Why Women Don't Sleep Well—and How to Get Your Rest!

Have you ever felt frustrated watching a man sleep like a baby while you tossed and turned? Do the strategies that used to help you sleep no longer seem to work? Blame biology, at least in part.

As early as adolescence, gender-based differences in physiology and lifestyle make sleep disorders far more common in women than in men. Because these factors change over time, a woman's sleep problems also change—usually for the worse. So it is no surprise that a 2007 poll from the National Sleep Foundation reported that 67% of American women frequently experience sleep problems.

Fortunately, once you understand what trig-gers your sleep problems, you can take steps toward a better night's rest.

The Childbearing Years

Some women don't need a calendar to remind them when their period is due. A group of symptoms called premenstrual syndrome (PMS)—including breast tenderness, headaches and joint and muscle pains—can cause sufficient discomfort to interfere with rest. A more severe form is premenstrual dysphoric disorder (PMDD), which can cause insomnia, depression, anxiety and fatigue.

Polycystic ovary syndrome is an endocrine dis-order in which the ovaries are enlarged and have multiple cysts. Symptoms include infrequent or irregular periods, weight gain, excessive hair growth, prediabetes and infertility. About 30% to 40% of women with this syndrome experience sleep apnea, in which breathing repeatedly stops during sleep. Sleep apnea causes persistent fatigue and raises a person's risk for cardiovascular disease by increasing blood pressure and decreasing oxygen going to the heart.

During pregnancy, the quality of sleep worsens for more than 80% of women. The uterus presses on the bladder (so you wake up often to urinate) and on the stomach (causing heartburn that can keep you awake). Pregnant women also are prone to restless legs syndrome (RLS), an irresistible urge to move the legs, which interferes with sleep.

Sleep disturbances worsen after the baby is born, thanks to nighttime feedings. For the 10% to 15% of women who develop postpartum depression in response to the hormonal fluctuations that follow childbirth, sleeplessness often accompanies depression.

Midlife And Beyond

The transition to menopause can be brief or may last as long as seven years. During this stage, called perimenopause, periods become irregular. Due to fluctuating hormone levels, many women experience hot flashes and night sweats caused by dilating blood vessels. These rapid changes in body temperature can awaken women repeatedly.

Menopause typically occurs between ages 48 and 55. One in two postmenopausal women ex-perience a sleep disorder, such as sleep apnea or RLS, while nearly two in three have insomnia at least a few nights each week. One culprit is excess weight, particularly in the neck area. The average woman gains eight pounds after menopause, increasing her risk for sleep apnea.

Another sleep-disturbing factor may be the worry that accompanies caregiving, as women in midlife assume responsibility for aging par-ents and/or ailing husbands.

Advancing age increases a woman's risk for ar-thritis, diabetes, cardiovascular disease, depression and other chronic conditions. In addition to the discomforts of the diseases themselves, the medications used to treat such conditions can affect sleep.

For Better Slumber...

The good news: Several simple steps can yield big improvements.

• Eat light—and early—in the evening. A heavy, spicy or late-night dinner may trigger heartburn that keeps you awake.
  

Better: A light dinner two to four hours before bedtime. limit beverages to avoid middle-of-the-night trips to the toilet.

• Skip the buzz. Limit caffeinated beverages to two per day, both before lunch. Have no more than one alcoholic drink per evening, at least three to four hours before bed. When you drink too much or too late, your blood alcohol level drops in the middle of the night, causing brain arousal that wakes you up.
  
• Quit smoking. Many smokers wake at night when blood levels of nicotine fall.
  
• Argue in the morning (or not at all). Evenings should be free from confrontations, strenuous workouts and heart-stopping action films that rev you up when you need to wind down.
  

Exception: Sex. It promotes sound sleep.

• Avoid evening naps. Nap only in the af-ternoon—and for no more than 45 minutes—to minimize disruptions of your nighttime sleep cycle.
  
• Create a relaxing bedtime ritual. Light reading or soothing music tells your brain it's almost bedtime. A warm bath is especially good because raising the body temperature promotes deep sleep.
  
• Don't push back your bedtime. Your body clock works best when bedtimes and awakening times are consistent.
  
• Don't lie there staring at the clock if you can't sleep—get up and do something boring. Tossing and turning is futile and frustrating. Fold some laundry or read something dull until you feel sleepy.
  
• Get help for hormonal problems. Consult your doctor if you suffer from PMS, PMDD or hot flashes.
  
• Don't suffer in silence. Talk to your doctor if your sleep disturbances are due to illness, stress or the side effects of drugs.
  
• See a sleep specialist if you have insomnia more than three times per week for more than a month...if you think you have RLS...or if reports of your snoring and gasping lead you to suspect sleep apnea. You may need an overnight evaluation in a sleep clinic. Your doctor can provide a referral.