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Sleep expert Dr Lindsay Brown explains why insomnia is more prevalent in women, and what we can do about it.

Of the many health topics that have been thrust into the spotlight in recent years, sleep is, arguably, the most important. Why? Because sleep is at the very core of our wellbeing. Quality sleep supports the immune system, lowering our risk of developing serious illnesses. Sleep benefits our mental health, and it aids recovery, too. Sleep deprivation and deficiency have been associated with chronic health problems, including heart disease, kidney disease, high blood pressure, diabetes, stroke and depression. It stands to reason, then, that we need to make quality sleep a priority where our wellbeing is concerned.

That said, securing at least seven hours of quality kip per night is often easier said than done. Sleep disrupters, such as insomnia, are common, affecting around one in three people in the UK. And, those most likely to suffer from insomnia? Women.

A 2020 study that explored gender difference in the prevalence of insomnia found that the prevalence of insomnia in women is significantly higher than in men. It resolved that, because insomnia is linked with serious health conditions, everybody (but, especially women) should implement effective interventions to reduce associated risks. So, why aren’t women and anyone else with a uterus hearing even a whisper about it?

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It’s truly not surprising that there’s so little info on why insomnia more commonly impacts women (and those assigned female at birth). Historically, we have been neglected from important medical studies and trials under the assumption that women are just small men. There’s a catastrophic lack of knowledge about women’s health as a whole, and this is just one life-altering concern that’s been left on the sideline.

The question is: what’s causing us to experience such a higher prevalence of insomnia, and what can we do about it?

What causes insomnia?

The NHS rather blandly defines insomniacs as those who “regularly experience problems sleeping“, however, sufferers will attest that insomnia can be excruciating to live with. Physically, it may trigger an increase in aches and pains from your body’s lack of rest and recovery. Psychologically, it can be extremely damaging to mental wellbeing. And, the exhaustion feels altogether overwhelming.

“If someone takes more than 30 minutes to fall asleep, is awake for more than 30 minutes during the night or wakes more than 30 minutes before their alarm and feels unrefreshed the next day, this is called insomnia,” explains Dr Lindsay Browning, sleep expert at Trouble Sleeping and author of the self-help sleep book Navigating Sleeplessness. “To count as chronic insomnia these issues must happen at least three times per week and have been happening for at least three months. If you are struggling to fall asleep or stay asleep and it is affecting your ability to function during the day, this is likely to be insomnia and should be taken seriously.”

There are many causes of insomnia. It commonly affects people during stressful periods, such as sitting exams or moving home. However, there are other triggers. “There can also be physical causes of poor sleep, such as pain or a fever, or hormonal fluctuations which can affect sleep,” says Dr Browning.

“Usually, when the cause of the sleeping issue has been resolved (eg the stressful situation has resolved, the person is no longer in pain or their hormones are back to their normal balance), the person’s sleep will return to normal. However, sometimes the sleeping problem (or insomnia) can continue long after, as the person may now be focusing on their sleeping problem and doing things that actually make their sleep worse.”

Why is insomnia more common in women?

So, is it that women are experiencing a higher volume of stressful events? Or, is something else at play?

It could be both, according to Dr Browning. “People assigned female at birth experience hormonal fluctuations during their lifetime that people assigned male do not, through their monthly menstrual cycle, during pregnancy and menopause,” she says. “These fluctuations in hormone levels have been directly linked to sleeping problems, and increased insomnia risk begins around the time puberty starts.” It’s thought that, along with the hormone fluctuations, side effects of things like pregnancy and menopause could increase the likelihood of insomnia too. “Restless leg syndrome (RLS), for example, is more common in women than in men, especially during pregnancy,” Dr Browning explains. “RLS is where someone feels the urge to move or rub their legs as they are falling asleep, making it harder to go to sleep.”

There’s also the fact that women are around three times as likely to experience common mental health problems, such as anxiety. “When someone has depression or anxiety they are at a greater risk of developing insomnia,” says Dr Browning. “Further, those who take on a societally ‘female’ role may experience greater stress as they tend to take on a larger share of caregiving responsibilities (both of their children and ageing parents),” she adds.

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Is it possible to get rid of insomnia?

Reiterating the study findings, Dr Browning emphasises the importance of taking measures to prevent insomnia from occurring in the first place. “In those with uteruses, insomnia is especially common during menopause when hormones can fluctuate wildly. In order to minimise the hormonal causes of insomnia, HRT can be a good solution for some if it is appropriate.” There are also environmental and habitual interventions you can make. “Improvingyour bedroom environment can help, such as sleeping in moisture-wicking natural fibres, keeping the room cool and using a water mist to help minimise night sweats.

“In those who aren’t yet experiencing menopause but are experiencing a monthly pattern to their insomnia, it may be worth speaking to your GP to see if there is anything that can be done to level out your hormones,” Dr Browning advises. “If your insomnia is stress linked, then it is important to identify areas in your life that are causing excess stress and try to reduce the stress where possible.”

If you’re already experiencing insomnia, avoiding caffeine and alcohol close to bedtime and having a wind-down routine may be beneficial. “However, if your insomnia is particularly severe or has been going on for a long time, then good sleep hygiene alone is unlikely to help,” Dr Browning warns. “In which case, CBT-I[cognitive behavioural therapy for insomnia] is the NHS-recommended treatment for insomnia. You should also speak to your GP to see if there are any other medical issues affecting your sleep which may need to be addressed.”

Images: Getty

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