New guide provides evidence-based overview of key sleep challenges faced by women

Dec 18 2017

Though sleep is essential to health and wellbeing, the unique barriers faced by women in maintaining good sleep health are often misunderstood or overlooked, according to a new resource "Women & Sleep: A Guide for Better Health" developed by the Society for Women's Health Research (SWHR^®) Interdisciplinary Network on Sleep. The guide provides an evidence-based overview of key sleep challenges women face throughout the lifespan. The Sleep Network also partnered with patients from MyApnea.org to develop "Women & Sleep Apnea," to raise awareness on a disorder that is widely perceived as a "man's disease." Both resources are designed to help women and their healthcare providers address sleep problems.

"Healthy sleep is essential for physical, emotional, and cognitive health just as a healthy diet and physical activity are. Yet, the barriers to healthy sleep faced by women are often overlooked, dismissed or accepted as an unavoidable part of life," said Susan Redline, MD, MPH, SWHR Network on Sleep Chair and Professor of Sleep Medicine, Harvard Medical School. "These are not unsolvable problems and this guide will help women and their healthcare providers improve diagnosis, treatment, and management of sleep disorders and circadian rhythm disorders."

Research has linked poor sleep - including short sleep duration and circadian disruptions, as well as sleep disorders such as sleep apnea and insomnia - to chronic health problems such as obesity, cardiovascular disease, diabetes, stroke, cancer, mental illness, and dementia. However, the sleep needs specific to women are under-recognized. The SWHR Network on Sleep guide addresses sleep challenges for women in three areas:

• Sleep challenges across the lifespan, including the impact of hormonal changes, challenges of pregnancy and early parenthood, impact of sleep on fertility, and the role of menopause
• Types of sleep and circadian rhythm sleep-wake disorders, including sleep apnea, insomnia, restless legs syndrome, hypersomnia, shift work sleep-wake disorder, and parasomnias, which are abnormal movements or behaviors during sleep
• Impact of sleep and circadian rhythm sleep-wake disorders on health and well-being, including heart disease, diabetes, mental health, cancer, pain, and cognitive decline

The SWHR Network on Sleep developed additional resources to highlight the specific challenges of sleep apnea in women, in partnership with patient representatives from MyApnea.org. Approximately 90 percent of women with sleep apnea are undiagnosed. The toll of sleep apnea is well documented, with short-term impact including fragmented sleep, low blood oxygen, sleepiness, and cognitive deficits, and over time, increased risk for vehicle crashes, high blood pressure, heart disease, stroke, and diabetes. "The health consequences of a missed diagnosis are profound and it's critical to recognize that the signs and symptoms of sleep apnea in women are different, and often more subtle, than the hallmark of loud snoring we associate with sleep apnea in men," said Redline.

The SWHR Interdisciplinary Network on Sleep brought together 12 researchers and clinicians across sleep-related fields, including epidemiology, obstetrics/gynecology, neurology, pain, physiology, psychiatry, pulmonology, and sleep medicine. Launched in 2014, the Network promotes awareness, education, and research that highlights sex and gender differences in sleep and circadian rhythms, and their impact on health and well-being across the lifespan. "This work facilitates discussions between women and clinicians about sleep," said SWHR president and CEO Amy M. Miller, PhD. "While more research is needed to expand scientific understanding of sleep disorders and the differences between women and men that impact sleep, there is a lot we do understand and can address though awareness and dialogue about how sleep disorders can be successfully managed."

The sleep guide assesses both the sex and gender-based factors that can impact women's sleep health. Research shows that women generally sleep longer and may have a higher sleep need than men. Various social and cultural factors impact women disproportionately. Women are often the primary caregiver for their families and frequently have jobs that require shift work. Single parents, especially women, who are the sole source of family income and childcare, are at higher risk for short sleep duration and insomnia.

Women in general are 40 percent more likely to suffer from insomnia or symptoms of insomnia compared to men, and the causes for this disparity are unclear. "Research into how the brain controls sleep suggests that the neuronal pathways controlling sleep may be different between males and females. Such evidence makes it tempting to speculate that the sleep circuitry for women is different than it is for men, and when combined with those social factors, it may leave women at higher risk for sleep disorders," said Jessica Mong, PhD, SWHR Network on Sleep Co-Chair and Professor of Pharmacology, University of Maryland School of Medicine. "While there are many interventions that can help address these disorders, sometimes it be as simple as improving sleep hygiene. The health risks of not taking action are simply too great to ignore this critically important component of women's health."

SWHR leads the way in advocating for greater funding for women's health research and for the study of biological differences between women and men that affect disease, its presentation, and treatment; promotes the inclusion of women and minorities in medical research; pushes for the analysis of research data for sex and ethnic differences; and informs women, healthcare providers, and policymakers about women's health issues.​​