· We need to get rid of the guilt associated with sleep that's been around for centuries. We've got to start seeing sleep as a vital part of taking care of ourselves and others, not as neglecting our duties.
The Lancet, a leading international medical journal, published a special issue on sleep disorders, highlighting them as an underrecognized public health issue. It suggested that the prevalence of insufficient sleep and sleep disorders is likely to continue to rise.
One of the articles pointed out that women have a 1.3 to 1.7 times higher likelihood of suffering from insomnia than men. With hormonal fluctuations (like before menstruation, during pregnancy, postpartum, and after menopause), not only is there a potential increase in the incidence of insomnia in women, but the severity of insomnia symptoms could also worsen.
On March 6, 2024, Fortune magazine published a commentary noting that there's a pervasive attitude in society that "rest is a luxury, not a necessity," leading people to feel guilty about resting and deliberately cutting back on sleep. If we set aside the guilt, women are more prone to sleep issues during puberty, pregnancy and postpartum, and menopause.
The author of the article is Barbara Rhoden, who works with Primasun, a clinical sleep care platform. She argues that improving women's sleep quality requires not just individual effort but a shift in societal attitudes and policies.
Why do women have a harder time sleeping?
Barbara Rhoden explains that women may face sleep issues at every stage of their lives due to biological mechanisms.
During puberty, fluctuations in progesterone and estrogen levels can disrupt women's circadian rhythms and sleep cycles. Symptoms like cramps, headaches, and bloating often affect sleep quality. Research shows that women's sleep architecture changes during each phase of the menstrual cycle, with the most significant changes occurring in the luteal phase. In the latter stages of the menstrual cycle, women often experience increased sleep latency, more frequent nocturnal awakenings, and poorer sleep quality.
During pregnancy, women have a higher risk of developing obstructive sleep apnea, and hormonal changes lead to increased nighttime urination. Both significantly impact sleep quality and duration.
Postpartum, the sudden shift in hormones, along with psychological health challenges like anxiety and depression, lead to excessive daytime sleepiness in women. A 2023 study revealed that 67.8% of women struggled with poor sleep quality in the six months following childbirth.
Barbara Rhoden's experience as a new mother was: "You close your eyes for just a moment, and a soft whimper or wail wakes you up in a panic, filled with guilt."
During menopause, over 80% of women experience hot flashes and night sweats, keeping them awake night after night.
The social factors affecting women's sleep cannot be ignored. Barbara Rhoden felt guilty about sleeping not only as a mother but also when she stayed up late in the lab and couldn't wake up to her alarm.
"This guilt seems to resonate with a societal consensus that rest is a luxury, not a necessity," she writes.
Women face specific social expectations. Research indicates that by age six, girls start absorbing gender stereotypes that shape their understanding of their roles in the world. By age ten, girls have internalized most stereotypes, including "beginning to see caring for others as a woman's job."
"Growing up, women constantly remind themselves to put others' needs before their own, affecting their career and quality of life," writes Barbara Rhoden. 81% of married women feel selfish for taking time out for self-care, whether it's a spa day or a 15-minute nap.
"In a world where women constantly feel pressed for time, rest and sleep are often the first sacrifices. These societal expectations not only challenge women's self-perception but also lay the groundwork for lifelong health impairments," she says.
Redefining sleep as a necessity
Decades of clinical research have proven that sleep is a foundation for health. Insufficient sleep can cause or exacerbate various chronic diseases, including obesity, diabetes, depression, cardiovascular diseases, and more. Moreover, people with sleep problems have a higher risk of early death.
Barbara Rhoden asserts: "Ensuring good sleep for women requires not just personal effort but a shift in societal attitudes and policies."
She offers several suggestions: First, we need to eliminate the centuries-old guilt associated with sleep. We have to redefine sleep as a necessary part of caring for ourselves and others, not as neglecting our responsibilities. Second, elevate sleep as a public health issue. Every institution needs to recognize sleep as a foundation of health and identify new policies and initiatives to improve women's sleep; lastly, expand sleep support to ensure women of all backgrounds have access to the resources needed to improve sleep, including sleep education and clinical care.
