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Harvard Commentaries
35320
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Woman to Woman Woman to Woman
 

Women and Sleep: Not Always the Best of Friends


January 14, 2013

By Alice Y. Chang M.D.

Harvard Medical School


Lately, I hear myself echoing many of my female patients: Why am I so tired all the time? Recently, my husband took my 15-month-old son out of town for four days. I felt rested like I haven’t been in the past two years since I became pregnant. And I had the energy to do projects well into the evening. I laughed when my husband was either asleep when I called him at 9 p.m. or kept saying during our phone calls: “Why am I so tired? I thought I was supposed to be on vacation!”

This little personal experiment highlighted for me not only the importance of sleep quantity but sleep quality. For sleep to be restful, it is best for it to be uninterrupted. While I was around, my husband on some level relaxed. He didn’t seem to hear the baby wake up at night and probably slept more deeply.

Unfortunately, a young child is not the only reason why a woman may feel tired throughout her life. Here are several common reasons why women might not sleep well and tips for getting more rest:

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Pregnancy

Most women expect that sleep might be more difficult during the last trimester of pregnancy, but difficulty sleeping can start in the first trimester. There are actually several factors that can influence sleep during pregnancy:

  • Back pain — This can occur anytime during pregnancy, although it is more common during the last trimester. A good position to learn early in your pregnancy is sleeping on your left side. This position helps to improve blood flow to the uterus and your baby. In this position, put a pillow between your knees to ease tension on the back.
  • Increased urination — Because of the position of the uterus early and late in pregnancy, your may feel like running to the bathroom, even in the night. Although you should be drinking a lot during the day, decrease the amount of fluids you drink in the evening.
  • Leg cramps — No specific cause is usually found. Occasionally a woman may have a low potassium, magnesium, or calcium level in her blood. Gently stretching your legs before going to bed can help. 
  • Wild dreams — The hormonal changes during pregnancy can lead to some vivid dreams. If you have particularly scary or anxiety-filled dreams, this can interfere with sleep. Talking them out during the day can ease your mind.
  • Heartburn — Hormonal changes and the physical pressure of the uterus on the diaphragm can lead to first-time symptoms of heartburn, or worsen heartburn that you already have. In either case, symptoms tend to be worse at night. Try not to eat for two to three hours before going to bed. Limit your intake of spicy and fried or fatty foods, especially at night. If you get hungry or have nausea, eat a few plain crackers. Sleeping on a few pillows or raising the head of your bed several inches also can help.
  • Tender breasts — Wearing a comfortable bra to bed can ease your symptoms.
  • Baby kicks — Babies are often most active when we are not moving around. If your baby is particularly active or you are a light sleeper, these kicks can wake you up at night.
  • Restless leg syndrome (RLS) — This “creepy-crawly” feeling that makes you move your legs can easily interfere with your sleep, even if you don’t remember the feeling in the morning. Sometimes, it’s your bed partner who notices this more than you, especially if you are a big kicker. Iron deficiency is associated with restless legs, and your obstetrician may recommend additional iron supplements if a blood test confirms a low iron level. If that is not the cause, there isn’t much you can do about it while you’re pregnant. Fortunately, it usually goes away after the delivery.
  • Snoring — Pressure on the diaphragm and increased swelling in your nasal membranes may lead to snoring during pregnancy. Heavy snoring can be accompanied by sleep apnea, when you actually stop breathing for short periods during sleep. Sleep apnea can severely disrupt quality sleep and has been associated with high blood pressure and preeclampsia in pregnant women. So it is important to see your doctor if your partner notices this new symptom.

