[by Tamara Sellman RPSGT CCSH for Advanced Cardiovascular Sleep Disorders Center]

If you spend even a little bit of time in online forums and social media, you've probably run across lots of complaints from women regarding sleep. Why can't I sleep? Why am I so tired during the day? 

Women experience a lot of the same concerns as men when it comes to sleep. Major reasons for sleep disruption include shift work, inadequate stress management, underlying and untreated sleep disorders, medical conditions and their treatment side effects, and poor sleep hygiene.

Recent details about gender-related sleep differences in Alabama, reported by Yellowhammer News, show that the Centers for Disease Control (CDC) has found that in our state:

• men are slightly more sleep deprived than women (39.3 percent vs 38.7 percent)
• the 45 to 54 years old age group is most likely to get less than the recommended 7 hours of sleep nightly, and
• we most commonly blame arthritis, asthma, cancer, depression, and diabetes for not getting enough sleep

However, one chief cause for problems with sleep in Alabama and elsewhere comes at the expense of simply being a woman: hormones.

Hormones, women and sleep problems

The female hormones estrogen and progesterone have specific functions in the body. They also interact with other kinds of hormones, including melatonin, otherwise known as "the sleep hormone." When melatonin is disrupted by imbalances in other hormones, it can make it difficult for the brain and body to slip into sleep mode at night.

MENSTRUATION

At menarche, the start of the menstrual cycle, hormones start their monthly cyclical release into the bloodstream, signaling fertility. While one's "period" is only apparent for one week, a complex set of processes takes places before and after one's period which involve the rise and fall of hormone levels. For some, this rise and fall is tolerable, but for others, it can lead to a host of complaints, including pain, irritability, daytime fatigue, and insomnia. 

Insomnia, in particular, can be blamed on the monthly cycle during the process when the core body temperature rises. The neurochemical processes of sleep, which directly connect to our circadian rhythms, require the core body temperature to cool down at night in order to facilitate sleep. When it doesn't, insomnia can be a result.

FERTILITY

The use of hormone-based contraception may or may not improve some of the discomfort of menstruation, such as irritability and soreness. However, if contraceptive hormone levels are too high or too low, that could lead to problems with sleep.

PREGNANCY

As if having a monthly period isn't already enough to disrupt sleep, pregnancy throws in a score of additional issues: extreme shifts in hormone levels lead to discomfort that can disrupt sleep, as can an overactive bladder at night, or pregnancy-related conditions such as sleep apnea or gestational diabetes. 

MOTHERHOOD

Once the baby is born, postpartum issues with hormone levels can continue until the body returns to its pre-pregnancy "normal" (or at least close to it.) On top of that, unaddressed weight gain can lead to continued problems with sleep apnea. Managing life as a new parent, unfortunately, makes sleep seem impossible with overnight feedings and care of a newborn. Continued nighttime problems with children at bedtime can further exacerbate sleep deprivation. When the kids become teens, they bring a whole new level of challenges to motherhood that can lead to nighttime anxiety, a common cause of insomnia and disrupted sleep.

MENOPAUSE

As the female body reaches the end of fertility, shifts in female hormones can wreak havoc on sleep. Two key problems for women later in life (whether pre-, peri- or post-menopause) include night sweats and 3am insomnia. Menopause is also the time when women who may not have had problems with snoring and sleep apnea soon develop one or both of these problems, thanks to hormones and aging. Other age-related disorders such as Parkinsonism, heart disease, and arthritis may also deal additional blows to one's sleep life in the golden years.