Seep directly affects the quality of life, health, and performance in daily activities of any individual. Therefore, it is fundamental to have a night of good quality sleep.
In the short term, a poor night of sleep causes fatigue, daytime drowsiness, headaches, and a higher tendency to make mistakes or be involved in accidents. This happens due to problems with memory, concentration and motor control. However, what are the long-term consequences of poor sleep quality?
In this article, we shall go over women's sleep quality, an important health and quality of life indicator.
Why do Women Need to Sleep More Than Men?
There are several reasons why women may need more hours of sleep than men. First and foremost, women are 40% more likely to suffer from insomnia than men. Additionally, women are almost twice as likely to be diagnosed with depression and anxiety, two disorders that are deeply linked with insomnia. People with insomnia regularly have difficulty falling asleep or maintaining sleep, and suffer from daytime drowsiness.
Secondly, hormones can be another reason for different sleep needs. Hormones regulate the sleep-wake rhythm. These hormones interfere in situations like fatigue, alertness, and hunger. Throughout their lives, women can experience monthly hormonal changes, affecting their circadian rhythms and creating a greater need for sleep.
According to the census carried out in 2022 by the Brazilian Institute of Geography and Statistics (in Portuguese: Instituto Brasileiro de Geografia e Estatística or IBGE), life expectancy for women in Brazil is 79.0 years. Nowadays, most women live long enough to go through menopause and live 30 years more after their last menstruation. Women spend a long time in their climacteric period, considering that it presents itself among women between 40 and 65 years old. Many women go through menopause with few or no symptoms, yet a small percentage of women suffer from symptoms serious enough to interfere with their day-to-day performance. Common complaints include hot flashes, night sweats, insomnia, mood swings, fatigue, and excessive daytime drowsiness.
The climacteric is a transitional period between the reproductive and non-reproductive life of a woman. During this stage, sleep disorders occur due to hormonal imbalance and the decline in estrogen production, which are hormones associated with the regulation of women's sleep. Hot flashes and sweating that come with hormonal imbalance can also occur at night and, consequently, obstruct sleep. It is important to pay attention to the frequency of these episodes so that the disorder does not become chronic. Sleep hygiene and physical activity also play an important role throughout the transition to menopause.
Climacteric episodes last three minutes on average, yet they tend to intensify at night. This leads to frequent awakenings that cause fragmented sleep patterns and the loss of sleep quality. During this period, besides the common symptoms like hot flashes, night sweats, muscle pain, headaches, decreased libido, and mood swings, there are other issues which are often overlooked by physicians: insomnia or even obstructive sleep apnea (OSA).
The Southern American Association published an article titled “Major Sleep Disorders Among Women (Women’s Health Series)” in 2013 (source: https://sma.org/southern-medical-journal/article/major-sleep-disorders-among-women-womens-health-series/. Said article states that women have a higher incidence than men of suffering from insomnia and depression due to poor sleep. Women have more tendency than men to complain about insomnia, headaches, irritability, and fatigue than about “characteristic” symptoms such as loud snoring or breathing interruptions during sleep. Therefore, women with obstructive sleep apnea have a higher cardiovascular mortality.
In order to avoid insomnia during the climacteric period, specialists recommend implementing a sleep hygiene program. Here are some suggestions:
- Go to bed and get up at the same time every day, even on weekends.
- Engage in physical activity, preferably in the morning or afternoon.
- Avoid stimulating drinks at night, such as coffee, black tea, soda, or energy drinks.
- Have an early dinner and opt for light meals.
- Avoid consuming alcoholic beverages.
- Reduce exposure to light at night.
- Keep the room free of lights or noises.
- Take a warm bath.
- Engage in relaxing activities at night, such as reading, painting, embroidering, listening to calm music, and meditating.
Remember: if difficulty falling asleep or maintaining sleep throughout the night becomes persistent, contact your physician. There are specific treatments to correct this situation.
Obstructive Sleep Apnea in Women
Obstructive sleep apnea is a condition characterized by the obstruction of the upper airways during sleep. Usually, this obstruction is accompanied by a decrease in blood oxygen saturation, followed by a brief awakening during the night to breathe.
Initially, it may seem like a condition easy to diagnose. Nevertheless, this is not always the case, at least with the feminine sex. This is because the main characteristics change, since women’s snore is lighter and its sound is more discrete than men’s. Furthermore, these episodes are shorter, which means there are cases in which not even the bed partner nor the patient detects them.
