6 Things to Look for When Your Female Patient Can’t Sleep

Sleep is fundamental to good health and sense of well-being. When either of these is affected, sleep quality needs to be a key consideration.

With that premise, sleep expert Carmel Harrington, PhD, researcher and author about sleep on behalf of ResMed discusses 6 things for you to look for-and ask about-when your female patients tell you they can’t sleep.

Dr Harrington is author of The Sleep Diet and The Complete Guide to a Good Night's Sleep.

Throughout their lives, women require more sleep than men-but they experience more trouble getting it. Some of the problems and the times women encounter sleep difficulties include:

• The female monthly cycle. During the second half of the cycle, a woman may experience difficulty in getting to sleep or getting the amount of sleep she needs. Many women become sleep-deprived at this time and suffer all the ill effects, including depression, moodiness, tiredness, and lack of energy, all of which are recognized characteristics of the premenstrual syndrome. Rather than immediately prescribing an antidepressant at this time, it is important to investigate the woman’s sleep. The first step is to get her to complete a sleep diary and if sleep is the problem, a sleep health program should be implemented.
• Polycystic ovary syndrome (PCOS). About 1 of 2 women with this disorder have sleep apnea. For this reason, it is critical to investigate sleep in a woman with PCOS.
• Postnatal depression. This can be severely debilitating not only for the young woman experiencing it, but also for her family and friends. Little is known about what causes postnatal depression, but women with the most disturbed sleep are at significantly greater risk. Rather than prescribing an antidepressant, women presenting with postnatal depression should be queried about their sleep: if sleep deprivation is occurring, a sleep program should be implemented with some urgency.
• Menopause and postmenopause. Many women at and beyond menopause have difficulty in sleeping, and either a sleeping pill or an antidepressant is prescribed without any investigation of their sleep health. About 10% of postmenopausal women have sleep apnea, which is associated with significant sleep deprivation and all of its symptoms-including restless sleep, fatigue, waking up unrefreshed, and depression. These are often perceived as traditional menopausal symptoms, but rather than immediately treating with medication, investigating sleep quality is a good first step.
• Chronic disorders. Any woman of any age who has a chronic disorder, such as depression, obesity, type 2 diabetes mellitus, hypertension (especially resistant hypertension), heart disease, or a hormonal cancer (such as breast cancer), should have her sleep investigated. Poor quality and/or insufficient sleep is highly associated with these chronic disorders. Improving sleep health may improve their parameters. 
• Clues to sleep apnea. It is not normal for a woman to feel fatigued every day or to lack the energy to enjoy life. When a woman presents with these symptoms, her sleep health is a relevant consideration. Keep in mind that a woman’s language around sleep may be different than that of a man-for starters, women don’t like talking about snoring and many won’t admit to it. Women are more inclined to focus on sleeplessness and lack of energy.