Women and Women and Sl pSleep

What You Will LearnWhat You Will Learn

• The Benefits and Importance of Sleep p p• States and Stages of the Sleep Cycle• Unique Physiology of Women’s Sleepq y gy p• Common Disorders in Women that Affect Sleep• Women’s Role in Society and Sleep• Where to find additional materials and

information

• Healthy Sleep Tips Along the Way!

Importance and Importance and Benefits of Sleepp

Why is Sleep Important?Why is Sleep Important?

• Key to our health, performance, safety and y , p , yquality of life

• As essential a component as good nutrition and i i l h l hexercise to optimal health

• As necessary as the water we drink, the air we breathe and the food we eat to function and livebreathe and the food we eat to function and live at our best

Women’s SleepWomen s Sleep

Women…Women…• Have unique physiology that can disrupt sleep• Are more likely than men to report poor sleepAre more likely than men to report poor sleep• Are more likely to experience daytime

sleepinesssleepiness• Are three times more likely to suffer insomnia• Experience more depression and anxiety that• Experience more depression and anxiety that

disrupts sleep

The Benefits of Adequate, R i SlRestorative Sleep

Quality Sleep Promotes:Quality Sleep Promotes:– alertness and daytime productivity– mental wellnessmental wellness– hormone production that restores, rejuvenates

and repairs body organs and systemsand repairs body organs and systems– weight maintenance and can aid weight loss– overall good health and wellness– overall good health and wellness

S d S States and Stages of the of the

Sleep CycleSleep Cycle

Sleep is regulated by b d two body systems:

1. Sleep/Wake Homeostasis – The Process that

Balances Sleep and WakefulnessWakefulness

2. Circadian Biological Clockg– The Clock-Dependent

Process that Regulates Al tAlertness

Circadian Biological ClockCircadian Biological Clock

• The internal Retino-hypothalamic tract

mechanism that regulates when we feel sleepy and whenfeel sleepy and when we feel alert

• Resides in the brain and is affected by Suprachiasmatic nuclei

Hypothalamus

light and darkp

The Sleep CycleThe Sleep Cycle

•Alternating states and stages of sleep that occur over an 8 hour time period:over an 8-hour time period:

•NREM: Non-Rapid Eye Movement, Stages 1-4; 75% f th i ht75% of the night

•REM: Rapid Eye Movement; Dreams occur 25% of the night

During the Sleep Cycle During the Sleep Cycle

• Core body temperaturetemperature

• Growth hormoneC ti l• Cortisol

• MelatoninSl t• Sleep stage– Body temperature lowers– Hormone levels rise andHormone levels rise and

fall

Unique Unique Physiology of Physiology of

’ SlWomen’s Sleep

Unique Physiology of Women’s SleepUnique Physiology of Women s Sleep

• Menstruation• PregnancyPregnancy• Post-partum• MenopauseMenopause

Menstruation and SleepMenstruation and Sleep

Hormonal changes unique to women can cause more g qthan half the sleep problems women experience.

• Progesterone:Promotes sleep and increases NREM sleep– Promotes sleep and increases NREM sleep while decreasing wakefulness

• Estrogen:• Estrogen: – Enhances REM sleep and regulates flow of

other hormones secreted during sleepother hormones secreted during sleep

Sleep Promoting Tips During M iMenstruation

• Exercise regularly, but not close to bedtimeExercise regularly, but not close to bedtime• Avoid caffeine, it can contribute to bloating• Avoid alcohol which can lead to fragmentedAvoid alcohol, which can lead to fragmented

sleep • Avoid large meals and too much fluid close toAvoid large meals and too much fluid close to

bedtime• Pain relievers can lesson sleep disrupting a e e e s ca esso s eep d s upt g

cramps

Pregnancy and SleepPregnancy and Sleep

In a NSF women & sleep poll, 79% of women said their sleep was more disturbed during pregnancy than at any other time.