Obstructive sleep apnea is twice as common in men, although this disorder increases in women over 50. Besides snoring, symptoms associated with apnea include excessive daytime drowsiness, fatigue, migraines, depression, anxiety, tachycardia, cognitive alterations, and lack of productivity, among others. These factors contribute to the difficulty of diagnosis.
Obesity and advanced age are the two biggest risk factors for sleep apnea. During menopause, women undergo hormonal changes leading to increased abdominal fat and decreased progesterone levels. Both factors can explain the increased risk of sleep apnea.
Other factors can influence the onset of sleep apnea in women:
- Menstruation: One-third of menstruating individuals have trouble sleeping due to cramps, headaches, and bloating. Higher levels of daytime drowsiness, tiredness, and fatigue are also reported.
- Pregnancy: During pregnancy, women may develop restless leg syndrome, which hinders sleep. Pregnant women are also more likely to suffer from depression, sleep apnea, pain, and urinary incontinence, which consequently disrupts sleep. These sleep problems can continue into the post-partum period when hormone levels drop, and simultaneously, caring for a newborn with an irregular sleep cycle begins, often resulting in even more daytime drowsiness.
- Menopause: During menopause, up to 85% of women may experience hot flashes. When these occur at night, women wake up sweating, thereby disturbing sleep. The risk of developing sleep apnea also increases during menopause, causing more fatigue and excessive daytime drowsiness.
In the long term, the consequences of sleep apnea are potentially severe and fatal. This reinforces the need for diagnosis and treatment as soon as possible.
This sleep disorder can worsen or cause, among others:
- Cardiovascular diseases (heart failure, irregular heartbeat or arrhythmia, infarction, hypertension, among others).
- Diabetes.
- Stroke (hemorrhagic).
- Migraine.
- Cognitive alterations such as problems with memory, concentration and attention.
- Weight gain.
- Dementia (caused by Alzheimer’s disease).
- Depression.
Polysomnography is the study of choice to diagnose sleep disorders, along with a clinical and physical examination.
Besides the well-known study that involves spending the night at a sleep lab surrounded by non-friendly equipment, there is the Biologix Solution. The Biologix Sleep Test®is a type IV polysomnography that measures channels such as oxygen saturation, heart rate, actimetry and snoring through the microphone of a cellphone. This test can be performed at home and is simple, practical, and effective. Furthermore, healthcare practitioners use it for diagnosing and treating sleep apnea. At bedtime, the patient only needs to place the Oxistar sensor®, a high-performance oximeter, on their finger and start the test in the Biologix app. Upon waking up the next morning, after finishing the test, the result will be available at the exam portal in a matter of seconds.
For treating sleep apnea, the degree of such must be considered. For severe cases, the best option is Continuous Positive Airway Pressure (CPAP). It is a device that enhances quality of life and reduces the risk of strokes and cardiovascular problems. This sleep therapy provides appropriate airway pressure, its use does not only immediately reverse apnea, but also reduces drowsiness and improves quality of life, alertness and mood.
In addition to CPAP, using oral appliances is a great alternative for mild or moderate cases. These devices are utilized only during sleep and are designed to position the jaw forward and, therefore, allow the airway in the throat to remain unobstructed. Although an adaptation period, periodic check-ups, and adjustments are needed, people usually find it quite easy to use oral appliances.
Hormone replacement therapy also helps improve sleep quality for women during menopause. However, it is essential to first consult with a gynecologist to evaluate the risks and benefits of this type of treatment and to consider each woman's medical history. Not only for weight loss but also for reducing abdominal circumference.
Moreover, lifestyle changes are crucial. For example, maintaining regular sleep and wake schedules, exercising in the morning, preparing light meals for dinner, engaging in relaxing activities, and avoiding alcohol and tobacco.
It is important to highlight that women report their sleep problems differently than men. For instance, women seeking treatment for sleep apnea are more likely to focus on symptoms like fatigue and depression, whereas men describe snoring and shortness of breath during sleep. This can lead to fewer women being diagnosed or being misdiagnosed with insomnia when sleep apnea is the underlying condition.
In conclusion, it is important to note that around 85% of sleep apnea patients worldwide are undiagnosed. This draws attention to the importance of physicians and patients recognizing and treating the early signs and symptoms of obstructive sleep apnea.
Seek help and sleep better
This content was developed by the Biologix team. Biologix is a company created to revolutionize the diagnosis of obstructive sleep apnea (OSA), aiming to reinforce the importance and impact of apnea on the quality of life of the population.