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Breastfeeding

Breastfeeding is a rest-defying activity on many levels. There are factors beyond just the night feedings to contend with. Although we have an image of the peacefully breastfeeding mother in a rocking chair, possibly relaxed by prolactin levels that rise during breastfeeding, reality can be very different. The rest of the day you may have anxiety from worrying about how your baby is breastfeeding, whether he or she is getting enough milk, or whether you have enough breast milk. If your baby is sleeping through the night — by the way, it might surprise you that this definition is five hours of uninterrupted sleep — you might experience breast tenderness or wet nightclothes from leakage. Some solutions to consider:

  • Wear your bra to bed. In particular, special maternity bras and pads will give you extra support to limit breast tenderness and prevent breast-milk leakage on your clothes or bed sheets.
  • Let Dad help. A friend of mine mastered getting her kids to sleep before pumping breast milk and going to bed at 9 p.m., then having her husband stay up to feed the baby at midnight. She would wake up to do the 3 a.m. feed so she could get at least six hours of sleep, and so would he. Other women will alternate “night call” for the baby, taking turns so one person does all the feeding one night and then the other gets to sleep. Others have their partners bring the baby to them to feed. Whatever method you design, make sure you design something. Don’t try to do it all on your own. Breastfeeding for six months to a year is a long time to go sleep-deprived.
  • Sleep with your baby in your bed, or put your baby in a bassinet near your bed. Having your baby sleep in bed with you is called co-sleeping, and it requires being especially attentive to the baby’s safety; this may not work for you if you will worry too much about the baby while you sleep. However, if your baby wakes up frequently, it might help him or her to feel and smell Mommy and Daddy nearby. In addition, it can be easier and more relaxing if baby is in the bed to feed him or her quickly without getting out of bed.

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Menopause

The moodiness and irritability of hormonal changes can be made worse by poor sleep quality at night. Hormonal changes themselves can affect your sleep quality. Most often, however, it is the hot flashes at night that affect your sleep.

  • Keep the room cool. Whether that means using a fan, air conditioner or keeping the window open at night, make sure you lower the temperature in the room. Also use lightweight blankets at night or no blankets.
  • Wear lightweight cotton. Wear lightweight cotton fabric, which is less likely to become soaked at night. Wet clothes often wake you up more than the flashes themselves.
  • Consider HRT as a cause. Remember that symptoms of menopause are still an indication for short-term hormone replacement therapy. It should be seriously considered if your sleep is disturbed and should be prescribed at the lowest dose necessary to relieve symptoms.

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Night-Shift Work

Many women seek night shifts or night work in order to take care of their kids during the day. It’s hard to understand when they find time to sleep or actually take care of their kids. No one can do this every night, but the successful women find time to get rest and nap during the day. It is also ideal if you can take naps at work, even if it is for 15 or 20 minutes.

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Additional Tips

  • Avoid alcohol. Even though it seems to make you sleepy, alcohol actually can affect the quality of your sleep, so you don’t feel rested in the morning.
  • Exercise. Exercise can relieve tension and improve cardiovascular health. Just make sure that you do not exercise within three hours of trying to sleep.
  • Take naps. Accepting that you might not get the best rest at night, schedule time to nap. Even if you don’t actually fall asleep, lying down to rest can help. Also, some people might feel like a nap makes them feel worse when they wake up. This should subside within 30 minutes, and you will end up being more alert while you’re awake.
  • Accept or recruit help. While you should definitely get naps while your baby sleeps, you may also need to recruit family or friends to help. Sometimes, your sleep is deeper and more restful when someone is watching your baby. And, if your baby isn’t napping frequently anymore, your only chance for a nap may be when someone is helping you out.

After reading the above, you might feel an impending sense of doom that women are destined never to rest. Trying to look at the glass as half full, being aware of our need for rest is more than half the battle. We can’t change our biology, or maybe even the amount of sleep we get at night, but we can take measures to get the best rest we can, unload our lives and decrease expectations. This can help to increase the rest we get, decrease anxiety, and contribute to our overall health and well-being.

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Alice Y. Chang, M.D. is a former instructor in medicine at Harvard Medical School. She is currently associated with University of Texas Southwestern Medical Center. Her clinical interests and experience are in the fields of primary care, women's health, hospital-based medicine and patient education.

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