences in sleep health: a Society for Women's Health Research Report. Journal of Women's Health, 23(7), 553-62. doi: 10.1089/jwh.2014.4816.
National Sleep Foundation. (2018). Insomnia. What are Different Types of Insomnia? Retrieved from https://www.sleepfoundation.org/insomnia/content/what-are-different-types-insomnia.
Nicolau, Z. F., Bezerra, A. G., Polesel, D. N., Andersen, M. L., Bittencourt, L., Tufik, S., & Hachul, H. (2018). Premenstrual syndrome and sleep disturbances: Results from the Sao Paulo Epidemiologic Sleep Study. Psychiatry Research, 264, 427-431. https://doi.org/10.1016/j.psychres.2018.04.008
Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., & Denberg, T. D, for the Clinical Guidelines Committee of the American College of Physicians. (2016). Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine, 165(2), 125–133. doi: 10.7326/M15-2175
Palmer, M. & Willis-Gray, M. G. (2017). CE: Overactive Bladder in Women. American Journal of Nursing, 117(4), 34–41. doi: 10.1097/01.NAJ.0000515207.69721.94.
Smith, R. L., Flaws, J. A., & Mahoney, M. M. (2018). Factors associated with poor sleep during menopause: results from the Midlife Women's Health Study. Sleep Medicine, 45, 98-105. https://doi.org/10.1016/j.sleep.2018.01.012
Theorell-Haglow, J., Miller, C. B., Bartlett, D. J., Yee, B. J., Openshaw, H. D., & Grunstein, R. R. (2017). Gender differences in obstructive sleep apnoea, insomnia and restless legs syndrome in adults–What do we know? A clinical update. Sleep Medicine Reviews. doi.org/10.1016/j.smrv.2017.03.003