Sleep Health Across a Woman’s Lifespan
The divergence between male and female sleep quality starts at puberty and has several implications for women’s health across the lifespan, according to research presented at the American Association of Nurse Practitioners (AANP) annual meeting, held from June 17 to 22, 2025, in San Diego, California.
Nanette Alexander, DNP, APRN, ANP-BC, FAANP, discussed the factors that influence sleep in women from puberty through pregnancy, motherhood, menopause, and older adulthood. Dr Alexander is a shareholder/owner of PRIME HealthCare, PC, in Glastonbury, Connecticut.
Lack of Sleep Studies in Women
Understanding the differences in sleep health between men and women can be complicated by a lack of literature on women’s sleep patterns. Historically, large clinical trials on sleep have not been equitable for women, Dr Alexander explained.
“Traditionally, for women of childbearing age, there was a fear of potential pregnancy during drug trials so they would not be admitted,” she said in an interview with The Clinical Advisor.
There are no known sex-based differences in sleep health among preadolescent children. But as girls begin puberty, hormone changes and other factors start to influence their sleep.
Menstruation Is a Turning Point for Sleep Health
Menstrual pain and premenstrual symptoms interrupt the daily activities of 8% to 11% of early adolescents.
“We know that for some young women, menstruation is not a big deal,” Dr Alexander said. “Others struggle with premenstrual syndrome, premenstrual dysphoric disorder, and mood changes, so when [a patient has] a lot of swings [in hormones] it can affect sleep.”
In studies of premenarcheal and postmenarcheal adolescents, researchers have found that the onset of menstruation is a critical transition point for sleep health. Unhealthy sleep patterns that begin in early adolescence can affect an individual’s quality of life and have repercussions for their overall health across their lifespan, Dr Alexander explained.
In adolescence and young adulthood, some patients begin using hormonal contraception, which is associated with a 6% higher prevalence of sleep disturbances compared with patients who use non-hormonal contraceptives.
The relationship between hormonal contraceptives and sleep health is unclear, although it is known that progesterone enhances obstructive sleep apnea (OSA), which subsequently improves sleep efficiency.
If a patient is initiating or changing their hormonal contraception and presents with sleep complaints, clinicians should consider adjusting the patient’s prescription.
The Relationship Between Sleep, Fertility, and Pregnancy
Sleep may be a modifiable target to improve reproductive outcomes. Menstrual cycle irregularity and/or prolonged cycles are linked to decreased sleep duration, insomnia symptoms, and disturbed sleep.
Disruption of the circadian rhythm impairs the hypothalamic-pituitary-gonadal axis, which affects fertility. Shift work and shorter sleep durations are associated with higher rates of miscarriage.
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Women struggle with premenstrual syndrome, premenstrual dysphoric disorder, and mood changes, so when [a patient has] a lot of swings [in hormones] it can affect sleep.
Nanette Alexander DNP, APRN, ANP-BC, FAANP
Throughout pregnancy, about 50% to 75% of women will experience insomnia symptoms. Sleep durations that are too long or too short are linked to an increased risk of developing gestational diabetes mellitus.
Sleep disturbances during pregnancy are associated with higher rates of emergency cesarean sections, preterm births, depressive symptoms, glucose intolerance, and gestational hypertension.
Physical exercise during pregnancy can help alleviate aches and pains, which can improve sleep quality. Some women can also benefit from cognitive behavioral therapy (CBT) to reduce insomnia symptoms during pregnancy and the postpartum period.
Sleep and Motherhood
Predictably, women with children have poorer sleep health compared with women who do not, and the first 3 months of an infant’s life are when mothers get the least amount of sleep.
Having a support network is crucial to mitigate the burden of increased stress on mothers, Dr Alexander explained.
Dr Alexander shared the following sleep hygiene tips for women to follow during early motherhood and beyond:
- Keep a consistent sleep and wake schedule when possible; do not try to catch up on missed nighttime sleep in the morning.
- Keep the bedroom as quiet and dark as possible.
- Have a bedtime routine that includes a stress reduction practice, like meditation or yoga.
- Avoid caffeine or blue light-emitting devices before bed.
- Create a personalized sleep hygiene plan; some people, for example, benefit from a warm drink before bed, while for others, this leads to extra overnight trips to the bathroom.
How Menopause Influences Sleep Patterns
During perimenopause, fluctuating estrogen levels can disrupt sleep due to estrogen’s role in temperature regulation. Hormone therapy can improve sleep quality for menopausal women.
Clinicians should consider hormone replacement therapy (HRT) to alleviate insomnia symptoms in perimenopausal women if the patient is younger than 60 years old and is within 10 years of menopause, there are no contraindications, and the benefits of HRT outweigh the risks.
Aging and Sleep Disturbances in Women
Age-related neurobiological changes can reduce sleep quality for older adults. Additionally, comorbid conditions like Parkinson disease, dementia, respiratory disease, and depression can impair sleep. Among people aged 65 years or more, women are 1.7 times more likely to have insomnia symptoms; up to 40% of women over age 65 have insomnia symptoms.
Polypharmacy is a major factor in the decline in sleep quality that many older adults experience. Often, “as providers, we [prescribe] beta blockers or other medications to treat [conditions], but we neglect to think about the timing of the medications and what [the medications] can do for sleep,” Dr Alexander said. “Beta blockers can be disruptive, but they’re very much needed in heart failure patients. Diuretics can sometimes be timed a little differently, so people aren’t having more maturation during the night.”
Dr Alexander urges clinicians to look at what medications are prescribed and if they are needed. If the medication is added, what effect will it have on a patient’s sleep? “If it changes sleep, try to mitigate its effect on sleep or make a change within the formulary that’ll help mitigate the effects,” she said.
Medical Conditions That Can Affect Sleep
While comorbidities that affect sleep are most common in older patients, women of any age may have comorbid conditions that interrupt their sleep.
Table. Comorbidities That Influence Sleep Health
| Comorbidity | Effects on Female Patients |
| Polycystic ovarian syndrome (PCOS) | Elevated sleep disturbances compared with general population, increased sleep onset latency |
| Restless leg syndrome (RLS) | Prevalence of RLS is nearly double in men versus women; women tend to have more distress associated with RLS symptoms than men |
| Narcolepsy | Women of all age groups took longer to receive a diagnosis, had more episodes of cataplexy, and had more excessive daytime sleepiness earlier in life compared with men |
| Obstructive sleep apnea (OSA) | Women may present with more atypical OSA symptoms: insomnia, fatigue, anxiety, depression, tiredness, and morning headaches; women have increased risk of developing OSA after menopause, and women have higher incidence of subclinical myocardial damage or heart failure than men |
| Insomnia | Risk ratio of 1.41 for women versus men |
| Intimate partner violence | In a study of female veterans, a lifetime history of intimate partner violence was linked to twofold to fourfold odds of current clinical insomnia. These results suggest that there are both direct and indirect relationships between sleep and anxiety-related disorders. |
Hear from Dr Nanette Alexander as she discusses the importance of a full night’s sleep and offers clinicians advice on how to ease their patients’ sleep concerns:
This article originally appeared on Clinical Advisor
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