Hormonal changes and psychosocial issues are behind the problem; see how to improve sleep quality

The dance of hormones that takes place in the female body since puberty impacts all aspects of women’s health, including the quality of sleep. This was one of the main conclusions of research recently published in the scientific journal Sleep Medicine Reviews.

But what is the relationship between sleep and these hormonal changes? There are many. Due to the increase in progesterone during menstruation, for example, daytime drowsiness tends to increase. Cramps also have an influence, especially when they are more intense and can lead to interruptions in rest.

“Women go through different phases of sleep characteristics during their lives depending on the different reproductive periods”, explains gynecologist Helena Hachul de Campos, professor of women’s health at the Faculty of Medicine of Hospital Israelita Albert Einstein.

“The regularity of the cycle also counts, as data shows that women with an irregular cycle have twice the risk of suffering from problems with sleeping and sleep quality”, says Hachul, who is head professor of the Sleep sector at Woman at the Federal University of São Paulo (Unifesp) and researcher at the Sleep Institute.

Those who live with premenstrual syndrome, popularly known as PMS, may have their quality of rest even more compromised, increasing insomnia and drowsiness during the day, especially due to mood swings, which make women more anxious, for example. But this varies from person to person, from cycle to cycle and depending on the moment in life they are in — the more stressed they are, for example, the more difficulty they have with sleeping.

Polycystic ovaries must also be considered, a syndrome that is very prevalent in women during the reproductive period. Scientific literature shows that women who suffer from it tend to be more overweight and have metabolic syndrome, factors that are associated with obstructive sleep apnea, a disorder that causes interruptions in breathing during rest.

Pregnancy is another phase that affects sleep a lot. The first trimester is usually quite hectic, as it involves nausea and frequent trips to the bathroom. With the arrival of the second quarter, things tend to calm down. In the third, the abdominal enlargement caused by the baby’s growth begins to put pressure on the bladder, forcing the pregnant woman to get out of bed more often to pee, in addition to causing difficulty breathing, which leaves sleep fragmented.

Pregnant women with high blood pressure are even more at risk of suffering from apnea. “Around 46% of pregnant women have some sleep complaints and the more frequent they are, the greater the risk of worse neonatal outcomes”, warns Helena Hachul.

But it is with the arrival of menopause that women’s sleep tends to change in earnest. “The changes are more evident and constant after the major hormonal drop that occurs at this stage”, says pulmonologist and sleep medicine specialist Luciane Impelliziere Luna de Mello, professor of the postgraduate course in sleep medicine at Hospital Israelita Albert Einstein and doctor at the Sleep Institute, linked to Unifesp.

In addition to hot flushes (hot flashes) and increased urinary frequency, which can leave rest fragmented, women have to deal with social and emotional changes, such as depression, anxiety and empty nest syndrome, caused by their children leaving home. , among others.

There is also scientific evidence that female hormones play an important role in the biological clock. “For all these reasons, the incidence of insomnia, which was 30% before menopause, jumps to 60% after menopause,” reports Hachul.

Apnea is also a more common problem at this stage of life. “The change in the distribution of body fat characteristic of this period, which causes it to accumulate more around the waist, is decisive, as with each additional centimeter of abdominal circumference, the risk of apnea increases by 5%. ”

Overload also harms sleep

Women also tend, at different stages of adult life, to accumulate more tasks than men. Obligations and worries about work, home and children often mean that they have less time to sleep. And when it’s time to rest, many can’t relax, as they’re thinking about everything they have to do the next day.

In addition to practical issues, there are emotional ones that also keep women up at night. “They are more sensitive to mood disorders, such as depression and anxiety, and issues linked to the accumulation of tasks, which causes them to suffer more insomnia because of these factors”, says Mello.

For all these reasons, doctors need to be extra careful when analyzing and treating women’s sleep. “We have to evaluate them as a whole, checking how their hormones and menstrual cycle are, what their current stage of life is, who they live with, whether they share tasks, whether they take medication, whether they have other illnesses, among many other factors. , because all of this influences”, says Hachul.

“Another issue that we have to take into account is that they often underestimate the respiratory issues that trigger apnea, which, in many cases, we only identify when doing a polysomnography, an exam that analyzes sleep”, adds Mello. This is worrying because, even with milder conditions, women already experience symptoms such as snoring and pauses in breathing, which can cause choking and brief awakenings.

With regard to the treatment of sleep disorders, in addition to medication strategies, which must be evaluated individually, care related to sleep hygiene must also be considered. These include: always sleeping at the same time, eating light meals at night, drinking coffee only until lunch time, not staying on your cell phone or computer late, avoiding intense physical exercise close to rest time, leaving the room dark and just go to bed when it’s time to sleep. “It is also important to hydrate well and have a healthy diet, since, for a good night, it is essential to have a good day too”, concludes Hachul.