A majority
of American adults (63%) do not get the recommended eight hours
of sleep needed for good health, safety, and optimum performance.
In fact, nearly one-third (31%) report sleeping less than seven
hours each week night, though many adults say they try to sleep
more on weekends. (from the National Sleep Foundation's 2002 Sleep
in America poll).
Before Thomas Edison's invention of the light bulb, people slept
an average of 10 hours a night; today Americans average 6.9 hours
of sleep on weeknights and 7.5 hours per night on weekends. I
think that I actually get more sleep than the average American-usually
a full 8 hours during the week and more on weekends. But I know
my own body, and I know that less than 8 hours of sleep makes
me a grumpy, useless mess. Sleep deprivation and sleep disorders
are estimated to cost Americans over $100 billion annually in
lost productivity, medical expenses, sick leave, and property
and environmental damage (National Sleep Foundation).
Sleep is a basic human need, as important for good health as diet
and exercise. When we sleep, our bodies rest but our brains are
active. Sleep lays the groundwork for a productive day ahead.
Although most people need eight hours of sleep each night, the
National Sleep Foundation (NSF) 1998 Women and Sleep Poll found
that the average woman aged 30-60 sleeps only six hours and forty-one
minutes during the workweek. Research has shown that a lack of
enough restful sleep results in daytime sleepiness, increased
accidents, problems concentrating, poor performance on the job
and in school, and possibly, increased sickness and weight gain.
Getting the
right amount of sleep is vital, but just as important is the quality
of your sleep. Conditions unique to women, like the menstrual
cycle, pregnancy and menopause, can affect how well a woman sleeps.
This is because the changing levels of hormones that a woman experiences
throughout the month, like estrogen and progesterone, have an
impact on sleep. Understanding the effects of these hormones,
environmental factors and lifestyle habits can help women enjoy
a good night's sleep.
Your
Monthly Cycle & Sleep
Changes in women's bodies occur at different times in the menstrual
cycle and may affect sleep. For example, the NSF poll found that
50% of menstruating women reported bloating that disturbed their
sleep. On average, these women reported disrupted sleep for two
to three days each menstrual cycle. These changes can be linked
to the rise and fall of hormone levels in the body. The hormone
progesterone, which rises after ovulation (when an ovary releases
an egg), may cause some women to feel more sleepy or fatigued.
However, poor quality sleep is more likely at the beginning of
the menstrual cycle when bleeding starts.
Hormones,
of course, are not the only factors that influence sleep. Stress,
illness, diet, lifestyle and the sleep environment all play a
part. Women's sleep experiences vary greatly during the menstrual
cycle and certain types of sleep problems are associated with
each phase of the cycle:
Before Ovulation
(days 1-12): Typically, the period (bleeding or menstruation)
occurs for about five days. After the period ends, an egg ripens
in the ovary.
During menstrual bleeding, women tend to get less restful sleep
than at other times. 36% of women polled by NSF said their sleep
was most disturbed during the first few days of their menstrual
periods.
Ovulation
(days 13-14): An egg is released. If the egg is fertilized, pregnancy
occurs. Otherwise the cycle continues and a menstrual period results
in about 14 days.
After Ovulation
(days 15-28): If pregnancy doesn't occur, the lining of the uterine
wall begins to break down; it is shed during the menstrual period.
Progesterone levels start off high at the beginning of this phase,
reaching their peak level around days 19-21. Then levels begin
to decrease toward the end of the phase. Women may find it more
difficult to fall asleep. This may be related to the rapidly falling
levels of progesterone.
Premenstrual
Syndrome (PMS) symptoms may occur during the later portion of
this phase (starting about days 22-28). These include bloating,
headaches, moodiness, irritability and abdominal cramps. The most
common sleep-related problems reported by women with PMS are:
insomnia (difficulty falling asleep, staying asleep, waking up
too early or waking unrefreshed), hypersomnia (sleeping too much),
and daytime sleepiness.
A healthy
sleeper spends about 15-20% of his or her sleep time in deep sleep.
