Is sleep a feminist issue?  

Often carrying a heavier burden of responsibility, women are more likely than men to find it difficult to get a good night's sleep

It’s 6.45am on Monday morning and I can’t get out of bed. My alarm went off three-quarters of an hour ago, but my body still isn’t ready to get up.

It’s not because I was late going to bed. I was in bed by 9.30pm and asleep by 10pm. But, as per usual, I found myself wide awake at 2am. Thoughts of everything I had to do this week piled one on top of the other and it took me hours to get back to sleep. Now I’m starting my week bleary-eyed and exhausted.

It’s not much of a consolation but I know I’m not the only one. According to Dr Liam Doherty, a consultant respiratory physician in the Bon Secours Hospital, Cork, “insomnia is the inability to fall or stay asleep and it affects everyone at some point”.

However, it’s more serious for some. “It becomes chronic when it persists for more than three months and interferes with daily life,” says Doherty. “This happens to 10% of people.”

Motty Varghese, a sleep physiologist in Dublin’s Sleep Therapy Clinic, estimates that this figure is even higher. “The National Sleep Foundation in the US reports that up to 30% of adults struggle with insomnia, and while there’s a lack of data for Ireland, there’s reason to believe it’s just as common here,” he says.

Insomnia doesn’t believe in equality of the sexes and affects far more women. In 2017, a poll in Britain and the US found women were 40% more likely to sleep badly than men. This tallied with a 2006 Chinese University of Hong Kong study which reached the same conclusion.

Waking at 4am

Co Meath mother of three Triona Ryan was in her 30s when her sleep patterns began changing. “I started having nights where I’d wake at 4am and not be able to go back to sleep,” she says. “With the kids getting up at 6am, that made for long days.”

Her sleep deteriorated further when her mother was diagnosed with cancer five years ago. “There were nights when I went to sleep holding my phone in my hand in case something happened, and I was needed,” says the 43-year-old. “She passed away two years ago, and sleeping has got worse as the months have gone on. In my experience, grief is the biggest thief of sleep.”

Ryan’s experience is typical for females, according to Doherty. “Women often carry more of life’s burdens than men,” he says. “As a result, they are more stressed, and this could be why their sleep is more affected.”

A 2016 University of Cambridge review found that women were also almost twice as likely as men to suffer from anxiety. “Anxiety is proven to be a predisposing factor for insomnia,” says Varghese.

Cork-based consultant psychologist Dr Gillian Moore-Groarke identifies mothers as particularly poor sleepers. “All mothers and new parents expect to lose sleep in the early days,” she says. “What they don’t expect is how long this can go on or how they can get into a state of hypervigilance – not sleeping or sleeping very lightly because they feel anticipatory anxiety, a sense that they have to be ready to respond to their child’s needs at all times.”

This isn’t confined to the baby years. “When children become teenagers and start going out at night, it can kick in all over again,” says Moore-Groarke.

Women’s hormones can work against them too. “The biological mechanisms of hormone regulation relating to menstruation and menopause can precipitate sleep difficulty,” says Varghese.

‘I was brought to my knees’

Marie Mulhall, a 53-year-old mother of three from Roscommon, has experienced serious difficulties with sleep. “I used to sleep for an average of eight hours a night until I had a hysterectomy at the age of 42,” she says. “Afterwards, I’d average four or five hours of extremely broken sleep.”

Her quality of life soon plummeted. “My memory was so affected that I couldn’t read books as I’d be a few pages in when I’d realise I couldn’t remember anything I’d read,” says Mulhall. “My relationships deteriorated, and my children suffered as a result of my low mood and fatigue. I had night sweats and chronic anxiety. I was a young, able, and strong woman but I was brought to my knees.”

That was until she had her hormones tested. “My body was completely depleted of its hormone requirements,” she says.

Oestrogen is one of those hormones and it plays a role in temperature regulation. When its levels fluctuate during menopause, women’s body thermostats can run riot, leading to hot flushes during the day and sweats at night.

Our body’s core temperature needs to drop to activate the physical reaction that puts us to sleep. If we lack oestrogen, it won’t drop and our bodies try to cool themselves by sweating instead, keeping us awake in the process.

Melatonin is another hormone associated with sleep. “It’s primarily influenced by the light we’re exposed to,” says Varghese. “If we get adequate exposure to bright light in the daytime and reduce our exposure to light in the evening, it can help to regulate our melatonin levels.”

Ryan tried melatonin supplements to help her sleep, but they didn’t work. Doherty isn’t surprised. “Melatonin can help with jet lag or if you work shifts but if your brain is wired from all the thoughts rushing through your head or because of anxiety, it has limited effectiveness.”

Impact of the pandemic

The pandemic did little to help women get their eight hours of sleep a night.

This was highlighted by a University of Southampton study carried out in 2020. It found that women were one and a half times more likely than men to have lost or quit their jobs because of lockdown. They were doing two hours a day more housework and childcare during lockdown than men. At the same time, they were almost twice as likely as men to report that they were losing sleep. The researchers drew a direct line of cause and effect between the extra pressure placed on women and their inability to sleep.

