1. Women and Sleep

2. What You Will Learn The Benefits and Importance of Sleep States and Stages of the Sleep Cycle Unique Physiology of Women’s Sleep Common Disorders in Women that Affect Sleep Women’s Role in Society and Sleep Where to find additional materials and information Healthy Sleep Tips Along the Way!

3. Importance and Benefits of Sleep

4. Why is Sleep Important? Key to our health, performance, safety and quality of life As essential a component as good nutrition and exercise to optimal health As necessary as the water we drink, the air we breathe and the food we eat to function and live at our best

5. Women’s Sleep Women… Have unique physiology that can disrupt sleep Are more likely than men to report poor sleep Are more likely to experience daytime sleepiness Are three times more likely to suffer insomnia Experience more depression and anxiety that disrupts sleep

6. The Benefits of Adequate, Restorative Sleep Quality Sleep Promotes: –alertness and daytime productivity –mental wellness –hormone production that restores, rejuvenates and repairs body organs and systems –weight maintenance and can aid weight loss –overall good health and wellness

7. States and Stages of the Sleep Cycle

8. Sleep is regulated by two body systems: 1.Sleep/Wake Homeostasis –The Process that Balances Sleep and Wakefulness 2.Circadian Biological Clock –The Clock-Dependent Process that Regulates Alertness

9. Circadian Biological Clock The internal mechanism that regulates when we feel sleepy and when we feel alert Resides in the brain and is affected by light and dark Retino-hypothalamic tract Suprachiasmatic nuclei Hypothalamus

10. The Sleep Cycle Alternating states and stages of sleep that occur over an 8-hour time period: NREM: Non-Rapid Eye Movement, Stages 1-4; 75% of the night REM: Rapid Eye Movement; Dreams occur 25% of the night

11. During the Sleep Cycle Core body temperature Growth hormone Cortisol Melatonin Sleep stage –Body temperature lowers –Hormone levels rise and fall

12. Unique Physiology of Women’s Sleep

13. Menstruation Pregnancy Post-partum Menopause

14. Menstruation and Sleep Hormonal changes unique to women can cause more than half the sleep problems women experience. Progesterone: –Promotes sleep and increases NREM sleep while decreasing wakefulness Estrogen: –Enhances REM sleep and regulates flow of other hormones secreted during sleep

15. Sleep Promoting Tips During Menstruation Exercise regularly, but not close to bedtime Avoid caffeine, it can contribute to bloating Avoid alcohol, which can lead to fragmented sleep Avoid large meals and too much fluid close to bedtime Pain relievers can lesson sleep disrupting cramps

16. Pregnancy and Sleep In a NSF women & sleep poll, 79% of women said their sleep was more disturbed during pregnancy than at any other time.

17. Changes in Sleep During Pregnancy Second Trimester Improved sleep and energy; possible snoring, heartburn, and frightening dreams Third Trimester Difficulty sleeping, increased urination, snoring, back pain, restless legs First Trimester Difficulty sleeping through the night; daytime sleepiness; increased urination, and nausea

18. Pregnancy Related Sleep Problems Snoring or Sleep Disordered Breathing (SDA) –30% of women experience during pregnancy –This can lead to high blood pressure, headaches, and daytime fatigue Restless Leg Syndrome (RLS) –Increased risk during pregnancy due to lower levels of ferritin iron and folate –RLS may disrupt sleep and lead to daytime sleepiness

19. Sleep Tips for Pregnancy Drink lots of water, but not too close to bedtime Raise the upper body and elevate your head on a pillow to reduce heartburn Exercise regularly to improve circulation and reduce leg cramps, stretch, walk or massage legs Use pregnancy pillows for support. Nap, if possible and as necessary Sleep on left side to allow easy blood flow to fetus

20. Postpartum and Sleep Moods can change and range from feeling temporarily blue to having full on clinical depression Motherhood may bring lighter sleep Irregular schedules Additional Responsibilities

21. Use of HRT inconclusive Menopause and Sleep 75-85% of menopausal women have hot flashes that disrupt sleep Menopausal women have 8 times the risk for sleep disordered breathing (snoring) or sleep apnea Women are more likely to suffer from depression from hormone fluctuations during menopause

22. Common Disorders in Women that Affect Sleep

23. Insomnia –Depression and Anxiety Disorders Restless Leg Syndrome Obstructive Sleep Apnea Fibromyalgia, Pain and Headaches

