Often overlooked and undervalued, quality sleep is one of the most powerful tools at your disposal. While we often focus on nutrition and exercise, the truth is, without quality sleep, the benefits of these efforts can be significantly diminished.
One third of women have difficulty sleeping, and most report poorer quality sleep than men, and lack of. The long-term impacts of this are often dismissed as everyday symptoms like fatigue, muscle soreness, decreased alertness, obesity, depression, anxiety, low motivation, mood swings, and irregular menstrual cycles. However, sleep plays a major role in most aspects of a woman's life.
By making a few simple lifestyle changes and prioritising a sleep routine, just as we would exercise, work, or nutrition, we can significantly improve our quality of life.
Quality sleep is often deemed a luxury in modern society, but it is an essential and fundamental component of health that can enhance nearly every aspect of our daily functioning.
What Happens When We Sleep?
Sleep is a complex process that plays a vital role in overall health and well-being. It consists of several stages, each serving distinct functions crucial for physical and mental restoration. The sleep cycle includes two main types of sleep: non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. NREM sleep is further divided into three stages.
During NREM Stage 1, the body transitions from wakefulness to sleep. This stage is light and brief, lasting only a few minutes.
NREM Stage 2 follows, characterised by deeper relaxation and a decrease in body temperature and heart rate. This stage promotes the consolidation of memories and enhances learning.
NREM Stage 3, also known as slow-wave or deep sleep, is essential for physical recovery and restoration. During this stage, the body repairs tissues, boosts immune function, and releases growth hormones crucial for muscle development and repair.
REM sleep occurs approximately 90 minutes after falling asleep and is marked by rapid eye movements and vivid dreaming. This stage is critical for cognitive functions such as memory consolidation and emotional regulation. REM sleep stimulates the brain regions used in learning and can enhance problem-solving skills and creativity.
Throughout the night, the body cycles through these stages multiple times, with each cycle lasting about 90-120 minutes. Each stage plays a vital role in maintaining overall health and cognitive function, highlighting the importance of achieving sufficient and quality sleep for optimal well-being.
Consistent inadequate sleep can disrupt the entire sleep cycle, affecting the body's ability to repair and regenerate tissues, consolidate memories, and maintain overall health and well-being.
Sex Differences in Sleep
Sleep needs and patterns vary between men and women due to biological, hormonal, and social factors. Research indicates that women, on average, require 11 additional minutes of sleep each night compared to men. Despite this, many women struggle to achieve the quality and quantity of sleep they need.
Women generally fall asleep faster and spend more time in deep sleep stages than men. Deep sleep, also known as slow-wave sleep, is crucial for physical and mental restoration. This suggests that women have a greater physiological need for sleep. However, despite spending more time in these restorative stages, women often report poorer quality sleep, and more disturbances.
One-third of women have trouble sleeping, and they are 40% more likely to experience insomnia compared to men. Insomnia, characterised by difficulty falling or staying asleep, can have significant impacts on hormonal health, and is one of the most frequently reported health complaints among perimenopausal women. Sleep disturbances are also commonly reported during pregnancy and tend to increase in frequency and duration as the pregnancy progresses.
Women often juggle multiple responsibilities, including paid work, unpaid household labor, caregiving duties, and family responsibilities. These roles can lead to sleep disruptions as women are more likely than men to wake up during the night to attend to household or caregiving tasks or take naps during the day. Such interruptions can significantly impact sleep quality and contribute to feelings of sleep deprivation.
Hormonal fluctuations and social factors can significantly impact women’s sleep patterns. Additionally, the circadian rhythm plays a crucial role in regulating sleep-wake cycles. Women's circadian rhythms can be influenced by hormonal changes throughout the menstrual cycle, pregnancy, and menopause, further complicating their sleep patterns and needs.
Circadian Rhythm
Humans live according to a 24-hour cycle of light and darkness. Our body's internal clock, located in the brain's hypothalamus, is synchronized to this daily pattern through signals from the eyes. This clock helps regulate our sleep-wake cycle and other biological processes. Light exposure affects when we feel sleepy or alert.
With the advent of artificial light, our exposure to light during the evening and night has increased, disrupting our natural sleep-wake cycle. This can lead to circadian rhythm sleep-wake disorders, where our internal clock is out of sync with the external environment.
For women, this disruption can be further complicated by hormonal changes. Women note more fluctuations in sleep quality, disturbances, insomnia, wakeups, and non-restorative sleep during the pre-menstrual week and the first few days of menstruation compared to other times in their menstrual cycle. Additionally, women with premenstrual syndrome often report more disturbing dreams or nightmares, as well as symptoms like sleepiness, fatigue, decreased alertness, and concentration.
The circadian rhythm and menstrual cycle are interconnected, meaning that changes in one can affect the other.
The Menstrual Cycle
Menstrual and circadian rhythms interact in women, influencing each other such that circadian rhythms are modified based on the phase of the menstrual cycle and menstrual irregularity has been linked to disrupted circadian rhythmicity.
