Sleep is a physiological process and is of great importance for our physical and mental health. However, throughout our development, it undergoes some changes in its rhythm, structure, quality and quantity. When we are children and teenagers, we need more hours of sleep, when adults we sleep around 7 to 8 hours and when we get older this number can vary from 5 to 6 hours of sleep per night.
Such changes, among others, may result from some intrinsic factors, such as: age and sex. Sex? Yes! That's right! Men and women may have different characteristics in their sleep pattern throughout development, as well as being more vulnerable to certain sleep disorders. For example, men tend to be more likely to have obstructive sleep apnea, while women are more likely to develop insomnia. And that's what we're going to talk about today. The Woman's Sleep!
Several studies report that women have more sleep complaints and are at greater risk of being diagnosed with insomnia compared to men. Sleep alterations in women can be caused by several factors, such as biological, genetic, social and emotional. Women for various periods during life, have significant hormonal changes, whether during the menstrual period, during or after pregnancy or even during menopause, which can lead to changes in their sleep pattern. The exhausting daily routine, in an attempt to reconcile professional and family life, is also a factor that leads to the worsening of sleep quality in women.
SLEEP AND TPM
During the menstrual period, 6 to 8% of women may have clinically relevant premenstrual symptoms, the famous PMS (Premenstrual Tension), which can often be distressing, leading to impairments in their daily functions such as drowsiness, fatigue, decreased alertness etc. Many women in this phase usually report sleep-related complaints, such as insomnia, frequent awakenings, non-restorative sleep and nightmares (1). Such changes could often be associated with hormonal levels and, in this case, progesterone (2).
SLEEP IN PREGNANCY AND POSTPARTUM
Another period that can lead to sleep impairment in women is during pregnancy. In this phase, the woman undergoes significant hormonal changes that can affect the sleep-wake cycle. In addition to these changes, pregnancy itself causes a multitude of physical, emotional and physiological changes, such as anxiety, urinary incontinence, back pain, fetal movement, general abdominal discomfort, breast tenderness, leg cramps, heartburn and reflux, which can lead to sleep fragmentation (3) and often insomnia.
During the puerperium, women's sleep is also impaired, due to the baby's routine, breastfeeding in the middle of the night and the endless cramps of the little ones. However, when babies assume their biological maturity to sleep, mothers' sleep tends to return to normal, but in some cases sleep interruptions initiated during pregnancy or postpartum stressors can evolve into an insomnia disorder, as mothers tend to maintain maladaptive sleep-related behaviors and increase hyperalerts (3).
SLEEP AND MENOPAUSE
Menopause is also a condition that can lead to changes in sleep patterns in women. Studies show that 38% to 60% of women during this period may experience their first stage of insomnia (4) or even obstructive sleep apnea. One of the explanations for this phenomenon would be the decrease in estrogen that leads to vasomotor symptoms (hot flashes and night heat), increased irritability, anxiety, depression and memory loss. Hormonal changes can be responsible for insomnia in the transition from menopause to post-menopause, but they can also be caused by psychosocial and biological changes that usually occur in women's lives at this stage (5). Middle-aged women often also begin to face other challenges such as changes in the body and sexuality due to aging, retirement, children leaving home, all of which can lead to the presence of depressive symptoms, which are often associated with the conditions of insomnia (5).
Finally, the role that women assume in society can often be a factor that also changes their sleep pattern. With an exhausting and often inflexible routine, women end up taking on too heavy a burden, whether in relation to their professional, family and social life. This may have been one of the main reasons for this condition, which enhances the vulnerability of women to insomnia, as this, associated with the biological and hormonal aspects mentioned above, can lead to emotional changes and consequently to greater anxiety, depression and stress. these triggering and maintaining factors of insomnia.
Below are some guidelines to improve sleep quality in these cases:
1) Have some time for yourself, taking care of your self-esteem and self-care can contribute to your well-being;
2) Whenever possible, do physical activities and have a good diet, this can alleviate the effects caused by sleep fragmentation
3) Relax, recognize that you can be doing your best and value your attitudes, don't be too rigid with yourself.
4) Breathe, exercise meditation, breathing and relaxation, these activities are proven to improve anxiety and depression symptoms as well as insomnia symptoms.
5) Review your inappropriate sleep habits and behavior, sleep hygiene can improve insomnia symptoms, especially in relation to difficulties in initiating and maintaining sleep
6) If necessary, seek help, cognitive behavioral therapy, in addition to working with emotional issues caused by hormonal changes, mentioned in the text, also helps to reduce the symptoms of insomnia, allowing more flexibility in relation to your thoughts and feelings.
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1 Khazaie H, Ghadami MR, Khaledi-Paveh B, et al. Sleep quality in university students with premenstrual dysphoric disorder. Shanghai Arch Psychiatry 2016;28(3):131–8. 2 Sharkey KM, Crawford SL, Kim S, et al. Objective sleep interruption and reproductive hormone dynamics in the menstrual cycle. Sleep Med 2014; 15(6):688–93. 3 Nowakowski, Sara et al..Cognitive Behavioral Therapy for Insomnia and Women's HealthSleep Medicine Clinics, 2019 Volume 14, Issue 2, 185 - 197 4 National Institutes of Health. National Institutes of Health State-of-the-Science Conference statement: management of menopause-related symptoms. Ann Intern Med 2005;142(12 Pt 1):1003–13. 5 Hachul H., Bezerra A.G., Andersen M.L. (2017) Insomnia and Menopause. In: Attarian H. (eds) Clinical Handbook of Insomnia. Current Clinical Neurology. Springer, Cham