Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.
Insomnia is a common symptom for which women seek medical advice. Insomnia is characterized by problems initiating sleep, staying asleep, or returning to sleep after waking up.
Insomnia rarely occurs in isolation. It’s usually present alongside other medical, psychiatric, and sleep conditions. Insomnia could also be associated with stress, sleep habits, and the environment.
Anyone can have insomnia; however, women are more likely to have insomnia compared to men. The exact reason for this is not known. Researchers believe it could be due to the influence of hormones and other factors.
Insomnia generates over five million office visits per year in the United States, making it one of the most common patient complaints.
About 30-40 percent of adults in the United States experience insomnia per year. The estimated prevalence of short-term insomnia in the United States is 9.5 percent. About 1 in 5 cases of short-term insomnia cases transitions to chronic insomnia.
According to the National Health Interview Survey data, the unadjusted prevalence of insomnia increased by 8 percent over a decade, from 17.5 percent in 2002 to 19.2 percent in 2012.
Insomnia is more common in women than in men. Various studies show a higher incidence and prevalence of insomnia amongst women. It’s estimated that women have a 40 percent higher lifetime risk of insomnia than men.
Causes of Insomnia in Women
The causes of insomnia for women are varied, and they are not always the same compared to the causes in men. Insomnia usually results from an interplay of various risk factors. These risk factors could be:
- Genetic Factors: Some women have a genetic predisposition for insomnia. Although these genetic factors have not been well elucidated, they are often congenital abnormalities associated with other conditions like depression, type 2 diabetes, anxiety, coronary artery disease, etc.
- Advanced Age: Older women are more likely to have insomnia. Women in menopause or peri-menopause are at higher risk of insomnia.
- Family History: Someone with a relative who has insomnia is at a higher risk of having insomnia.
- Pregnancy: Up to 30 percent of women complain of sleeping troubles during pregnancy. Insomnia in pregnancy is usually due to hormonal changes associated with pregnancy. Estrogen and progesterone are involved in the regulation of sleep. Their levels vary during pregnancy, and these changes in pregnancy can lead to sleeping problems.
- Psychiatric Disorders: Insomnia is often present with psychiatric disorders. Psychiatric disorders can sometimes have insomnia as a symptom. Psychiatric conditions like depression are more common amongst women.
- Stress and Anxiety: Physical and mental stress can alter the levels of hormones regulating your sleep. Changes in the amount of these hormones can lead to sleep problems.
- Urinary incontinence: Women tend to have a smaller bladder capacity. Pregnancy reduces the bladder capacity of women, making them more predisposed to insomnia. It may interrupt sleep as they wake up to void their bladder. Women with urinary problems might find it difficult to fall asleep after waking up.
- Drugs: Substance abuse, like drugs and alcohol, could cause insomnia.
- Primary Medical Conditions:
- Obstructive sleep apnea: A disorder where there is a restriction of airflow. It causes difficulty in breathing during sleep.
- Chronic pain
- Heart failure
Types of Insomnia
- Short-term insomnia: It’s otherwise known as acute insomnia. It usually results from exposure to a stressor which could be physical, mental, or psychological. It lasts a few days to a few weeks, but symptoms are present for less than three months.
- Symptoms usually resolve when the stressor resolves. Occasionally, these symptoms of short-term insomnia could persist, leading to the development of chronic insomnia.
- Chronic Insomnia: Your doctor might tell you that you have chronic insomnia if your sleep troubles occur at least three times per week and persist for at least three months. Your chronic insomnia might result from initial short-term insomnia.
- Difficulty initiating sleep
- Difficulty staying asleep
- Waking up early and being unable to return to sleep
- Impaired daytime function: These could manifest as daytime sleepiness, poor attention, mood disturbance.
- Symptoms might be present with symptoms of other medical or psychiatric conditions.
Your doctor might say you have insomnia if you have the symptoms stated above, advising you to keep a sleep diary (a record of sleep times, sleep problems, and quality). The sleep diary will help your doctor evaluate your sleep without errors.
Your doctor might also assess your symptoms with some questionnaires, including the Epworth Sleepiness Scale (ESS) and Sleep Disorders Questionnaire (SDQ). Your doctor might also require you to take laboratory tests depending on other conditions that co-exist with your insomnia. Other testing modalities include polysomnography, actigraphy, and home sleep apnea testing.
According to the International Classification of Sleep Disorders (ICSD-3), your doctor will confirm insomnia when all four of the following criteria are met:
1) Difficulty initiating, maintaining sleep, or waking up too early
2) Sleep difficulties despite adequate sleep opportunity for sleep
3) Impaired daytime function
4) When sleep-wake difficulty is not explained by another sleep disorder
Treatment of insomnia could be behaviorally or medicinally based. Your doctor might initially recommend behavioral-based treatment for your insomnia; however, if your insomnia is severe, your doctor might prescribe medication.
Cognitive-Behavioral Therapy for Insomnia (CBT-i): A first-line therapeutic approach that consists of 5 straightforward modules, namely stimulus control therapy, sleep restriction therapy, cognitive restructuring therapy, relaxation therapies, and sleep hygiene. The components of sleep hygiene include:
- Creating an ideal sleep environment
- Having a consistent sleep-wake schedule
- Going to bed only when tired
- Avoiding late-evening exercise
- Refraining from stimulating drinks or drugs at bedtime
Medicinal Treatment: The choice of drug will depend on intrinsic factors like your age, comorbidities, the side effect of drugs, etc. Medications for sleeplessness include:
- Histamine receptor antagonists
- Melatonin receptor agonists
Untreated insomnia in women can increase the risk of developing other conditions, like high blood pressure. However, if promptly treated, it’s possible to maintain quality of life.
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