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Sleepless All Over Seattle: Women and Sleep Disorders
by Roberta Greenwood

“Amazingly elaborate mechanisms.” That’s how Dr. Nigel Ball of the Swedish Sleep Medicine Institute describes women. As a biologist with specific interests in workplace fatigue and sleep disorders in women, he cites sleep disorders as a major health concern for society.

“Modern life is very difficult for sleep,” he explains “and it’s particularly bad for working women. Almost all sleep disorders are more prevalent in women – and many women treated for depression actually suffer from sleep disorders.”

So, just how many of us aren’t getting a good night’s rest? According to a recent Gallup Poll, 35 percent of Americans acknowledge that insomnia is a troubling issue for them, yet 61 percent state they’ve never been questioned by their doctor concerning sleep issues. Ball isn’t surprised; the complexity of diagnosing and treating sleep disorders is time-consuming and many patients are unaware that a lack of sleep can be a serious concern.

Dr. Jane Guiltinan, clinical professor and director of the Bastyr Center for Women’s Wellness, stresses that this lack of understanding is a huge concern. “As practitioners, we need to get people to realize that adequate sleep is as important as diet and exercise in maintaining health and wellness.”

Why Can’t We Sleep?
According to a National Sleep Foundation survey, almost 75 percent of women between the ages of 30 and 60 get less than seven hours of sleep per night during the workweek. Working mothers are particularly prone to sleep disturbances and perimenopausal women indicate sleep disturbances are one of the most significant problems they face on a nightly basis.

Where research was once confined to male subjects, Ball says the increasing emphasis on sleep disorders in women is long overdue. “Women present with sleep disorders in a more subtle manner than men; many times they go to their primary care physician complaining of fatigue and mood changes – not a lack of sleep.”

Sleep patterns in women are disturbed most often by the menstrual cycle, pregnancy and menopause. Mother to 3-year-old Brittney, Jennifer Herberg recalls, “I definitely found during pregnancy my sleep was affected. In the beginning I was so sick, and further on I had to get up and use the bathroom about five times a night. I couldn’t find a comfortable position to sleep in so I was constantly tossing and turning.” That pattern can be difficult to break.
“Women have notorious sleep issues beginning in pregnancy,” explains Guiltinan. “They lead very busy, very complicated lives with little time for relaxation and stress management.”

Women are more likely to report sleep problems such as insomnia while men suffer from sleep apnea (sleep-disordered breathing) at a much higher rate. While no evidence exists that men and women need different amounts of sleep, it’s believed that due to the poor quality of many women’s sleep, they may need to spend a longer amount of time in bed to obtain the same number of hours of sleep. Both Ball and Guiltinan agree that at times, appropriate sleep aids (including Ambien, the newer Lunesta, calcium/magnesium supplements, and melatonin) can be helpful for many patients.

Teri Thomas, media and community-relations coordinator for Bastyr University and a local actor, never suffered from sleep problems until a few years ago. In fact, she laughs, she could fall asleep anywhere, anytime. That is, until she faced a serious medical diagnosis and couldn’t turn her brain off. Relaxation techniques weren’t successful for her, so she searched for an effective, non-invasive treatment that delivered results – and found it in the over-the-counter supplement, melatonin. “I swear by melatonin,” she declares. “It really worked for me; I used it for three weeks until my stress became manageable.”

Stress is a major factor in sleep disturbances; anxiety, depression and an over-stimulated lifestyle can lead to sleep deprivation, which has drastic results in our daily life. Consider this: American businesses lose over $3 billion annually due to sleep-related issues. Sleep deprivation is a major contributor to job-related injuries and loss of productivity; additionally, the National Highway Traffic Safety Administration estimates that driver fatigue is the direct cause of more than 100,000 crashes, resulting in 1,500 deaths, 71,000 injuries and monetary losses of more than $12.5 billion.

Those statistics don’t surprise Guiltinan. “I see lots and lots of people with sleep problems; many maintain a very stressful lifestyle while consuming high levels of caffeine, sugar and other stimulating foods,” she explains. “Lack of sleep is a major contributor to health issues. During sleep, the body rests and repairs itself; if you deprive the body of adequate rest, immune systems can be compromised, leading to recurrent infections, constant colds, weight gain and depression.”

Getting Help
If you’re having difficulty sleeping, it’s important to ensure that no serious underlying medical problems are the cause. Sleep apnea, narcolepsy (excessive daytime sleepiness) and restless legs syndrome are serious medical conditions that require intervention and treatments that differ from insomnia, explains Ball. “It’s always a good idea to begin with a full medical evaluation, including a comprehensive interview and possibly blood work. Once the cause of the sleep disorder is determined, treatment can vary from patient to patient.” Often, specific techniques (such as stimulus control therapy or sleep restriction therapy) will require monitoring by professionals and “sleep centers” can be extremely helpful in diagnosing the underlying causes of sleep disorders.

“We’re so fortunate in Seattle,” says Ball. “Dr. Ralph Pascualy of the Swedish Sleep Medicine Institute is considered a visionary in the field of sleep disorders. He recognizes that these issues can be long-term and he’s incorporated many progressive components into our women’s sleep program.” Ball also recommends No More Sleepless Nights by Peter Hauri and Shirley Linde as a good resource for understanding sleep disorders. Bastyr University offers a comprehensive program to deal with sleep disorders and Guiltinan stresses that many small alterations in lifestyle habits can lay the foundation for more restful sleep. “Just adding soy to the diet can alleviate problems with light sleep,” she explains, “while several herbal teas (passion flower, chamomile) can calm an overstimulated system and ready it for sleep.”

Most researchers agree that the normal range for restful sleep is a minimum of seven to nine hours a night. Like the majority of women, Emily Evans-Wilson of Seattle rarely gets that. “I have much more trouble sleeping – ever since starting menopause.” She began estrogen therapy and got immediate results but has since cut way back. Now she uses Tylenol PM a few times a week and “I read every night before turning out my light. It seems to capture my mind and slow me down.”

Evans’s nighttime habits are often referred to as “sleep hygiene,” and Ball says their importance can’t be stressed enough. “It’s easier to fall asleep if you have certain rituals – it signals the body and mind to slow down and begin to rest.” Some tips for good sleep hygiene include:

• Don’t go to bed unless you’re sleepy.
• If after 20 minutes you can’t sleep, get out of bed and find something else that will help you relax.
• Get up and go to bed at the same time every day. Don’t make exceptions for the weekends.
  Limit alcohol, caffeine and sugar consumption before bed.
• Avoid strenuous exercise within six hours of your bedtime.

And, according to Ball, “make your bedroom comfortable. No computer, TV, harsh lighting, pets or kids. If you want improved sleep, return your bedroom to its intended functions: sex and sleep.”

Most importantly Ball concludes, families need to recognize that women require time for themselves – “Women should listen to their bodies and minds; take time each week to walk, invest in a hobby, meditate. Your sleep will improve and so will the quality of your life.”

Roberta Greenwood is a writer and environmental activist who lives with her husband and daughter in Bellevue.

©2005 Caliope Publishing Company