Research suggests that women with PMS experience less deep sleep
(about 5% of their total sleep) all month long.
Pregnancy:
Sleeping for Two
Pregnancy is an exciting and physically demanding time. Physical
symptoms (body aches, nausea, leg cramps, fetus movements and
heartburn), as well as emotional changes (depression, anxiety,
worry) can interfere with sleep. In the NSF poll, 78% of women
reported more disturbed sleep during pregnancy than at other times.
Sleep related problems also become more prevalent as the pregnancy
progresses.
First
Trimester (Months 1-3)
High levels of progesterone are produced, increasing feelings
of sleepiness. Also, the number of times a woman wakes up during
the night to urinate increases. Disturbed sleep patterns may begin.
Interrupted sleep can cause daytime sleepiness. Women tend to
sleep more during this time than before they were pregnant, or
later in pregnancy.
Second
Trimester (Months 4-6)
Progesterone levels still rise, but slowly. This allows for better
sleep than during the first trimester. The growing fetus reduces
pressure on the bladder by moving above it, decreasing the need
for frequent bathroom visits. Sleep quality is still worse than
it was before pregnancy.
Third
Trimester (Months 7-9)
Women experience the most pregnancy-related sleep problems now.
They may often feel physically uncomfortable. Heartburn, leg cramps
and sinus congestion are common reasons for disturbed sleep, as
is an increased need to go to the bathroom. (The fetus puts pressure
on the bladder again.) One recent study reported, that by the
end of pregnancy, 97% of women were waking during the night.
Pregnant women who have never snored before may begin doing so.
About 30% of pregnant women snore because of increased swelling
in their nasal passages. This may partially block the airways.
Snoring can also lead to high blood pressure, which can put both
the mother and fetus at risk. If the blockage is severe, sleep
apnea may result, characterized by loud snoring and periods of
stopped breathing during sleep. The lack of oxygen disrupts sleep
and may affect the unborn fetus. If loud snoring and severe daytime
sleepiness (another symptom of sleep apnea and other sleep disorders)
occur, consult your physician.
Sleep
Tips for Pregnant Women
1. In the third trimester, sleep on your left side to allow for
the best blood flow to the fetus and to your uterus and kidneys.
Avoid lying flat on your back for a long period of time.
2. Drink lots
of fluids during the day, but cut down before bedtime.
3. To prevent
heartburn, do not eat large amounts of spicy, acidic (such as
tomato products), or fried foods. If heartburn is a problem, sleep
with your head elevated on pillows.
4. Exercise
regularly to help you stay healthy, improve your circulation,
andreduce leg cramps.
5. Try frequent
bland snacks (like crackers) throughout the day. This helps avoid
nausea by keeping your stomach full.
6. Special
"pregnancy" pillows and mattresses may help you sleep
better. Or use regular pillows to support your body.
7. Naps may
help. The NSF poll found that 51% of pregnant or recently pregnant
women reported at least one weekday nap; 60% reported at least
one weekend nap.
8. Talk to
your doctor if insomnia persists.
Once her baby
is born, a mother's sleep is frequently interrupted, particularly
if she is nursing. Mothers who nurse and those with babies that
wake frequently during the night should try to nap when their
babies do. Sharing baby care to the extent possible, especially
during the night, is important for the mother's health, safety,
performance and vitality.
After-birth
blues (post-partum depression) may also be related to sleep problems.
This is usually a temporary condition treatable with professional
help.
This is a great chart to include that identifies the sleep needs
of children at different ages. http://www.sleepfoundation.org/children/children_tips.pdf
Understanding
Menopause
Menopausal symptoms vary from woman to woman. However, women report
the most sleeping problems during menopause. Snoring, for example,
has been found to be more common and severe in post-menopausal
women.
When a woman
approaches natural menopause, her ovaries gradually (over several
years) decrease production of estrogen and progesterone. If a
woman has her ovaries surgically removed (oophorectomy), periods
end immediately, and menopausal symptoms become more severe.