Changes in Sleep During Pregnancy

S d T i tSecond TrimesterImproved sleep and energy; possible snoring, heartburn,

d f i ht i d

First TrimesterDifficulty sleeping

and frightening dreamsthrough the night; daytime sleepiness; increased urination, and nauseaand nausea

Third TrimesterDifficulty sleeping, increasedDifficulty sleeping, increased urination, snoring, back pain, restless legs

Pregnancy Related Sleep ProblemsPregnancy Related Sleep Problems

• Snoring or Sleep Disordered Breathing (SDA)g p g ( )– 30% of women experience during pregnancy– This can lead to high blood pressure, g p ,

headaches, and daytime fatigue• Restless Leg Syndrome (RLS)

– Increased risk during pregnancy due to lower levels of ferritin iron and folateRLS may disrupt sleep and lead to daytime– RLS may disrupt sleep and lead to daytime sleepiness

Sleep Tips for PregnancySleep Tips for Pregnancy

• Drink lots of water, but not too close to bedtime• Raise the upper body and elevate your head on

a pillow to reduce heartburn• Exercise regularly to improve circulation and

reduce leg cramps, stretch, walk or massage llegs

• Use pregnancy pillows for support.• Nap, if possible and as necessary• Sleep on left side to allow easy blood flow to

f tfetus

Postpartum and SleepPostpartum and Sleep

• Moods can change and range from feelingMoods can change and range from feeling temporarily blue to having full on clinical depressionp

• Motherhood may bring lighter sleep• Irregular schedulesIrregular schedules• Additional Responsibilities

Menopause and SleepMenopause and Sleep

• 75-85% of menopausal women have hot flashes75 85% of menopausal women have hot flashes that disrupt sleep

• Menopausal women have 8 times the risk for psleep disordered breathing (snoring) or sleep apnea

Use of HRT inconclusive

• Women are more likely to suffer from depression from hormone fluctuations during Use of HRT inconclusivemenopause

Common Disorders in Disorders in W th t Women that Affect Sleepp

Common Disorders in Women h Aff Slthat Affect Sleep

• Insomnia– Depression and Anxiety DisordersDepression and Anxiety Disorders

• Restless Leg Syndrome• Obstructive Sleep Apnea• Obstructive Sleep Apnea• Fibromyalgia, Pain and Headaches

Insomnia

Did you know?Did you know?

•Women are 1 4 times more likely to •Women are 1.4 times more likely to develop insomnia vs. men

What is Insomnia? What is Insomnia?

• Complaints of quality and quantity of sleepComplaints of quality and quantity of sleep– Difficulty falling asleep– Frequent awakeningsFrequent awakenings– Waking too early

Not waking refreshed– Not waking refreshed

InsomniaInsomnia

• Insomnia is more frequent in women across allInsomnia is more frequent in women across all age groups

• Insomnia is more common in the unmarried, ,divorced or separated; and elderly; and those under stress

• Often occurs during the menstrual cycle, pregnancy, post-partum, menopause and post

l hmenopausal phases

Depression and Anxiety DisordersDepression and Anxiety Disorders

• Depression and anxiety disorders can lead to orDepression and anxiety disorders can lead to or worsen insomnia

• Likewise, insomnia can lead to or worsen depressive and anxiety disordersp y

Women are twice as likely as men to suffer o e a e t ce as e y as e to su efrom depression

Tips for Insomniacs

• Use the bedroom for sleep and sex only

Tips for Insomniacs

Use the bedroom for sleep and sex only• If you can’t sleep, engage in a relaxing activity• Do not watch the clock!Do not watch the clock!• Avoid late afternoon and evening naps• Avoid caffeine smoking and alcohol• Avoid caffeine, smoking and alcohol• Consult your doctor for treatment

R l L Restless Legs Syndrome (RLS)Syndrome (RLS)

Restless Legs SyndromeRestless Legs Syndrome

RLS is a neurological movement disorder withRLS is a neurological movement disorder with unpleasant sensations or tingling in the legs during rest or sleep that cause an urge to move

• Symptoms include:– Urge to move limbs during sleep– Difficulty sleeping– Daytime sleepiness

