• More women complain of sleep problems during menstruation (71 per cent) than during the week preceding menstruation (43 per cent).
• Sleep-disrupting conditions such as anxiety and depression are twice as likely to occur in women than in men.
Gender
It is a sad fact of life that you are more likely to have sleep problems if you are a woman. The reason for this is partly due to the female bodily cycles. Much of women’s lives is governed by the sex hormones oestrogen and progesterone, and hormonal fluctuations, as in the menstrual cycle, pregnancy and the menopause, can severely affect sleep either directly, or through their effects on anxiety and general mood. Pre-menstrual women commonly report sleeping difficulties in the week before their period starts, but even women who don’t suffer from pre-menstrual symptoms can still take longer to fall asleep, wake more often and feel less refreshed after sleep during the second phase of their cycles. Sleep disturbances also become more common during the menopause, when women report waking up more often at night and feeling more tired during the day.
Studies on the effects on sleep of Hormone Replacement Therapy (HRT) and oral contraceptives have shown that these hormones have direct effects on the brain. Oestrogen has widespread effects on mental performance, mood, movement coordination and pain. However, the monthly fluctuation of oestrogen and progesterone impacts on cognitive function, mood, appetite and temperature, as well as the sexual organs and breasts, making it more difficult to work out how they affect sleep directly.
There is evidence to suggest that women’s role in society may affect their sleep even more than hormonal changes. The added pressures many women face of juggling stressful jobs with their roles as mothers and wives can often pose an intolerable burden, exacerbated by the fact that many women ignore their fatigue.
Age
Ageing can greatly affect sleep, with the number of hours declining as you get older. While a young adult will sleep on average for 7-8 hours, by old age this will go down to about six. Quality of sleep is affected too. Stage 4 sleep is reduced, and the proportion of REM sleep, which makes up abut 50 per cent of baby sleep, will, in the latter stages of life, go down to 15-20 per cent. Although the cause may be inevitable, there are still steps you can take to improve the situation (see Chapter 4).
General constitution
Your sleep is more likely to be poor if your general health is poor, even if you are not suffering from a specifically sleep-related disorder (see Chapter 6). Conditions such as heart disease, general breathing problems and arthritis can make it difficult to get comfortable at night, and will almost certainly have an impact on your sleep. Consult your doctor if this becomes an issue. For many people emotional issues and character make-up may come into play.
must know
Adult sleep A recent US National Sleep Foundation survey looking at the relationship of sleep problems in adults aged between 55-84 found:
• Nearly one in four adults had at least four medical conditions.
• Depression, heart disease, pain and memory problems were most associated with insomnia.
• Ninety per cent of those that did not have any medical condition thought their sleep quality was good or excellent. This went down to 78 per cent if they had 1-3 medical conditions, and 59 per cent if they had four or more conditions.
• Obesity, arthritis, diabetes, lung disease, stroke and osteoporosis were more likely to be associated with other sleep problems (e.g. snoring, restless legs).
The role of diet
The role of food and drink in sleep is often overlooked but there is increasing evidence that healthy eating habits can have many beneficial effects. The first stage is to identify and eliminate the main sleep spoilers.
must know
UK safe limits for alcohol
• Men should drink no more than 21 units of alcohol per week (and no more than four units in any one day).
• Women should drink no more than 14 units of alcohol per week (and no more than three units in any one day).
• Pregnant women: if you have one or two drinks of alcohol (one or two units), once or twice a week, it is unlikely to harm your unborn baby. However, the exact safe limit is not known.
Alcohol
Drinking small amounts of alcohol (especially a glass of wine with meals) can be pleasurable, and its benefits well recognized. The problem comes when alcohol is drunk in large doses.
Drinking alcohol at night is commonly believed to be helpful for sleep. This is a myth. Drinking large doses may make you fall into a deep sleep straight away, but as soon as the immediate effects of the alcohol wear off (usually after 3-5 hours), you will wake up feeling exhausted, and your sleep is likely to be disrupted for the rest of the night. Drinking large amounts of alcohol can depress brain activity and induce unconsciousness. Breathing is also invariably impaired, leading to snoring. Alcohol also has a diuretic affect, which means that, depending on how much you’ve drunk, you could end up getting up to go the toilet several times during the night.
Caffeine
Caffeine is a very powerful stimulant that is known to cause the delay of sleep onset. Studies have shown that a dose equivalent to one cup of coffee taken at bedtime can both increase the time taken to fall asleep and decrease sleep quality, especially in non-REM deep sleep (see page 19). In a few individuals, a dose of coffee in the morning can also have an effect the following night, indicating that extremely low concentrations of caffeine can affect sleep. Like all stimulants, caffeine may make you feel increasingly alert during the day, but, as well as causing insomnia, prolonged, high-dose usage (more than six cups of coffee a day) can lead to the following nasty side-effects:
How much alcohol is in your drink?
| Sample drink | Quantity | Alcohol by volume | Units |
|---|---|---|---|
| Can of lager | 500ml | 4.00% | 2 |
| Glass of cider | 500ml | 4.00% | 2 |
| Alcopop | 400ml | 5.00% | 2 |
| X-Strong lager | 500ml | 8.00% | 4 |
| Glass of wine | 160ml | 12.50% | 2 |
| Cocktail | 125ml | 40.00% | 5 |
| Shot of spirits | 25ml | 40.00% |
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