A neurology expert describes why women experience insomnia at higher rates than men and how co-occurrence of insomnia with other medical conditions, including psychiatric disorders, can affect occurrence.
Charlene Gamadelo, MD: Why do women seem to suffer from insomnia twice as much as men in the literature? There are several potential explanations. There may be a solo explanation or a combination of all 3 in any particular presentation. One, there’s a sex or biological reason related to hormones. I’ll talk about that in a second. Next, from a gender or sociocultural aspect, there could be a higher risk because women are more likely to be the primary caretakers in the family. They’re more likely to be the ones to put their health on the back burner to take care of others. This may be at the expense of their sleep, whether it’s to take care of a crying baby or an ailing child or parent. There’s disproportionate cultural demands that women may have may come at the expense of sleep.
The third 1 is a comorbidity. Some conditions that are also more likely to present in women are more likely to lead to insomnia. Some of these include depression, anxiety, and other sleep conditions like restless leg syndrome. There are many things related to the journey of a woman that can make them more likely to have insomnia.
It’s worth going back to my first risk factor, which is sex and physiology. That gets to the hormones. For women throughout the life cycle, whether it’s during their menstrual stage, perimenopause, or menopause, there are ongoing fluctuations in hormones. During the menstrual cycle or in pregnancy, it could be on a month-to-month basis. Those ebbs and flows in estrogen and progesterone impact the ability to initiate and, more important, to maintain sleep.
Finally, at the spectrum of menopause, fluctuations in hormones remain. Typically, it’s at the lower side, but this comes with symptoms related to that transition into the menopausal stage, including symptoms like hot flashes. As noted, this can affect sleep consolidation. It’s complicated, and there are mucky reasons for why women may have more difficulty with sleep than men. That’s the start in terms of how we understand it.
What are some of the conditions that women suffer from that may set them up for a higher risk for insomnia? There are quite a few, and they span medical, psychological, and psychiatric. The big 1 is depression and anxiety, which can come part and parcel with insomnia. It’s an interesting dynamic because it can go in both directions. With depression and anxiety, on average, women suffer from that at twice the rate than men. When an individual has depression or anxiety, that puts them at higher risk for insomnia. In the other direction, for individuals who initially suffer with insomnia, it puts them at higher risk for developing depression or anxiety. It goes in a bidirectional way. Also, treating 1 can help with the stabilization and management of treating the other. It’s become a well-focused place for sleep specialists to work in conjunction with our psychiatry peers.
In addition to the psychiatric or psychological conditions, there are medical conditions that may be associated with insomnia. Oftentimes, that’s because these symptoms may impact them during the night, so it affects the sleep consolidation. Some are specific to women, like bladder. Bladder concerns what we call nocturia. If this is happening during the night, it affects sleep consolidation; ie, it can result in insomnia. This is also more prominent in women than men. Similarly, there can be pain-related conditions: joint-related issues, connective tissue concerns, rheumatological, fibromyalgia. Rheumatological conditions are also more prominent in women. These symptoms can be most prominent at night, so they can affect overall sleep quality. Any medical condition that can have symptoms that disrupt or affect a person at night can induce insomnia.
Transcript edited for clarity