Insomnia is common in females due to a combination of biological and social factors. A sleep specialist can provide medication and non-medication options to support those with insomnia.
Insomnia is a sleep disorder wherein a person has difficulty falling or staying asleep. It affects about 1 in 3 adults in the United States every year.
Most people have short-lived symptoms, but about 1 in 10 have chronic insomnia disorder. This is defined as experiencing distressing insomnia symptoms on at least 3 nights per week for at least 3 months.
Although insomnia can affect anyone, a 2020 meta-analysis suggests that females are 58% more likely to experience it than males. This can have important health consequences for females. Insomnia is associated with many health effects, including an increased risk of heart disease and stroke.
The female sex hormones estrogen and progesterone are involved in a variety of processes that regulate sleep. Fluctuating levels during menstruation, pregnancy, and perimenopause can cause insomnia. Stress and mood disorders, such as anxiety and depression, can also increase the risk of insomnia in females.
“There are multiple factors — both biological and social — that account for higher rates of insomnia in women compared with men,” Dr. Jennifer L. Martin, Ph.D., told us.
Dr. Martin is a clinical psychologist and behavioral sleep medicine specialist at the University of California, Los Angeles and a spokesperson for the American Academy of Sleep Medicine (AASM).
Learn more about some of the reasons that females are more likely than males to experience insomnia, including the role that hormones play in regulating sleep, here.
Differences in sleep patterns emerge early in life. “Even in young children, there are differences in some aspects of sleep between boys and girls,” said Dr. Martin.
It is unclear exactly when differences begin.
Sleep is a dynamic process regulated by a variety of internal and external factors. These vary throughout a female’s life and can have profound impacts on sleep from childhood all the way to the postmenopausal phase of life.
The role of hormones in insomnia
The body uses hormones to quickly send messages throughout the body. Among other things, hormones are regulators of sexual function and reproduction.
They also perform a variety of other important roles, including the regulation of:
- growth and development
Two of the main female sex hormones, estrogen and progesterone, work heavily in the areas of the brain that regulate sleep. Studies suggest that these molecules have two primary sleep-related functions:
- Hypnotic effects: By regulating brain waves and sleep-wake cycles, estrogen and progesterone can directly affect sleep patterns.
- Breathing effects: Progesterone, in particular, is a strong respiratory stimulant and supports airway function and breathing during sleep.
Estrogen and progesterone levels change
Sleep in pregnancy and postpartum
Pregnancy is a challenging time for quality sleep. Not only do hormone levels change, but substantial energy is needed to support a growing fetus.
Both the amount and quality of sleep
Lack of sleep is also normal after the baby arrives. Caring for a newborn is around-the-clock work. However, for many new parents and caregivers, sleep problems can last for longer than they expected.
The study authors suggest that these findings may be due to hormonal changes and changes in work and sleep schedules. They also note that pregnancy could be a trigger for longer-term chronic sleep problems.
Sleep during perimenopause
“During menopause, many women also have trouble sleeping due to hot flashes,” Dr. Martin explained. “This tends to improve over time, but some women have trouble getting their sleep back on track after menopause.”
For some females,
Dr. Martin added that the benefits and risks of hormone replacement therapy are different for each female. “A detailed discussion between a woman and her doctor [is] needed to make an informed choice.”
Stress, depression, anxiety, and sleep
Stress and mood disorders are important factors that can also contribute to insomnia in females.
“There are also differences in how daily life differs for men and women, and these factors may impact sleep,” Dr. Martin said. “For example, even today, women still have more responsibilities related to childcare and household tasks than men. This is true even if women are working outside the home.”
She also explained that females are at increased risk of mood disorders that can affect sleep, such as anxiety and depression.
According to data from the Substance Abuse and Mental Health Services Administration, the prevalence of depression is
Stress, depression, and anxiety are significant drivers of insomnia in transgender women as well. In fact,
Dr. Martin emphasized the importance of prioritizing healthy sleep habits.
“Find a bedtime and rise time that work for you and stick to [them],” she said. “Most people know the basics, like limiting caffeine and alcohol and having a comfortable sleep environment. If you haven’t checked these things off yet, see if you can do one small improvement in one of these areas.”
People who have made these changes and haven’t seen any improvement within 3 months may have chronic insomnia. “This is the time to reach out to your doctor or a sleep specialist for help. Some people with insomnia also have other sleep disorders, so getting an evaluation from a specialist can be very helpful,” explained Dr. Martin.
The AASM has information about how to find a sleep specialist on its website.
“There are effective, safe non-medication treatments out there,” Dr. Martin noted. The recommended first-line treatment is called cognitive behavioral therapy for insomnia (CBT-I).
CBT-I involves exploring examining how thoughts, feelings, and behaviors contribute to symptoms of insomnia. It provides participants with healthy strategies to relax and establish good sleep habits. A person can seek CBT-I from a trained healthcare professional or through a digital app.
For some people, treatment for insomnia may also require medication.
Insomnia is common among females and may come and go throughout different phases of life, including pregnancy and menopause. A combination of biological and social factors increases the risk of insomnia in this group. These factors include hormonal changes and short-term or chronic stressors.
Developing healthy sleep habits can help some females. However, people who have been sleeping poorly — particularly if the symptoms have lasted for longer than 3 months — should consider connecting with a healthcare professional.
Chronic insomnia may require support from a sleep specialist, who can provide both medication and non-medication treatment as needed.