Sleep problems can affect anyone, but women are more likely to experience insomnia than men. Poor sleep can provoke daytime sleepiness and contribute to a range of conditions that affect physical and mental health.
No single factor explains the disparity of insomnia between men and women; instead, multiple different elements combine to create heightened sleep challenges for women. Knowing about these potential causes can help women address sleeping problems with a doctor so that they can start sleeping better and overcome insomnia.
Insomnia is considerably more common in women than men. Higher rates of insomnia in women have been found in numerous studies, and some estimates place the lifetime risk of insomnia as 40% higher in women.
Women may also experience insomnia differently than men. For example, in older adults, women are more likely to experience multiple symptoms of insomnia as opposed to men who often report only one symptom.
Overall, it’s common for women to suffer from sleeping problems. In research conducted by the National Sleep Foundation, up to 67% of women said that they had a sleeping problem at least a few nights during the past month, and 46% had problems almost every night.
There is no clear consensus on why insomnia is more common in women. Researchers believe that it may be due to a combination of elements, including sex and gender differences and independent factors.
Sex-based differences in sleep are related to biologies, such as differences in hormone production and circadian rhythms between males and females. Gender-based differences may also be driven by social and cultural disparities that influence sleep. Other factors that affect sleep, such as predispositions for certain physical or mental health issues, may also contribute to higher rates of insomnia in women. All of these factors may play a role in women being more likely to have sleeping problems.
Hormones are the body’s chemical messengers and play an integral role in the functioning of virtually every system of the body. Hormones can directly affect sleep or have indirect effects based on how they modify other aspects of health and wellness.
Hormonal differences are likely to be an underlying driver of distinct sleep patterns in women, including higher rates of insomnia. Hormone production, though, is dynamic and changes over the course of a woman’s life and during her monthly menstrual cycle. The following sections review how hormonal changes can unfold and affect sleep over time.
In the United States, girls have their first period at an average age of 13 years old. This occurs during puberty, a broader series of physical changes including increased production of sex hormones like estrogen.
Research indicates that an elevated risk of insomnia starts with the onset of menstruation. The exact explanation for this is unknown, but it may be tied to how sex hormones influence the sleep-wake cycle and other fundamental systems of the body. In addition, evidence suggests girls during puberty have a higher risk of depression, a mental health condition that is often tied to sleeping problems.
The phases of the monthly menstrual cycle are driven by shifts in hormone production. Rising and falling levels of estrogen and progesterone can induce physical and emotional changes over the course of each month, though these changes may affect every woman differently.
Levels of these hormones fall considerably in the days leading up to each period, causing about 90% of women to experience physical or mood changes, including sleep disruptions. Fluctuating hormone levels can alter a woman’s sleep stages during the night, known collectively as her sleep architecture.
Premenstrual dysphoric disorder (PMDD) is a more severe form of PMS that frequently involves more pronounced sleeping problems. Around 70% of women with PMDD report symptoms of insomnia before their period.
Substantial hormonal changes that occur during and after pregnancy can affect sleep. During pregnancy, a woman no longer experiences the same monthly fluctuations associated with the menstrual cycle, but major hormonal shifts that begin in the first trimester can cause fatigue, morning sickness, weight gain, and a range of other physical and emotional changes. Ongoing hormonal fluctuations during pregnancy can disrupt the sleep-wake cycle, and many women find sleeping problems to be the worst during the third trimester.
Within the first 24 hours after giving birth, women experience another significant hormonal shift as levels of estrogen and progesterone drop rapidly back to pre-pregnancy levels. Physical and emotional effects during this postpartum period may create sleeping difficulties or daytime sleepiness.
Sleeping problems are considered to be a core symptom of perimenopause and menopause. An estimated 38-60% of women during this time report symptoms consistent with insomnia.
Reduced or fluctuating levels of sex hormones can disturb sleep in multiple ways. For example, hormone changes can cause hot flashes and night sweats, another central symptom of the menopausal transition that affects up to 85% of women. Women with frequent night sweats may have more sleep interruptions and greater difficulty getting back to sleep.
Hormonal changes associated with aging and postmenopause may also influence sleep by altering circadian rhythms and the body’s system for regulating its temperature during a normal sleep-wake cycle. An intersection of these hormonal changes with other factors, including a higher level of mood disorders and physical ailments, likely contributes to sleeping problems in older women.
Sleep is complex and influenced by a range of factors that relate to the diverse aspects of a person’s health. Many women have sleep problems initiated by the general causes of insomnia, such as sleep disorders, mental health conditions, poor sleep habits, circadian rhythm disorders, and coexisting medical problems.