24. Insomnia Did you know? Women are 1.4 times more likely to develop insomnia vs. men

25. What is Insomnia? Complaints of quality and quantity of sleep –Difficulty falling asleep –Frequent awakenings –Waking too early –Not waking refreshed

26. Insomnia Insomnia is more frequent in women across all age groups Insomnia is more common in the unmarried, divorced or separated; and elderly; and those under stress Often occurs during the menstrual cycle, pregnancy, post-partum, menopause and post menopausal phases

27. Depression and Anxiety Disorders Depression and anxiety disorders can lead to or worsen insomnia Likewise, insomnia can lead to or worsen depressive and anxiety disorders Women are twice as likely as men to suffer from depression

28. Use the bedroom for sleep and sex only If you can’t sleep, engage in a relaxing activity Do not watch the clock! Avoid late afternoon and evening naps Avoid caffeine, smoking and alcohol Consult your doctor for treatment Tips for Insomniacs

29. Restless Legs Syndrome (RLS)

30. Restless Legs Syndrome RLS is a neurological movement disorder with unpleasant sensations or tingling in the legs during rest or sleep that cause an urge to move Symptoms include: –Urge to move limbs during sleep –Difficulty sleeping –Daytime sleepiness

31. Restless Legs Syndrome 10% of women experience RLS Approximately 20% of pregnant women experience RLS RLS can cause insomnia that may be misdiagnosed as depression RLS is very common in elderly women and men

32. Sleep tips for Restless Legs Syndrome Exercise regularly but not to close to bedtime Yoga and/or stretching before bed may help Check your iron and folate levels Consult your doctor or a sleep specialist for treatment

33. Obstructive Sleep Apnea “Sleep Apnea is an extremely common condition in both males and females – as common as asthma.” Meir Kryger, MD

34. Obstructive Sleep Apnea Sleep Apnea is a serious disorder with breathing disruptions during sleep and frequent awakenings Symptoms: –Loud snoring –Pauses in breathing –Gasps for breath and arousals during sleep –Daytime sleepiness

35. Obstructive Sleep Apnea Approximately 2.3 million women suffer from sleep apnea Ten percent of postmenopausal women have sleep apnea In women, sleep apnea is often misdiagnosed as depression Sleep Apnea can lead to hypertension and stroke, consult your doctor if you think you may have sleep apnea

36. Fibromyalgia, Pain and Headaches More women than men report that a medical condition, pain or a physical discomfort disturbs their sleep Migraine headaches are three times more common in women and disrupt sleep Fibromyalgia and headaches can intensify sleep difficulties and contribute to daytime sleepiness

37. Sleep and Lifestyle Sleeping in a World That Never Sleeps

38. Sleep and Lifestyle Parenting and sleep Sleep and the caregiver The Working Woman

39. Parenting and Sleep Three key steps for developing positive sleeping habits: 1.Develop a regular sleep schedule that is the same every day 2.Establish a consistent bedtime routine 3.Put baby to bed drowsy but awake Put baby to bed on their back!

40. Sleep Tips for Mom Make your own sleep a priority Set (and keep) a regular wake time Grab some short strategic naps Add some break time between the day’s activities and your evening wind-down Form a satisfying bedtime ritual with children and yourself Consult your doctor if you are feeling depressed

41. Sleep and the Caregiver Women frequently lose sleep when caring for an ill family member

42. Sleep and the Caregiver 84% of caregivers for Alzheimer’s patients are women and on average, caregivers are sixty-five years old Caregivers often have to coordinate medical care and personal care for patients Caregivers must make sure they receive adequate sleep. If sleep deprived, caregivers should seek help and research other available resources

43. Sleep Strategies for the Working Woman Identify a specific bedtime and stick to it Avoid caffeine 4-6 hours of bedtime Gradually adapt schedule to night shifts or on call shifts Say “yes” to sleep when tempted to stay up late Deal with worries before bed or put on hold Don’t skimp on sleep – most adults need 7-9 hours Exercise regularly, at least 4 hours before bedtime

44. Sleep: Essential to a Woman’s Health and Quality of Life A woman’s sleep is uniquely influenced by hormones, biological life stage, stress level, health, mood, parental status, work hours and other responsibilities

45. References Kryger, Meir H., A Woman’s Guide to Sleep Disorders, McGraw Hill (2004). Walsleben, Joyce and Rita Baron-Faust, A Woman’s Guide to Sleep, Three Rivers Press (2000) Wolfson, Amy, The Woman’s Book on Sleep, New Harbinger Publications, Inc. (2001).