This is the third of a nine-part print and online series looking at the science of sleep and the vital role of sleep in maintaining overall health.
Like millions of Canadian mothers, Dawn Trudeau's sleep troubles began when her daughter was born.
"You're getting up at all hours for feedings and whatnot, and I had a hard time getting her to sleep through the night," says the Ottawa-based, 46-year-old social media marketer and blogger at TheModernMomBlog.com. "My husband is great, and he would help in a minute but he just did not hear the baby crying," she says.
Even after her daughter started sleeping through the night consistently at age 4, Ms. Trudeau says her sleeping problems persisted to the point of insomnia. "I kind of got used to it at that point." And now that her daughter is 7, her sleep disturbances are also business-related.
"Things go through your head and you can't shut anything down," she says. "You think, tomorrow I have a meeting here, she's starting school tomorrow, did I give her enough lunch? … I have a client and they have deadlines. Your mind goes crazy at night."
She continues, "Everyone else would go to sleep and I'd stay up, I'd say, I've got to do laundry now, I'd be so wired, I'd drink coffee, too."
Ms. Trudeau says she knows the lack of sleep affects her the day after and beyond. "I don't have much mental alertness after a night like that. But you still go on, you have to get your child to school, you have to work and you have to focus. It's very hard, and I tend to overcompensate with coffee."
According to a 2005 Statistics Canada survey, women reported more problems getting to sleep and falling asleep than men (35 per cent versus 25 per cent).
A U.S.-based 2002 National Sleep Foundation study found similar results: Women were more likely than men to experience at least one symptom of insomnia at least a few nights a week (63 per cent versus 54 per cent).
And a 2013 study out of Duke University found that women experience more mental and physical consequences from inadequate rest. "We found that women had more depression, women had more anger, and women had more hostility early in the morning," said Duke researcher Michael Breus.
Elliott Lee, a sleep specialist based at Ottawa's Royal Mental Health Centre, says that, in general, women do sleep more poorly than men.
"Women have a lot of different challenges with respect to their sleep that men don't have to contend with," he says. "They have biological factors that predispose them to poor sleep, like pregnancy and the menstrual cycle, and menopause is an extreme challenge to sleep."
In addition to these biological factors, Dr. Lee says there are several medical and psychological pieces to the no-sleep puzzle. "Women are more vulnerable to having more psychiatric difficulties which can affect sleep, particularly mood and anxiety disorders."
Another reason women have poorer sleep is that they often have an "on-call" type of sleep, related to child-rearing years, says Helen Driver, a sleep specialist at the Kingston General Hospital Sleep Research Unit in Kingston, Ont.
Studies have shown that if you expose men and women to the sound of a baby crying, womens' biological measures of heart rate and stress levels go up much higher than men.
But the counterintuitive finding is that several studies have shown that women appear to sleep longer than men, says Dr. Lee: about 15-20 minutes more than men on average. But they seem to need more sleep in order to feel refreshed in comparison to men.
"When we do sleep recordings, paradoxically women's sleep appears to be better than men," Dr. Driver says. "So there must be something we're not measuring."
One of the problems is that, like many other medical studies, sleep studies were predominantly done on men, he adds. And then researchers "assumed women must have the same issues. It's only in the last couple of decades more research has focused on women's sleep."
Problems and solutions
Regardless, the effects can lead to problems. "Certainly when men or women don't get enough sleep or a poor quality of sleep, it can lead to a lot of medical and psychiatric problems, from mood disorders and cardiovascular disease, even cancer has been associated with a lack of sleep or sleeping at the wrong time," Dr. Lee says.
To combat women's poor sleep, Dr. Lee says the most important thing to convey is to make sleep a priority. "Getting the right amount of sleep, for most people that's 7-9 hours. Go to bed at a regular time, wake up at the same time every morning and try to keep that routine as tight as possible. Avoid anything that can affect the quality of sleep: alcohol, caffeine, cigarettes."
Dr. Lee also suggests that people avoid things late at night that can reset that sleep cycle, like the backlit screens of computers, tablets and smartphones. "The light from those screens can reset the inner biological clock and can trick the brain into thinking it's time to stay up and that can lead to people having difficulty falling asleep, staying asleep and it can lead to more problems the next day."
Dr. Driver suggests having a bedtime ritual. "It really just helps you to get ready for sleep, to tune out what happened during the day and decrease the busyness levels and slow down, relax and start the process of going to sleep by reducing whatever those external stimulating factors might be."
As for hormonal changes, for women in perimenopause or menopause, hot flashes can disturb sleep, Dr. Driver says. If hot flashes are the problem, cooling the environment can help. Or some women may choose to supplement with hormone replacement therapy if they don't have risk factors.
Women with children who are having the "on-call" type of sleep sometimes have to be de-conditioned in order to sleep better.
"If exercise is part of a routine, it's good, but the other issue is the type and intensity of exercise. If you're doing a yoga routine with a mindfulness session at the end, that's not going to be disruptive to your sleep. But if you've been running, doing high-intensity aerobic exercise, then you need to allow more wind-down time."
Dr. Atul Khullar, the medical director for the Northern Alberta Sleep Clinic and the senior national consultant physician for a national network of MedSleep sleep clinics, suggests checking for any medical conditions. "Low iron, depression, anxiety, they can often sneak up on people. What we see a lot in our insomnia patients is that … not sleeping well is a sign of multiple other issues in their mental and physical health."
There are some people who need medication, but that's the minority, he adds. "You need a thorough assessment before any sort of sleeping pill is prescribed. It's only really indicated for short-term issues."
As for other remedies that people turn to like Benadryl and the Gravol, "Those can be extremely dangerous for elderly people: They can cause confusion and dizziness, and there's a lot of tolerance for them. They can really kind of slow your brain down."
One of the biggest problems is that people "catastrophize" not sleeping, says Dr. Driver, which makes it worse. "If you have one night of bad seep, you'll cope."
One woman's strategies
As for Ms. Trudeau, she has found some strategies. "After a certain time of night, I put my cellphone away; it really helps me, because that's work to me. If I can take a few hours before bed to stop with the electronics and work, it does make a big difference," she says. She has also started keeping a journal beside her bed to record the thoughts that might be keeping her up at night.
Ms. Trudeau also found that a warm bath or walk outside can help calm her mind and get her body ready for sleep. "I can get out and get some fresh air and just vent a little bit," she says.
She is also trying to let herself off the hook when it comes to "doing it all" before she hits the hay.
"I pick my battles: It doesn't matter if every stitch of laundry is done every day," she says. "I just try to take some stress out of my evening. I try to get my daughter in bed, read her a story and say, 'That is enough.' "