Changing and
decreasing levels of estrogen cause many menopausal symptoms including
hot flashes, which are unexpected feelings of heat all over the
body. They are usually accompanied by sweating. In the NSF poll,
36% of menopausal and post-menopausal women reported hot flashes
during sleep. On average, they occurred three days per week and
interfered with sleep five days per month. Hot flashes persist
for an average of five years. While total sleep time may not suffer,
sleep quality does. Hot flashes may interrupt sleep; frequent
awakenings cause next-day fatigue.
Treatment
with estrogen (Estrogen Replacement Therapy, ERT) or with estrogen
and progesterone (Hormone Replacement Therapy, HRT) may relieve
menopausal symptoms. The effects of HRT and ERT vary among women
depending on the form taken (pill, patch, gel, cream or injection)
and the number of years used.
Many other
products target problems associated with menopause. These include
nutritional products and medications such as calcium supplements,
vitamin D, and bisphosphonates for the prevention or treatment
of osteoporosis (thinning and weakening of the bones); estrogen
creams and rings for vaginal dryness; and sleep-promoting drugs
for insomnia. All forms of estrogen that enter the blood stream
reduce hot flashes.
An alternative
treatment for menopausal symptoms may come from soy products (tofu,
soybeans, soy milk). They contain phytoestrogen, a plant hormone
similar to estrogen.
A few small
studies indicate that soy can help lessen hot flashes. Phytoestrogens
are also available in over-the-counter nutritional supplements
(ginseng, extract of red clover). These supplements are not regulated
by the Food and Drug Administration (FDA); their proper doses,
long-terms effects and risks are not yet known.
Deciding what,
if any, product to use and, if so, for how long, are questions
a woman should discuss with her doctor. The answer will depend
on personal and family medical history.
Most
Common Sleep Problems In Women
Nearly 40 million American men and women suffer from sleep disorders.
However, sleep problems affect more women than men. New research
exploring women's sleep experiences may lead to specially tailored
treatments.
Insomnia
Insomnia is the most common sleep problem. Women are more likely
than men to report insomnia. In fact, according to the NSF poll,
53% of women aged 30-60 experience difficulty sleeping often or
always: 60% of women aged 30-39, 47% aged 40-49, and 50% aged
50-60. Yet only 41% of all the women surveyed think they've had
insomnia in the past year. Fortunately, there are a number of
approaches to improving sleep, including those you can do yourself
such as exercise, establishing regular bedtimes and wake times,
dietary changes (less or no caffeine and alcohol) and improving
your sleep environment.
If insomnia
persists, and lifestyle, behavioral or diet changes do not help,
a doctor may prescribe a sleep-promoting medication (hypnotic).
In some instances, there may be an underlying and treatable cause,
such as depression (women are twice as likely to report depression
as men), stress, anxiety or pain. Doctors may prescribe antidepressants
(for depression), anxiolytics (anti-anxiety drugs), pain medications
and/or hypnotic medications to improve sleep.
Sleep
Apnea
An estimated 12 million plus Americans have sleep apnea including
one in four women over 65. While apnea is more common in men,
it increases in women after age 50. Sleep apnea is a serious sleep
disorder that is characterized by snoring, interrupted breathing
during sleep or excessive daytime sleepiness. Recent studies have
also found that sleep apnea is associated with increased blood
pressure, a risk for cardiovascular disease and stroke. If any
of these symptoms appear, it is important to address them with
your doctor. A number of effective treatment approaches are available.
One common
culprit for day time drowsiness (if you know you've had your eight
hours) is dehydration. Make sure you are drinking enough fluids.
Anemia (low iron levels) is also another cause for sleepiness.
If you frequently feel out of energy and tired check with your
doctor, a simple blood test can determine if you are anemic. If
after trying everything you still have trouble sleeping, talk
to your doctor.
Resources:
National
Sleep Foundation
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Here
are some tips from the National Sleep Foundation for improving
your nighttime sleep.
1.
Maintain a regular bed and wake time schedule including weekends.