The menstrual cycle in healthy women involves cyclic variations in the production of hormones like estradiol, progesterone, luteinizing hormone, follicle-stimulating hormone, prolactin, and growth hormone. These reproductive hormones not only regulate reproductive processes but also impact sleep and circadian rhythms, among other functions.
Progesterone, which rises sharply during the luteal phase following ovulation, has a sedative effect and can promote feelings of relaxation. However, a study found a rapid increase in progesterone levels during this phase has been associated with disrupted sleep, characterised by increased nighttime awakenings and overall poorer sleep quality. This suggests that while progesterone contributes to sleep-promoting effects, its fluctuations can also disrupt sleep architecture, particularly if the rise is too abrupt or excessive.
Estrogen, another key hormone in women's reproductive cycles, promotes REM sleep, the phase where dreaming occurs, and is involved in memory consolidation. However, fluctuations in estrogen levels, especially during menopause, can lead to hot flashes and night sweats, disrupting sleep. Estrogen levels fluctuate throughout the menstrual cycle, peaking during the follicular phase and declining during the luteal phase. These fluctuations can influence sleep patterns by interacting with other hormones such as cortisol and melatonin. Cortisol, known as the stress hormone, follows a diurnal rhythm that peaks in the morning and gradually declines throughout the day. Estrogen can modulate cortisol levels, affecting how alert or relaxed a person feels during different times of the day. Additionally, estrogen has a complex relationship with melatonin, a hormone that regulates the sleep-wake cycle. Estrogen can affect melatonin production and sensitivity to light, which in turn impacts the timing and quality of sleep. These intricate interactions highlight how hormonal changes, particularly those involving estrogen, can affect women's sleep patterns and overall sleep quality.
Melatonin is crucial for regulating the sleep-wake cycle. Produced in response to darkness, melatonin levels typically rise in the evening, signaling the body to prepare for sleep. Exposure to light at night, especially blue light from electronic devices, can suppress melatonin production, making it more difficult to fall asleep and stay asleep. The menstrual cycle influences melatonin secretion, with studies showing 4.5 times higher melatonin levels during the late luteal phase compared to the follicular phase. This rise coincides with the peak in progesterone levels after ovulation, suggesting a coordinated hormonal influence on sleep patterns across the menstrual cycle.
In addition to hormonal changes, the human body temperature follows a circadian rhythm, fluctuating by 0.8–1 °C between daytime highs and nighttime lows. Women with ovulatory menstrual cycles exhibit an additional temperature rhythm tied to menstrual phase; during the luteal phase, body temperature typically increases by about 0.4 °C compared to the follicular phase. This increase in body temperature can influence sleep patterns, as higher body temperature is associated with increased wakefulness and lighter sleep stages.
Disrupted Sleep, Health Risks & PMS
Ignoring sleep can have significant long-term health consequences:
Mental Health: Poor sleep is directly linked to higher risks of anxiety and depression.
Reproductive Health: Sleep disruptions can affect menstrual regularity and fertility.
Overall Health: Poor sleep is associated with a greater risk of mortality, cardiovascular diseases, obesity, and certain cancers. Studies have shown that women who get adequate sleep live two years longer than those who don't.
Disrupted circadian rhythmicity, such as with shiftwork, affects reproductive function in women. Working shifts increases menstrual cycle irregularities and painful menstruation: 53% of pre-menopausal women working shifts reported changes in menstrual function compared to approximately 20% of women in the general population.
Working night shifts has been linked to a shorter life expectancy, with increased risks of health problems such as cardiovascular diseases, obesity, and certain types of cancer. It disrupts the circadian rhythm, affecting sleep quality and recovery from demanding shifts, especially for older employees. In 2007 the World Health Organisation classified night shift work as a probable carcinogen due to circadian disruption.
According to a study involving 172,321 adults, women who get adequate sleep live two years longer than women who don't. Regularly getting enough sleep resulted in an 18% reduction in risk of death, which was similar to managing stress levels and eating a healthy diet.
In a study spanning 22 years involving 74,862 women aged 30-55, it was found that 14,181 deaths occurred, revealing significantly higher all-cause and cardiovascular disease mortality among those who worked rotating night shifts (defined as just 3 nights per month) for 5 years or more, compared to women who never worked night shifts. Mortality from all causes appeared to be 11% higher for women with 6-15 years of rotating night shift work. CVD mortality appeared to be 19% and 23% higher for those groups, respectively. And, for those that worked 15+ years lung cancer mortality increased 23%.
Although, for most women, quality sleep may seem impossible, there is some research suggesting certain lifestyle changes can improve sleep quality.
Tips for Improving Sleep
Routine: just as you would follow a training program, meal plan, or work schedule, sleep requires a routine too.
