Insomnia is a common sleep disorder that tends to be more frequent in women. Insomnia refers to general trouble sleeping, whether it is trouble falling or staying asleep. Specifically in women, there are particular time periods when certain sleep disorders are more common. For example, insomnia in women tends to be more common during the last trimester of pregnancy; the enlargement of the stomach results in difficulties with positioning during sleep. Insomnia can also be more frequent in wo men who are going through menopause who may be awoken at night by hot flashes.
Sleep disorders can actually present differently in women compared to men, leading to difficulties in diagnosis. For example sleep apnea in women is more likely to present with insomnia rather than the typical sleepiness during the daytime and this can sometimes delay diagnosis. REM behavior disorder (a condition in which there is physical enactment of dreams), tends to present as nonviolent movements in women. The atypical presentation of sleep disorders can lead to a delay in medical treatment.
Various conditions that are more common in women can contribute to difficulty with sleep initiation and maintenance. For example migraine can be a cause of insomnia, which in turn can worsen headache and thus create a vicious cycle.
The relationship between sleep and hormones is complex and the outcomes are not very predictable. But by and large estrogen tends to make women a little more alert, it may make them less sleepy, and progesterone can make women a little calmer. The relationship is quite complex because it can vary by individual, and by cycle when the hormone levels fluctuate.
First are changes that happen with age in anyone, which includes some changes in the amount of sleep that is obtained. It is still not clear whether the sleep need is decreased in older adults; however the amount of sleep people who are sixty and above obtain is a little bit less and is more fragmented than what younger adults obtain. Interestingly the frequency of insomnia appears to change with age, with the rates of insomnia complaints rising until a certain age and then dropping.
And then there is an effect of the hormones, one of the consequences is that the difference between the frequency of sleep apnea in men and women becomes less pronounced. Women have to be aware that they can develop sleep apnea, especially after menopause. And so those are the two major things to watch out for during menopause, sleep apnea and insomnia, they both may become more prominent.
It is important to tell your primary care physician if you feel like you may have a sleep disorder. Most of the diagnosis is based on history, so telling your doctor and giving a good history of what is happening on a regular basis is important. A good history includes things that happen during sleep, such as snoring and leg movements. Also if you are regularly falling asleep during the daytime is important to let your provider know. Leg movements tend to become more prevalent with age. REM behavior disorder or the acting out of dreams can sometimes precede other medical or neurological disorders. Sleep apnea is common especially with advanced age. It is important to tell your doctor about any disruptive snoring, gasping at night, or difficulty staying awake. Sleep apnea can increase the risk of other diseases, including stroke and heart attack and should be treated if present. Thus, it is important you tell your doctor of any problems with sleep.
On your first visit a detailed history will be taken. From the history and physical evaluation a personalized treatment will be recommended. And depending on the symptoms a plan for follow-up will be determined. With insomnia, patients are followed relatively frequently because there could be a lot of changes that need to be done at the beginning of treatment. This is because it is difficult to know which medications will be helpful from the very first interview. There are guidelines for the medications but individual response, which is not possible to measure, has to be considered. Once the treatment stabilizes patients are usually followed on a yearly basis.
The process for diagnosis and treatment of sleep apnea is evolving. Generally, now a patient with suspected sleep apnea first will see a specialist, and typically then have a sleep study. After they are diagnosed and treatment has started, patients are usually follow-up initially more frequently (~1 month), and subsequently more rarely – yearly when the treatment is set.
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