That women suffer from insomnia more than men is a pretty well-known fact, and as women age, it seems to become even more pronounced. But the cause of the gender divide, like many other aspects of health and mental health, hasn’t been totally clear. A new study, however, looks into how the sleep-wake cycle works in women and men under normal conditions–and understanding the difference in healthy individuals actually reveals a lot about why women have more trouble sleeping and why they wake up earlier than men.
The team from McGill University had 15 men and 11 women come and spend 36 hours in the lab. They subjected the participants to a “cat nap” paradigm, where they’d raise and lower the lights, so that the participants slept for an hour and rose for an hour. They measured levels of melatonin, the central sleep hormone and other, subjective variables, like wakefulness and sleepiness. They made sure to study women during two phases of their reproductive cycles, since sex hormones can affect sleep quality.
They found that women’s sleep cycles ran at an earlier phase than men’s–that is, their sleepiness tended to set in earlier, and their nighttime alertness was lower than men’s. As the authors write in their paper, published in Proceedings of the National Academy of Sciences, this essentially means that women are beginning their sleep at a later time than men, relative to how their bodies are set. And this mismatch may explain why women have a harder time falling asleep and staying asleep than men.
“For a similar sleep schedule, we find that women’s body clock causes them to fall asleep and wake up earlier than men,” said study author Diane B. Boivin in a statement. “The reason is simple: their body clock is shifted to a more easterly time zone. This observed difference between the sexes is essential for understanding why women are more prone to disturbed sleep than men.”
And the findings explain other things about why women may have more trouble with sleep than men. The team also found that internal sleep cues weren't as strong in the early hours of the morning as men's, which could explain why women are more likely to waking up in the wee hours of the morning. It also sheds light on why shift work is harder on women’s health than on men’s.
“Our participants did not exhibit any sleep problems during the study,” said Boivin. “Just the same, our results are helping us understand, among other things, why women are more likely than men to wake up earlier in the morning and feel tired after a night’s sleep. As well, women are less alert at night than men.” Previous work has shown that although working the night shift is linked to a number of health risks in both sexes, it seems to be harder on women than men and, according to the study, why women are more prone to injury during shift work than are men.
While researchers are still probing what makes for a good night’s sleep, it’s probably wise to go to sleep as soon as you feel tired (if you can). This sounds like obvious advice, but most of us ignore sleep cues and push our waking time as long as we can. And as always, don’t drink coffee or alcohol near bedtime, and try to get away from screens in the hour or two before bed, since their light is known to confuse the sleep cycle. It’s always smart to do these things, but if you’re a woman, it may be necessary to pay special attention to how your body feels, and the variables from the outside that affect it.
We all have a poor night’s sleep from time to time: those nights when you lie awake for hours trying desperately to go to sleep but can’t stop worrying about tomorrow. Or when you repeatedly wake up throughout the night, or can’t get back to sleep in the early hours of the morning.
One-third of the world’s population experience short-term sleeping difficulties. These usually last only a few weeks. But for an unlucky 3% of Australians, these sleep disturbances may last a lot longer and lead to a diagnosis of insomnia.
A person with insomnia is unable to fall asleep, stay asleep, and/or wakes up too early at least three times a week for at least three months. This can lead to considerable distress.
Sufferers experience persistent tiredness, low energy and difficulties with concentration, attention and memory. They may feel down, stressed or anxious, not only about getting a good night’s sleep but about their ability to do their daily activities.
What Causes Insomnia?
Biological, social and psychological factors interact to trigger and maintain sleeping difficulties.
Biological factors include changes to the body’s natural 24-hour body clock, or circadian rhythms, which control the timing of when we feel sleepy and awake throughout the day. Circadian rhythms are sensitive to body temperature, light and physical alertness. When there is too much or too little of a combination of these factors, the body doesn’t release enough sleep-inducing hormones such as melatonin to feel sleepy.
Social factors, such as shift work or frequent international travel, can contribute by causing our body clock to become out of sync with the environment it’s in. Our bodies adjust slowly to these changes and depend on our being able to get sunlight exposure and exercise.
Psychological factors, including unhelpful thoughts (“I’m never going to get to sleep tonight”) and behaviours (watching the clock during the night), can reduce the amount and quality of sleep a person gets.
These factors interact in complex ways. Sleep sensitivity, or a family history of sleep disturbance, for example, make some individuals vulnerable to developing insomnia because they’re more likely to have their sleep disturbed by stressful events, such as a relationship breakdown.
Being unable to fall asleep often leads to bedtime worrying, which makes it even harder to fall asleep. To try to make up for a lack of sleep, you might then start going to bed earlier, sleep in or take daytime naps. Over time, these unhelpful thoughts and behaviours can create a cycle that makes the insomnia worse.
How Do You Treat Insomnia?
Successful treatment of insomnia requires getting help to change as many of the interacting factors as possible, rather than trying one or two things in isolation. This is what cognitive-behavioural therapy, or CBT, tries to do.
CBT re-trains people to view the bedroom as a place of sleeping instead of a place where they lie awake tossing and turning and worrying about not sleeping. CBT also helps people change their lifestyle and sleeping environment, learn relaxation skills and challenge the unhelpful worries and beliefs that contribute to insomnia.
CBT has been found to reduce sleeping difficulties by 50% on average, and reduces insomnia symptoms to a level where they are no longer considered clinically severe.
When people visit their GP for insomnia treatment, they’re often encouraged to use many of the techniques CBT uses. But these skills are difficult to teach in a short consultation, so many patients don’t use them.
Sleeping medications may then be prescribed to help a person fall asleep and stay asleep when correctly used for a short period. But sleeping medications only provide short-term relief and can be harmful or addictive if used longer term.
If your symptoms persist, your GP may refer you to a specialist doctor or psychologist for CBT.
Another credible alternative is web-based treatment. Research from Japan to America shows that, for some people, online insomnia treatment modules may be as effective as visiting a health professional in person.
We’re piloting a seven-week, interactive CBT program to help Australians with insomnia, called Sleep-e. So far, the data looks promising, suggesting it can reduce the severity of insomnia in people waiting for treatment at a public hospital-based insomnia clinic.
To get a good night’s sleep, try to establish a relaxing bedtime routine. Limit the use of computer tablets and mobile devices before bed. If you can’t sleep, get up and do a relaxing activity, such as reading a book, and return to bed only when you feel sleepy again.
Online programs can help you to practise good sleep hygiene habits, change unhelpful sleeping patterns and reduce the worry that can contribute to insomnia, helping you to get a better night’s sleep.