Our sleep-wake cycle is regulated by a "circadian
clock" in our brain and the body's need to balance both sleep
time and wake time. A regular waking time in the morning strengthens
the circadian function and can help with sleep onset at night.
That is also why it is important to keep a regular bedtime and
wake-time, even on the weekends when there is the temptation to
sleep-in.
2.
Establish a regular, relaxing bedtime routine such as soaking
in a hot bath or hot tub and then reading a book or listening
to soothing music. A relaxing, routine activity right
before bedtime conducted away from bright lights helps separate
your sleep time from activities that can cause excitement, stress
or anxiety which can make it more difficult to fall asleep, get
sound and deep sleep or remain asleep. Avoid arousing activities
before bedtime like working, paying bills, engaging in competitive
games or family problem-solving. Some studies suggest that soaking
in hot water (such as a hot tub or bath) before retiring to bed
can ease the transition into deeper sleep, but it should be done
early enough that you are no longer sweating or over-heated. If
you are unable to avoid tension and stress, it may be helpful
to learn relaxation therapy from a trained professional. Finally,
avoid exposure to bright before bedtime because it signals the
neurons that help control the sleep-wake cycle that it is time
to awaken, not to sleep.
3.
Create a sleep-conducive environment that is dark, quiet, comfortable
and cool. Design your sleep environment to establish
the conditions you need for sleep - cool, quiet, dark, comfortable
and free of interruptions. Also make your bedroom reflective of
the value you place on sleep. Check your room for noise or other
distractions, including a bed partner's sleep disruptions such
as snoring, light, and a dry or hot environment. Consider using
blackout curtains, eye shades, ear plugs, "white noise,"
humidifiers, fans and other devices.
4.
Sleep on a comfortable mattress and pillows.
Make sure your mattress is comfortable and supportive. The one
you have been using for years may have exceeded its life expectancy
- about 9 or 10 years for most good quality mattresses. Have comfortable
pillows and make the room attractive and inviting for sleep but
also free of allergens that might affect you and objects that
might cause you to slip or fall if you have to get up during the
night.
5.
Use your bedroom only for sleep and sex. It is best to
take work materials, computers and televisions out of the sleeping
environment. Use your bed only for sleep and sex to strengthen
the association between bed and sleep. If you associate a particular
activity or item with anxiety about sleeping, omit it from your
bedtime routine. For example, if looking at a bedroom clock makes
you anxious about how much time you have before you must get up,
move the clock out of sight. Do not engage in activities that
cause you anxiety and prevent you from sleeping.
6.
Finish eating at least 2-3 hours before your regular bedtime.
Eating or drinking too much may make you less comfortable
when settling down for bed. It is best to avoid a heavy meal too
close to bedtime. Also, spicy foods may cause heartburn, which
leads to difficulty falling asleep and discomfort during the night.
Try to restrict fluids close to bedtime to prevent nighttime awakenings
to go to the bathroom, though some people find milk or herbal,
non-caffeinated teas to be soothing and a helpful part of a bedtime
routine.
7.
Exercise regularly. It is best to complete your workout
at least a few hours before bedtime. In general, exercising regularly
makes it easier to fall asleep and contributes to sounder sleep.
However, exercising sporadically or right before going to bed
will make falling asleep more difficult. In addition to making
us more alert, our body temperature rises during exercise, and
takes as much as 6 hours to begin to drop. A cooler body temperature
is associated with sleep onset.. Finish your exercise at least
3 hours before bedtime. Late afternoon exercise is the perfect
way to help you fall asleep at night.
8.
Avoid caffeine (e.g. coffee, tea, soft drinks, chocolate) close
to bedtime. It can keep you awake. Caffeine is a stimulant,
which means it can produce an alerting effect. Caffeine products,
such as coffee, tea, colas and chocolate, remain in the body on
average from 3 to 5 hours, but they can affect some people up
to 12 hours later. Even if you do not think caffeine affects you,
it may be disrupting and changing the quality of your sleep. Avoiding
caffeine within 6-8 hours of going to bed can help improve sleep
quality.
Ever
wonder how much sleep your children need? Here
is a great chart.
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