Inadequate or dissatisfying sleep is the most common sleep disturbance in America. As many as 40% of adult Americans report at least occasional insomnia, and of those, nearly 20% have severe insomnia. Severe insomnia is defined as difficulty initiating or maintaining sleep at least three times a week for 1 month or more, with the problem being bad enough to cause fatigue during the day or impaired functioning.

Women are 30% more likely than men to report their insomnia, and it is more likely to be more severe. Sleep problems are especially common in peri-menopausal women and increase after age 40 and plateau by age 50. Sleep problems are also more concomitant with medical and psychiatric disorders, which are more prevalent, or at least more reported, in women.

Women and men over 65 are 50% more likely to complain of insomnia than younger individuals. Chronic health problems and increased use of medications associated with aging also increase the risk of sleep disruptions.

Twenty-nine percent of women report medications needed improve their sleep. Of those, nearly one-third rely on over-the-counter drugs, 13% use prescription drugs, and others use both.

Effects of Sleep Disruptions

Insomnia is associated with quality of life, productivity, depression, anxiety, cognition, and even safety. Individuals with insomnia have significantly greater impairment in their daily life functions than people without insomnia. Psychomotor and cognitive performance, attention, response time, and work performance, are all disrupted and altered in patients with sleep disorders.

The good news is that they are all reversible with treatment of the insomnia. Insomnia may also be associated with an increased risk of developing cardiovascular disease. In one study, women who had trouble with sleep onset or who had night time sleep interruption had significantly higher systolic and diastolic blood pressures than women without these sleep problems.

Determining the specific underlying cause of the insomnia is not only important in selecting the appropriate treatment, but important in recognizing other concurrent medical conditions that may need treatment. Insomnia is considered a symptom of an underlying problem.

Medical conditions and issues that can cause insomnia include hormonal changes, headaches, respiratory problems, arthritis, fibromyalgia, psychiatric and mood disorders, congestive heart failure, GERD, restless leg syndrome, anxiety, nocturnal hypoglycemia, chronic or intermittent pain, cancer, Alzheimer’s disease, Parkinson’s disease and peripheral vascular diseases.

A thorough history, physical exam and selected medical testing should be done to determine a differential diagnosis for any of these other conditions. Other causes can include caffeine, alcohol, nicotine, recreational drugs, medications, and stress.

Determining the chief sleep symptom is the first step in the evaluation process of insomnia. For example, difficulty in falling asleep, early awakening, and frequent night time awakenings. A sleep diary can be useful in identifying the sleep problems.

The diary should indicate bed times, awakening times, timing and quantity of meals, use of alcohol, caffeine, drugs, medications, exercise and its timing, duration of sleep, and rating of the sleep quality. Snoring can be reported by their bed partner. The diary should be kept daily for at least several weeks or even months in order to properly assess sleep patterns.

Sleep Problems Specific to Women

Menstrual Cycle: Sleep quality can vary during the menstrual cycle in premenopausal women. More sleep disturbances have been found during the late luteal phase compared with the midfollicular phase although these differences can be small or significant depending on the individual.

Women can experience a longer time falling asleep and more awakenings after sleep onset as well as decreased sleep quality and efficiency during the premenstrual phase. It has been thought that the luteal phase sleep disruptions may be due to an increase in core body temperature.

Women with premenstrual dysphoric disorder (PMDD) tend to have a higher percentage of stage 2 sleep (relatively light non-rapid eye movement), especially in the follicular phase, and less stage 3 sleep (deep non-rapid eye movement), in both phases of the cycle. They also have a lower percentage of rapid eye movement (REM) sleep, greater intermittent wakefulness and more disturbed sleep patterns.

Menopause: Women may experience many sleep disturbances during the perimenopause transition and menopause itself, especially those who do not take hormone replacement therapy (HRT). These sleep problems may be due to nighttime vasomotor symptoms, anxiety, or the effect of hormonal changes on brain neurotransmitters.

HRT is not FDA-approved as a treatment for insomnia. However, oral HRT has been shown to improve nighttime restlessness and awakening and is proven to relieve vasomotor symptoms. HRT has also been observed to decrease sleep disordered breathing. Using natural progesterone vs a progestin may also improve sleep due to the sedative effects of natural progesterone.

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This entry was posted on Saturday, October 13th, 2007 at 3:37 pm and is filed under Insomnia. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.