That said, many of these issues don’t affect women and men in the same way. Women often face distinct challenges to quality sleep as a result of biological factors or social and cultural norms. The following sections describe various barriers to sleep in women that may contribute to their higher rates of insomnia.
Sleep is often tied to mental health, and women are more likely than men to suffer from sleeping problems associated with conditions like depression, anxiety, and stress.
Women are diagnosed with depression at higher rates than men, and sleeping too much or too little is a frequent symptom of that disorder. Studies have also found that women are more likely to ruminate about their concerns, which can contribute to anxiety, limiting one’s ability to fall asleep easily or go back to sleep after awakening.
There is no single explanation of why women are more likely to be affected by these conditions and the corresponding detrimental effects on sleep. While biological factors may be involved, inequalities in social and cultural conditions, such as women’s disproportionate share in caregiving roles, may contribute to stress and worry that detract from emotional health.
Bladder problems can contribute to frequent urination at night, also known as nocturia, that can be a barrier to uninterrupted sleep. Women are twice as likely as men to suffer from urinary incontinence and other symptoms of an overactive bladder. Studies estimate that 76% of women over 40 experience frequent urination at night.
Sleeping problems are common for women during pregnancy. Around 30% of pregnant women say they rarely or never get a good night’s sleep, and more than 50% have insomnia-like symptoms. These sleeping difficulties can be tied to hormones as well as extensive physical changes associated with pregnancy.
More frequent urination at night, back and neck pain, difficulty finding a comfortable sleeping position, and heartburn can all interfere with sleep quantity and quality. Pregnant women are more likely to develop restless leg syndrome and may suffer from breathing problems, including sleep apnea.
Sleeping problems can persist after childbirth as well. Regular awakenings to feed or care for an infant, hormonal shifts, postpartum depression, and physical and emotional adjustment after pregnancy are among the factors that cause elevated rates of poor sleep in postpartum women. In general, it takes three to six months for a mother’s sleep to normalize after childbirth, although this may be affected by her infant’s sleep patterns.
Obstructive sleep apnea (OSA) is a breathing disorder that involves a decrease or complete halt of airflow, due to a reduction or complete pause in breathing during sleep. This leads to a reduction in oxygen levels, disrupted sleep (due to repeated episodes of awakening), and other serious potential health consequences. Men are diagnosed with OSA at a much higher rate than women, although both genders may be affected. However, it is unclear if gender bias may contribute to this phenomenon.
Women with sleeping problems are less likely to be referred to specialized sleep clinics where tests for OSA are normally conducted. This may reflect underlying gender bias in how women’s symptoms are evaluated. Because untreated OSA can be a major source of sleep disruption, underdiagnosis may contribute to ongoing sleeping problems in some women.
Restless leg syndrome (RLS) is a condition in which a person has a strong urge to move their limbs, especially their legs, when lying down and is commonly associated with sleep difficulties. Though the exact cause is unknown, RLS is more common in women than men, which at least in part may be due to higher rates of RLS during pregnancy.
Parasomnias are abnormal behaviors during sleep that can contribute to insufficient sleep. Most parasomnias do not show a gender predilection, but nightmare disorder, characterized by frequent disturbing dreams, is reported to be more common in women.
Not everyone is affected in the same way by a lack of sleep. Studies of sleep cycles have found that men and women may respond differently to sleep deprivation with women more quickly building up a “sleep debt” and experiencing the consequences of insufficient sleep.
At the same time, unequal work and family caregiving responsibilities often experienced by women in the household may result in less flexibility to recover from sleep deprivation. In one study, 80% of women reported that when they feel drowsy during the day, they frequently accept it and move on. In this way, sleep loss may become compounded over time.
Another factor that may affect the sleep differential between men and women is how they respond to certain medications. Studies of the sleep-promoting prescription drug zolpidem, also known as Ambien, discovered that women who took the standard dose felt the drug’s effects for longer, leading to morning drowsiness. This finding led the Food and Drug Administration to issue a different prescribed dose for women.
Sleep is essential to women’s health, and despite the numerous challenges to good sleep, there are steps women can take to improve their nightly rest.
Because of the wide range of factors that can influence sleep, it’s important for women to talk with their doctor if they are sleeping less than the recommended number of hours, if their sleep is frequently interrupted, or if they experience notable daytime sleepiness or impairment. Under the guidance of a health professional, insomnia can often be treated effectively as an underlying sleep disorder, physical ailments, or mental health disorders.
Women often benefit from finding ways to improve their sleep hygiene, which refers to a person’s sleep environment and habits. Examples of sleep hygiene enhancements include: