An estimated 10% of people in the U.S. experience chronic insomnia, and about a third of the population will have at least one insomnia symptom during their life. In general, women develop insomnia at higher rates than men.
Those with the condition have trouble falling asleep and staying asleep. The quality of the sleep they do get is often poor, which can lead to problems like car accidents, depression, and the potential for developing other related conditions.
Below, we’ll take a close look at what causes insomnia in women and what treatment options are available.
What Causes Insomnia in Women?
Women and people assigned female at birth experience insomnia more often than men and those assigned male at birth, but there’s no one specific reason why. Insomnia affects women for a variety of different reasons. Some, like parenting and caregiving, are societal, while others, like perimenopause and pregnancy, are biological.
Menstrual Cycle Changes
The female hormonal changes that occur as a result of puberty, pregnancy, and menopause (before, during, and after) can cause insomnia. One of those is the menstrual cycle, which has four phases across roughly 28 to 32 days: menstruation, follicular phase, ovulation, and luteal phase. During these phases, estrogen and progesterone, the two main female reproductive hormones, fluctuate.
Both estrogen and progesterone communicate with your central nervous system (CNS), which can affect your circadian rhythm, also called your sleep-wake cycle. People who experience premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) seem to be most affected by these hormonal changes and can experience sleep disturbances, including insomnia in the week leading up to their periods.
In addition, PMS and PMDD symptoms include mood changes, cramps, headaches, changes in body temperature, and anxiety — all of which can affect sleep.
Pregnancy
People can experience sleep changes during all three trimesters, but they often happen for different reasons.
- First trimester: Progesterone levels increase significantly, which can make you sleepy during the day and affect your quality of sleep at night.
- Second trimester: People tend to experience sleep that’s not as restful as it was prior to pregnancy, and they’re more likely to experience reflux that interrupts sleep.
- Third trimester: Most often, sleep trouble is from the physical discomfort of being pregnant. Frequent urination, acid reflux, restless legs, growing bellies, and fetal movement can all cause people to wake up.
During the third trimester, most people experience some type of sleep disturbance — up to 98%, according to one study. And pregnancy insomnia rates are higher during the third trimester than they are in the first and second, with up to 80% of people experiencing insomnia at some point in their pregnancy.
Anxiety around pregnancy and childbirth can also cause sleep disturbances that can continue after pregnancy into postpartum.
Perimenopause and Menopause
The same hormones that can affect sleep during menstruation and pregnancy are also responsible for sleep problems during perimenopause and menopause. Progesterone and estrogen levels drop as people age, affecting the body’s sleep-wake cycle.
Alongside these hormonal changes, people often experience night sweats, hot flashes, and mood changes, which can make it harder to fall asleep and stay asleep. Most often, insomnia and sleep disturbances happen during the menopause transition, which can take two to eight years.
Pre- and post-menopause, people are more likely to develop obstructive sleep apnea (OSA), which can go undiagnosed. If you or a partner suspect that you may have sleep apnea, a home sleep study can help.
Don’t Just Test Your Sleep. Understand It.
Measure key sleep metrics and review your results with a licensed sleep-care provider. Discuss sleep issues and options to make restless nights a thing of the past.
Depression and Anxiety
Insomnia and some mental health conditions have a bi-directional relationship, which means that they affect one another. Depression and anxiety can make it harder to sleep, and lack of sleep can make a person more depressed or anxious. Stress from thinking about sleep or ruminating on the day can make it hard for your brain to settle down and ease into sleep.
Depression in particular has been linked to insomnia. Studies show that those with depression can take longer to fall asleep, wake up more often, and have more variation in their REM sleep. Women also experience depression and anxiety at higher rates than men.
Chronic Pain Conditions
Chronic pain affects nearly 25% of American adults, and roughly 8% of those experience high-impact chronic pain that limits their life. Women are more likely to experience chronic pain than men.
Sleep disturbances are a common symptom of many chronic pain conditions, including:
- Fibromyalgia: People with the musculoskeletal disorder fibromyalgia experience widespread pain that can keep them awake and cause low-quality, unrestorative sleep.
- Arthritis: People with arthritis experience insomnia at a higher rate than those without the condition. Arthritis causes joint pain and movement limitation, which is what experts think leads to sleep problems.
- Migraines: Among people with migraines, insomnia is the most reported sleep disorder, though researchers aren’t sure exactly why.
Thyroid Disorders
Your thyroid is a small gland in your neck that produces body-regulating hormones. When your thyroid produces too much of these hormones, it’s called hyperthyroidism. When they produce too little, it’s hypothyroidism. Both can cause sleep issues.
- Hyperthyroidism: People with hyperthyroidism tend to have a hard time falling asleep and staying asleep, and many get sleepy during the daytime. It can also make anxiety worse, which has an impact on sleep.
- Hypothyroidism: Those with hypothyroidism tend to take longer to fall asleep and have worse quality sleep than people with correctly functioning thyroids.
Gastrointestinal Conditions
Gastroesophageal reflux disease (GERD) and acid reflux can cause nighttime awakenings and significant discomfort. Lying down can aggravate acid reflux symptoms, which is why it can be such a problem during sleep. Reflux can cause people to wake up, and in some cases, vomit at night.
Irritable bowel syndrome (IBS) is another gastrointestinal condition that can affect sleep. Frequent bathroom trips interrupt sleep, and there’s some research showing that poor sleep can worsen next-day IBS symptoms.
Sleep Disorders
It shouldn’t come as much of a surprise that other sleep disorders can worsen insomnia. When people with restless legs syndrome (RLS) try to go to bed, they get a strong urge to move their legs. Sometimes that urge can come with throbbing, itching, or other uncomfortable feelings that make it hard to fall asleep.
Your circadian rhythm can also impact your sleep if it’s irregular. Some people’s internal clocks don’t line up correctly with the external cues of their environment, which can make both falling asleep and staying asleep more difficult.
Caregiving Responsibilities
In general, women take on the majority of family caregiving roles, supporting children and aging relatives. Their added labor can be tiring in itself, especially when tasks have to be performed at night. For example, one review shows widespread sleep disturbances in new mothers, with some cases progressing to insomnia.
Shift Work
More than 70% of healthcare positions in the U.S. are held by women. In many caregiving professions, employees work long hours, often at night.
Your melatonin levels change throughout the day based on environmental cues like the sun rising and setting. People who work the night shift or split shift can have sleep problems like insomnia, because their circadian rhythms can’t adapt correctly to changing schedules or working at night.
Sleep Habits and Environmental Factors
There’s plenty of evidence showing that a regular sleep routine and healthy habits can help prevent sleep disorders like insomnia. Limiting screen time before bed and avoiding alcohol and caffeine can also help. Sticking to the same routine, even on the weekends, can train your body to fall asleep and stay asleep.
How Is Insomnia Treated in Women?
To effectively treat insomnia in women, it’s important to understand what may be causing it. A doctor can help you decide which of the following insomnia treatment options might be best for you.
- Cognitive behavioral therapy for insomnia (CBT-I): CBT-I is an effective, therapeutic treatment for insomnia. Across six to eight weekly sessions, professionals treat the factors that cause insomnia.
- Addressing underlying medical or hormonal issues: Some circadian rhythm problems stem from changes in hormonal levels, especially during pregnancy or menopause. Treating changing progesterone and estrogen levels may be beneficial.
- Improving sleep hygiene: Go to bed and wake up at the same time every day, even on weekends. Avoid screens before bed and make your bedroom an inviting, comfortable space that’s cool, dark, and quiet.
- Stress management techniques: Yoga before bed, box breathing (inhale for 4 counts, hold for 4, exhale for 4, hold for 4, and repeat), and meditation can all help your brain wind down and ready your body for sleep.
- Medications when appropriate: In some cases, sleep aids might be used. Your doctor can help you choose between supplements like melatonin, over-the-counter drugs like antihistamines, and prescription sleep medications. Sleep aids aren't recommended for long-term use, so it's best to use them to get sleep on track with advice from a doctor, and then, once good sleep habits and hygiene are implemented, work toward weaning them off.
- Sleep Coaching from Sleep Doctor: Our sleep care team can help you learn more about your sleep. A one-time sleep consult lets you talk through your sleep with a professional who can help you determine the best next steps. Our sleep coaching program offers ongoing support across four sessions and a personalized plan to help you sleep better.
When to Talk to a Doctor
There are certain instances that require a doctor’s advice and care. If you experience any of the following, you should reach out to your provider.
- Symptoms lasting more than three months
- Daytime sleepiness or impaired functioning
- Frequent nighttime awakenings
- Snoring, gasping, choking during sleep
- Crawling, pulling, or aching in the legs
- Concerns during pregnancy or menopause
Frequently Asked Questions
What can a pregnant woman take for insomnia?
There’s not much research available that looks specifically at pregnant people and sleep medications. Some experts think that antihistamines and melatonin are okay to take while pregnant, and others say they should be avoided because of the lack of clinical studies. Talk with your doctor to get personalized advice on safe sleep aids that can be taken while pregnant.
Can low testosterone cause insomnia in women?
Low testosterone levels have been shown to cause insomnia-like symptoms in men, but further studies are needed to determine how low testosterone affects women and people assigned female at birth. People of all genders have testosterone, progesterone, and estrogen — just at different levels depending on their reproductive organs.
Is insomnia more common in men or women?
Women experience insomnia at significantly higher rates than men. One in four women experiences insomnia, while it only affects one in five men.
Why is insomnia more common in women?
There’s no clear-cut reason why women experience insomnia at higher rates than men, but hormones, mental health, and chronic pain may play a part. Women and people assigned female at birth have hormonal fluctuations throughout their lives that affect sleep and their circadian rhythms.
They’re also more likely to work in healthcare and caregiving roles that affect sleep. Women also experience secondary insomnia more often than men, so they have insomnia symptoms as a byproduct of other conditions like depression and fibromyalgia.
