Sleep’s an Important Part of the Health Equation—Now More than Ever
By Dr. Janine A. Clayton
Here’s a wake-up call: Did you know that adults need about 7 to 8 hours of sleep a night for good physical and mental health?1 One-third of adults sleep less than that. And although a roughly equal proportion of men and women don’t get enough sleep, women report more sleep-related problems than men.2 Moreover, the health consequences are not the same for men and women, and in some cases, they are worse for women.3,4,5 So National Women’s Health Week (May 10–16) is an opportune time to highlight women’s unique sleep challenges.
For both sexes, insufficient sleep increases the risk for obesity, diabetes, high blood pressure, cardiovascular disease,4 and injuries.1,3 Depression is also related to insufficient sleep.6 In fact, the connections among insufficient sleep, high blood pressure, heart disease, obesity, and depression may suggest that insufficient sleep is part of a common disease pathway. Sleep can be disrupted in different ways: insomnia, sleep-disordered breathing, sleep apnea, narcolepsy, sleep that does not fully refresh, and frequent waking. An article in ORWH’s quarterly publication discusses a possible link between sleeping with artificial light and weight gain and obesity among women.
As noted above, some health effects of insufficient sleep are worse for women. Sleeping 5 hours or less nightly is associated with increased risk of high blood pressure among women but not men.7 Women are more likely to experience daytime sleepiness and report that sleep problems harm their daily functioning.8 Sleep apnea, although more common among men, may be more difficult to diagnose in women.9
In addition, women are more likely to have trouble falling asleep and wake up feeling not rested,10 report poorer sleep quality, and experience insomnia than men.11 Single parents, especially women (43.5%), are most likely to report insufficient sleep10—which may be related to gender roles they play.
The effects of insufficient sleep begin early in life, as do sex and gender differences. For young people, getting the needed amount of rest nightly—9 to 12 hours for children ages 6 to 12 and 8 to 10 hours for those ages 13 to 18—is crucial for healthy development.1,3 A higher proportion of girls than boys in middle school report getting insufficient sleep, a difference that continues into high school.12 As with adults, insufficient sleep among youth is associated with increased risk for obesity, diabetes, injuries, and poor mental health; behavioral problems in school and poor academic performance have also been reported.13,14
NIH takes sleep deprivation, especially among women, seriously. The 2018 Research Conference on Sleep and the Health of Women highlighted some of the major findings of NIH-funded research on sleep and the health of women, as well as the disproportionate burden of sleep deficiency and sleep disorders among women. The conference was a collaborative effort by the National Heart, Lung, and Blood Institute’s National Center on Sleep Disorders Research, ORWH, other Federal agencies, and participating members of the Trans-NIH Sleep Research Coordinating Committee.
Why are there sex and gender disparities in sleep? Reproductive hormones and lifestage transitions can affect sleep.11 Some sex differences seem to start around puberty, with a link between the development of secondary sex characteristics and later sleep and wake times for girls but not boys.15 Women are particularly vulnerable to developing insomnia when their reproductive hormones are in flux—for example, during menstrual cycle changes, pregnancy, and menopause.11
Around menopause, women are especially prone to fragmented sleep, in addition to being susceptible to the factors that cause poorer sleep quality for most people as they age—going to bed and waking earlier, sleeping lightly, having difficulty falling and staying asleep, and feeling not fully refreshed by sleep.1 About a quarter of menopausal women experience disrupted daytime functioning because of severe sleep disturbances,16 which are often prompted by menopausal hot flashes.17 Regardless of the underlying factors, the links among menopause-related sleep disturbances, mood disruptions, and higher risk for later depression and cardiovascular disease suggest that older women may need treatment for fragmented sleep.16 Midlife sleep disruptions also may be associated with health conditions such as chronic pain and stress.1
A good night’s sleep is important for good health, especially during times of stress, such as the current public health crisis. Fortunately, there are some practical steps that we can all take to get sufficient sleep. (See below, “Resources for Getting a Good Night’s Sleep.”) Please take the simple steps highlighted in the resources provided and listen to the wisdom of your body to get the rest you need. Lights out!
1 National Heart, Lung, and Blood Institute (NHLBI). Your Guide to Healthy Sleep. https://www.nhlbi.nih.gov/health-topics/all-publications-and-resources/your-guide-healthy-sleep. Accessed April 22, 2020.
2 Krishnan V, Collop NA. Gender differences in sleep disorders. Curr Opin Pulm Med. 2006; 12(6):383–9.
3 Centers for Disease Control and Prevention (CDC), Sleep and Sleep Disorders. https://www.cdc.gov/sleep/about_sleep/chronic_disease.html. Accessed April 22, 2020.
4 Liu Y et al. Prevalence of healthy sleep duration among adults—United States, 2014. MMWR Morb Mortal Wkly Rep. 2016; 65(6):137–41.
5 United Health Foundation. America’s Health Rankings. https://www.americashealthrankings.org. Accessed on April 24, 2020.
6 Chapman DP et al. Frequent insufficient sleep and anxiety and depressive disorders among U.S. community dwellers in 20 states, 2010. Psychiatr Serv. 2013; 64(4):385–7.
7 Cappuccio FP et al. Gender-specific associations of short sleep duration with prevalent and incident hypertension: the Whitehall II Study. Hypertension. 2007; 50(4):693–700.
8 Boccabella A, Malouf J. How do sleep-related health problems affect functional status according to sex? J Clin Sleep Med. 2017; 13(5):685–92.
9 Won CH et al. Sex differences in obstructive sleep apnea phenotypes, the multi-ethnic study of atherosclerosis. Sleep. 2019; zsz274, https://doi.org/10.1093/sleep/zsz274.
10 Nugent CH, Black LI. Sleep duration, quality of sleep, and use of sleep medication, by sex and family type, 2013–2014. NCHS Data Brief. 2016; (230):1–8.
11 Nowakowski S, Meers J, Heimbach E. Sleep and women’s health. Sleep Med Res. 2013; 4(1):1–22.
12 Wheaton AG et al. Short sleep duration among middle school and high school students—United States, 2015. MMWR Morb Mortal Wkly Rep. 2018; 67(3):85–90.
13 Paruthi S et al. Consensus statement of the American Academy of Sleep Medicine on the recommended amount of sleep for healthy children: methodology and discussion. J Clin Sleep Med. 2016; 12(11):1549–61.
14 Lowry R et al. Association of sleep duration with obesity among US high school students. J Obes. 2012; 2012:476914.
15 Foley JE et al. Changes to sleep–wake behaviors are associated with trajectories of pubertal timing and tempo of secondary sex characteristics. J Adolesc. 2018; 68:171–86.
16 Baker FC et al. Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nat Sci Sleep. 2018; 10:73–95.
17 Bianchi MT et al. Nocturnal hot flashes: relationship to objective awakenings and sleep stage transitions. J Clin Sleep Med. 2016; 12(7):1003–9.