Before Sleep (2 hours):
Warm Light: warmer hues, such as yellow or orange, even red, are preferable to cooler hues like blue light from electronics. Tip: try lighting a few candles and changing the bulbs in your bedroom or reading lamp to a warm incandescent bulb. Turn off phones, tv, computers, spend time reading, playing board games with the family, meditation, breath-work etc.
Regular Sleep/Wake Time: hormones are released on a 24-hour cycle, and are impacted by our habits, set a regular sleep and wake time and stick to it every night.
No Disturbances: Set aside any disturbances like phones, place them on the other side of the room, use an alarm clock rather than your phone.
During Sleep:
Cool Room: optimal room temperature is between 18-20 degrees.
Dark Room: sleep in a dark room, curtains closed, preferably be close enough to the window so you can pull the curtains open when you wake.
After Sleep (1 hour):
Set the Tone: don't reach for the phone immediately. Tip: use an alarm clock, then start increasing the time without your phone, start with a shower, then get ready, have breakfast, morning journal, walk, breath-work etc. - how you start your day sets the tone for the rest of the day.
Morning Light: open the curtains and sit in the sun, if you have a balcony go outside for some fresh air and direct sunlight. It's best to do this immediately upon waking, but you can wait until you are having breakfast. Tip: 20 minutes of direct sunlight in the morning improves quality sleep that night.
The Menstrual Cycle:
Follicular Phase (days 1–14): Progesterone and estrogen levels begin increasing, which can lead to increased energy and alertness during this time — this heightened alertness may make it harder for you to fall asleep as you normally do.
Morning Exercise: move your exercise routine to the morning.
Limit Stimulants: try to avoid caffeine, pre-workout and stimulants, especially after 10am.
Ovulation (days 14–16): Progesterone and estrogen levels peak again and can potentially cause an increase in body temperature, which could disturb someone’s ability to fall asleep throughout the rest of the cycle.
Cool: turn a fan on, the air con down, even change the sheets to a cooler fabric.
Luteal Phase & Menses (days 17-28): Serotonin decreases, which can affect mood and how someone feels physically — all of which will impact sleep. Additionally, women who do not have enough progesterone relative to estrogen may be more likely to experience PMS symptoms, including sleep disturbances.
Sleep More: due to the hormonal variations throughout the menstrual cycle, women often require more sleep pre-period. Aim to go to bed 15-20 minutes earlier.
Recovery: focus on additional recovery techniques like sauna's which increase human growth hormone, which is essential for repair and growth.
Nutrition: metabolism increases around 10-20%, with an increase in protein requirements by 12%. Consuming more food will aid in the production of hormones required for adequate sleep.
Supplements: magnesium promotes relaxation and muscle function, and eases other premenstrual symptoms, and vitamin B6 supports the production of melatonin.
Tips for New Mother's (Because I know you're going to say 'that's impossible'):
Co-Sleeping: From both a psychological and biological standpoint, babies are not naturally designed to sleep entirely on their own. Your baby depends on you, day and night, to provide for their needs. The benefits go beyond improved sleep for you, the carbon dioxide that the mother exhales will stimulate her baby to keep breathing, thus preventing apnea (periods in which a baby may stop breathing). This also results in fewer dips in a baby's blood oxygen level. I urge you to look into this, there are many ways you can co-sleep that don't involve any risks - only benefits for you and baby.
Shifts: If you are split carer then ask for your nights off during the luteal phase. If you're majority carer, see if you can get assistance a few nights pre-period, or the days you feel you need more sleep. Ask a friend, family member, even a nanny - it's ok to ask for help.
Nap: If you can't get assistance during evenings, try daytime naps, and sleep when baby does.
Other tips:
Exercise Daily: moderate to vigorous exercise can reduce the time it takes to fall asleep, and just 30 minutes of moderate daily exercise (brisk walking, swimming, weightlifting etc.) improves sleep quality.
Nutrition: diets high in fiber, protein, complex carbohydrates and healthy fats have been proven to improve sleep quality. Consume food within 1-2 hours of waking and try not to have dense heavy meals before bed, finish your meals 1-2 hours before bed.
Caffeine: has many health benefits, but when taken to close to sleep (either side) it can disrupt hormone release and sleep quality. Limit intake and stop several hours prior to sleep, and don't consume within the first 90 minutes of waking as it can interrupt the natural cortisol rhythm.
Alcohol: while alcohol makes you sleepy and fall asleep faster, it disrupts hormone release and sleep cycles, causing poor quality sleep and a cascade of imbalances.
Sleep is not just a restorative process; it's a fundamental component of overall health and well-being. By understanding the unique ways sleep interacts with hormones and the menstrual cycle, women can take proactive steps to enhance their sleep quality and, consequently, their quality of life.
Remember, prioritising sleep isn't just a luxury; it's a necessity for optimal health and vitality. Good nutrition and exercise will not counteract poor sleep habits, making it crucial to give sleep the attention it deserves.
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