Restless Legs SyndromeRestless Legs Syndrome

• 10% of women experience RLS10% of women experience RLS• Approximately 20% of pregnant women

experience RLSp• RLS can cause insomnia that may be

misdiagnosed as depressiong p• RLS is very common in elderly women and men

Sleep tips for Restless Legs SyndromeSleep tips for Restless Legs Syndrome

• Exercise regularly but not to close to bedtimeExercise regularly but not to close to bedtime• Yoga and/or stretching before bed may help• Check your iron and folate levelsCheck your iron and folate levels• Consult your doctor or a sleep specialist for

treatmenttreatment

Ob i Obstructive Sleep ApneaSleep Apnea

“Sleep Apnea is an extremely commonSleep Apnea is an extremely common condition in both males and females –as common as asthma.” Meir Kryger, MD

Obstructive Sleep ApneaObstructive Sleep Apnea

• Sleep Apnea is a serious disorder with breathingSleep Apnea is a serious disorder with breathing disruptions during sleep and frequent awakenings

• Symptoms:– Loud snoringg– Pauses in breathing– Gasps for breath and arousals during sleepGasps o b eat a d a ousa s du g s eep– Daytime sleepiness

Obstructive Sleep ApneaObstructive Sleep Apnea

• Approximately 2.3 million women suffer fromApproximately 2.3 million women suffer from sleep apnea

• Ten percent of postmenopausal women have p p psleep apnea

• In women, sleep apnea is often misdiagnosed , p p gas depression

• Sleep Apnea can lead to hypertension and stroke, consult your doctor if you think you may have sleep apnea

Fibromyalgia, Pain and HeadachesFibromyalgia, Pain and Headaches

• More women than men report that a medicalMore women than men report that a medical condition, pain or a physical discomfort disturbs their sleep

• Migraine headaches are three times more common in women and disrupt sleep

• Fibromyalgia and headaches can intensify sleep difficulties and contribute to daytime sleepiness

Sl d Sleep and Lifestyley

Sleeping in a World That Never Sleeps

Sleep and LifestyleSleep and Lifestyle

Parenting and sleep• Parenting and sleep• Sleep and the

caregivercaregiver• The Working Woman

Parenting and SleepParenting and Sleep

Three key steps for developing positive sleepingThree key steps for developing positive sleeping habits:

1. Develop a regular sleep schedule that is the p g psame every day

2. Establish a consistent bedtime routine3. Put baby to bed drowsy but awake

Put baby to bed on their back!

Sleep Tips for MomSleep Tips for Mom

• Make your own sleep a priorityMake your own sleep a priority• Set (and keep) a regular wake time• Grab some short strategic napsGrab some short strategic naps • Add some break time between the day’s

activities and your evening wind-downactivities and your evening wind down• Form a satisfying bedtime ritual with children

and yourselfa d you se• Consult your doctor if you are feeling depressed

Sl d h Sleep and the CaregiverCaregiver

Women frequently lose sleep when caring for an ill family member

Sleep and the CaregiverSleep and the Caregiver

• 84% of caregivers for Alzheimer’s patients are84% of caregivers for Alzheimer s patients are women and on average, caregivers are sixty-five years old

• Caregivers often have to coordinate medical care and personal care for patients

• Caregivers must make sure they receive adequate sleep. If sleep deprived, caregivers h ld k h l d h h il blshould seek help and research other available

resources

Sleep Strategies for h W ki Wthe Working Woman

• Identify a specific bedtime and stick to ity p• Avoid caffeine 4-6 hours of bedtime• Gradually adapt schedule to night shifts or on

call shiftscall shifts• Say “yes” to sleep when tempted to stay up late• Deal with worries before bed or put on holdDeal with worries before bed or put on hold• Don’t skimp on sleep – most adults need 7-9

hoursE i l l l 4 h b f• Exercise regularly, at least 4 hours before bedtime

Sleep: Essential to Sleep: Essential to a Woman’s Health and Quality of Lifeand Quality of Life

A woman’s sleep is uniquely influenced by hormones, biological life stage, stress level,

health mood parental status work hours andhealth, mood, parental status, work hours and other responsibilities

ReferencesReferences

• Kryger, Meir H., A Woman’s Guide to SleepKryger, Meir H., A Woman s Guide to Sleep Disorders, McGraw Hill (2004).

• Walsleben, Joyce and Rita Baron-Faust, A , y ,Woman’s Guide to Sleep, Three Rivers Press (2000)

• Wolfson, Amy, The Woman’s Book on Sleep, New Harbinger Publications, Inc. (2001).