The Sleep Disparity: Why Does Insomnia Hit More Women Than Men?
Women are 1.4 times more likely to report insomnia than men.
There are few pleasures in the world that come for free, and a good night’s sleep is perhaps the most undervalued on the list. Because really, is there a better feeling in the world than hitting the sack after a long, long day of work?
If facts are taken into account, a significant number of people are unable to experience this bliss — among whom, women fare the worst.
Women are 1.4 times more likely to report insomnia than men, and, in general, they suffer from sleep problems more often.
While the trend is well known, the reasons explaining this discrepancy are complex and indirect. Why are more and more women not getting enough sleep?
Triple Analysis: The Physical, Social and the Mental
The reasons cut through multiple layers and are linked to almost all aspects of a woman’s life. The body, the mind, and the lifestyle; each factor needs to be looked into separately.
Hormones make the basis of pretty much all medical differences that exist between males and females, and insomnia is no exception. From your menstrual cycles and pregnancy to eventually menopause — sleeping woes accompany all stages.
Dr Nupur Gupta, Director, Department of Obstetrics and Gynaecology at Fortis.
“The hormones produced by the ovaries — estrogen and progesterone — are intricately linked to sleep. In some cases, they can lead to hypersomnia, but most women complain of sleeping problems and insomnia.”Dr Nupur Gupta
The menstrual cycle, she explains, is divided into two parts. In the first 14 days, the production of estrogen increases, and in the second, progesterone is produced in a higher amount. When the body is preparing to menstruate, both hormones drop, which causes restlessness, irritability, anxiety, natural discomfort, and other PMS-associated symptoms.
The next phase that follows for most women is pregnancy, where the lack of sleep is impacted not just by hormones, but also by reasons such as weight gain, physical discomfort, back pain, increased blood supply to the gastric region, leg cramps or anxiety related to the future. Add to this the frequent urination through the night, iron deficiency and a host of other factors that lead to sleeplessness.
Finally, comes the perimenopause and menopause, which is associated with hot flashes, anxiety, genito-urinary problems, and urinary tract infections.
Overall anxiety increases at this age because of parallel changes in life like retirement, less family responsibilities, and children moving away. This increased anxiety, again, leads to trouble sleeping.
Moreover, even a woman’s body clock has a role to play. According to a study published in Proceedings of the National Academy of Sciences, women begin their sleep at a later stage than men (relative to how their bodies are set), and this discrepancy explains why they find it more difficult to fall and remain asleep. It also found that the internal sleep cues in women weren’t as strong in the early hours of the morning as in men, which could wake them up earlier.
The Direct Correlation Between Mental Health & Insomnia
Multiple studies have concluded that depression and anxiety are more commonly found in women than in men. In fact, women are nearly twice as likely to get diagnosed with depression.
Affective disorders such as these are closely linked to insomnia, which explains the differences in sleep problems between women and men. What’s more, these sleep troubles can in turn also cause mental health issues.
FIT spoke to Ritika Aggarwal Mehta, Consultant Psychologist at Jaslok Hospital and Research Centre, to better understand these complex links. “In general, women are known to have a higher risk of depression and anxiety.”
“Mental health disorders increase or decrease sleep. Inversely, a lack of sleep could trigger psychological conditions. Nobody is really sure what comes first. Sleep issues, even if they appear after a diagnosis, could definitely make the problem at hand worse.”Ritika Aggarwal Mehta
She adds that the risk increases as a woman ages, with the added pressure from work and family. The tendency among women is to put others before themselves; they’re looking after an older person and a younger person. Gender roles and differences crop up in the division of parental and familial responsibilities, putting a ‘double burden’ on women. They work late, wake up early and spend their days balancing the professional and personal. All of this may (and does) become overwhelming, making women more vulnerable to stress, anxiety, and sleeplessness.
How Do Women Get Some Sleep?
Any course of treatment would begin with certain lifestyle changes. Exercising, relaxing, avoiding gadgets before sleeping, meditating, and routinizing their days can help people fall asleep peacefully. But if the problem runs much deeper, lifestyle modifications may have to be accompanied by medical treatment: counseling, medicines and procedures such as hormone replacement therapy (HRT).
“Medicines such as anti-depressants may help, but they are never the first option. They can’t be prescribed for long-term use either. An ideal procedure is to identify the cause of the problem through cognitive behavior therapy, behavior therapy (or a combination of both), or perhaps a sleep study. You need to know how much of it is coming from an underlying mental or physical condition.”Ritika Aggarwal Mehta
Eliminate alternative explanations, narrow down on one and then treat it. If the cause is gynecological, then a specialist in the field can be referred to and routine checkups will be needed to avoid a relapse.
When a hormonal imbalance is the reason, can HRT be a viable option?
Dr Nupur Gupta says, “If lifestyle modifications and non-hormonal options don’t work, then we can give short-term hormonal treatment as a last resort. This is customized depending on who really needs it, and then administered accordingly.”
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