If one of the effects of Covid was that women experienced more job insecurity on top of having to cope with the increased stress of managing children, it’s no surprise that their sleep suffered, says Moore-Groarke. “The things that keep people awake at night are finances, stress within families and relationships, work worries, and health worries. These were all exacerbated during the pandemic.”

And if we continue to sleep badly, the implications could be serious. “Poor sleep contributes to heart disease, poor memory function, a higher risk of depression, weight gain and obesity, and a higher risk of type-2 diabetes,” says Moore-Groarke.

Understanding this doesn’t necessarily help though. As I lie awake in the darkness, I often find myself worrying about the damage my lack of sleep is doing to my body, not exactly sleep-inducing thoughts.

Ryan finds this too. “As bedtime gets nearer, I worry I won’t sleep and by the time I get into bed, the anxiety is so high it keeps me from sleeping,” she says. “It’s a vicious circle.”

Moore-Groarke has a term for this — orthosomnia: “It means the more you think about sleeping, the less likely you are to be able to sleep.”

No ‘one size fits all’ cure

There are many elements standing between women and the night’s sleep we crave. Is there anything we can do to overcome them?

“The first thing I do when I see a patient who can’t sleep is to rule out physical problems like sleep apnoea and restless leg syndrome,” says Doherty. “Then I look at sleep habits.”

The pace of modern life means many of us have developed habits that are inconducive to sleep. “We work and eat too late,” says Doherty. “We smoke and drink too much alcohol and coffee. We’re stressed. We spend too much time scrolling through our phones, looking at anxiety-inducing content. All of this leads to a wired brain, which works against sleep.”

There is no ‘one size fits all’ cure for insomnia, but there are steps that everyone can take to address poor sleep. “We would all benefit from a better and more consistent sleep routine,” says Moore-Groarke. “No exercise too close to bedtime. No eating or drinking alcohol too late. We should keep our bedrooms dark, restful, and cool at around 16 degrees. Many people benefit from meditation and mindfulness techniques too.”

Menopausal women may find that hormone replacement therapy (HRT) helps. A 2016 review by the Mayo Clinic found that it was associated with better quality sleep in women experiencing night sweats.

It’s already helping Mulhall. “I started HRT 10 months ago and I’m sleeping much better,” she says.

Cognitive behaviour therapy (CBT) is also recommended. “We can get into habitual ways of thinking and insomnia can become a self-fulfilling prophecy as we expect to struggle with sleep night after night,” says Doherty. “CBT teaches us exercises to break that loop.”

You learn to “rejig your thinking” and to replace negative thought patterns with positive ones, says Moore-Groarke.

“It’s a validated, successful and non-medicated method of treating insomnia,” adds Varghese.

Overall, the message is a hopeful one for women like Ryan, Mulhall and me. There are times when everyone spends the night tossing and turning in search of sleep, but this shouldn’t be accepted as the norm. With help, it should be possible for us to nod off into a restful slumber.

“A combination of biological mechanisms, psychosocial, and mental health factors makes women more predisposed to developing insomnia,” says Varghese. “But there is a lot women can do to improve their sleep and help is out there for them to do just that.”

Shut eye: fact file

We spend approximately one-third of our lives either sleeping or trying to do so. Yet there’s a lot we don’t know about it. 

Here are 10 key points about sleep and insomnia.

1. According to the American National Sleep Foundation, most adults need an average of seven to nine hours of sleep each night.

2. Most healthy adults fall asleep within 10 to 20 minutes of their heads hitting the pillow and stay asleep for an average of eight hours.

3. Insomnia is defined as having trouble getting to sleep and/or staying asleep. Some insomniacs stay awake for hours while others suffer from disrupted sleep because they wake up so often during the night.

4. Figures vary but it is thought that at any one time, 10% of the adult population is dealing with insomnia.

5. The National Sleep Foundation in the US estimates that 30% of us will experience it at least once in our lifetimes.

6. There can be physical causes such as sleep apnoea. This is a potentially serious sleep disorder in which breathing stops and starts repeatedly. If you snore loudly and feel tired after a full night’s sleep, you might have this condition.

7. Restless leg is a common condition where people feel an irresistible urge to move their legs. It affects 10% of sufferers to the extent that it disrupts their sleep. It’s exacerbated by alcohol and common in women who are deficient in iron. However, it’s easily treated.

8. Poor sleep can also be caused by poor sleep routines. Eating a big meal or drinking alcohol or caffeine too close to bedtime can affect sleep. So can smoking, exercising too late, and spending too long scrolling through anxiety-inducing news feeds.

9. Stress and anxiety are significant factors too. People who are worried about their finances, their relationships, their work, and their health are far more likely to struggle with sleep.

10. It is possible to improve your sleep pattern. Simple lifestyle changes can make a difference when it comes to poor sleep routines. Meditation and mindfulness can help to counter stress and anxiety. Techniques also taught as part of a programme of cognitive behavioural therapy.

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