It's Harder to Sleep if You're a Woman

It is exhausting being a woman, and often literally: According to CNN, women are more likely than men to suffer from insomnia. A study titled "Sleep in America" conducted by the National Sleep Foundation in 2005 found that 57 percent of women reported symptoms of insomnia a few times a week, compared to 51 percent of men. Causes include hormones, periods, restless leg syndrome (itself twice as common in women as in men), and other sleep-depriving health conditions that skew female, such as anxiety, depression, and fibromyalgia.

In other words, sleep disturbances come from both internal and external factors, and many of those factors affect women more. As with many side effects of bearing a uterus, "the ways hormones including estrogen and progesterone impact sleep quality are not fully understood," says Dr. Jennifer Martin, a member of the board of directors for the American Academy of Sleep Medicine (AASM) and associate professor at the David Geffen School of Medicine at UCLA. "Estrogen and progesterone do impact the brain and influence both sleep itself and internal biological 'circadian rhythms.'"

"Particularly during the end of the menstrual cycle (just before a woman has her period) and in the first days of a menstrual period, some women experience more sleep disturbances," Martin says. And women on hormonal birth control are not exempt from these symptoms. "Some women may experience improved sleep if use of hormonal birth control regularizes or reduces other symptoms related to menstruation; however, some women may experience worse sleep when using hormonal contraception."

Both pregnancy and motherhood are also factors. "Pregnancy can impact both the amount of time women sleep, especially during the first trimester, and can disrupt sleep quality, especially during the third trimester," Martin says. Although these changes will improve after a woman gives birth, motherhood swoops in to take their place: In a poll conducted by the National Sleep Foundation, 74 percent of stay-at-home-moms reported suffering from insomnia. Later on, menopause and related symptoms create sleep disturbances, too.

As far as external factors go, stress is the primary culprit. While hormones and fluctuating iron levels during the menstrual cycle can make women fatigued, Martin and other experts say that stress is especially harmful for women suffering from insomnia.

"Chronic insomnia is more common in women than men overall, and part of this may be due to stressors commonly faced by women," Martin says. These stressors can range from small-scale domestic particulars, which often fall to women, to major issues—like sexism at work—that chip away at women's mental health over time. And even if men and women experience the same amount of stress, they respond differently: According to the American Psychological Association (APA), stress demonstrably affects women more in several key ways. In a 2010 APA study, 28 percent of women and 20 percent of men reported feeling "a great deal" of stress in their lives. Forty-nine percent of women in the same study also reported that stress had kept them up at night at least once in the past month; women were also significantly more likely (41 percent vs. 30 percent) to experience physical or emotional symptoms because of their stress.

Difficulty sleeping certainly falls into this category. "It is important to note that occasional difficulties with sleep related to stress are a normal part of our biological 'stress response'," Martin says. "However, stress can sometimes lead to insomnia that persists long after the stressful situation itself has been resolved."

Insomnia is frequently reflexive: Worrying about insomnia can cause more insomnia. Sufferers often end up "catastrophizing" small events—such as the fact that they're not sleeping—that keep them up at night. "Catastrophizing refers to thoughts related to catastrophic outcomes of, for example, a single night of poor night of sleep," Martin explains. "Catastrophizing about sleep loss is a major contributor to insomnia." While Martin notes that both men and women are prone to these out-of-proportion thoughts when experiencing insomnia, women are particularly susceptible. "It is true that the way one approaches stress relates to how much sleep is disrupted," she says. "A recent study found that it is not the number of stressors, but your reaction to them, that determines your likelihood of insomnia." According to the APA, 78 percent of women say that getting a good night's sleep is "extremely or very important," while only 58 percent of men say the same. What's more, in the "Sleep in America" poll, men also said they need less sleep (a minimum of 6.2 hours) than women report they need (6.8 hours minimum) to function at an optimum level.

But although researchers and sleep specialists have long known women have more trouble with insomnia, it's still difficult to treat. Martin advises against relying on sleeping pills—which women are also more likely to take—and instead treats her patients with cognitive-behavioral therapy, or CBT, specifically for insomnia. "Cognitive-behavioral therapy for insomnia is now considered the best available treatment for chronic insomnia disorder," she says. "This approach is as effective, if not more effective, than sleeping pills. A key advantage of CBT-I is that possible side effects (such as feeling sleepy the following day) of hypnotic medications are avoided."

Barring that, there are adult coloring books.