Women and men sleep differently, so their sleep disorders should not be treated the same, suggests new research that explores the biological sex characteristics of sleep.
Men are more likely to have obstructive sleep apneawhile women are more likely to experience insomnia and report lower sleep quality. These are among the findings of a literature review published in April in the journal Sleep medicine reviews. The researchers are from Harvard University, Stanford University and the University of Southampton in the United Kingdom.
According to the co-author, this research is as much about precision medicine as it is about sleep disparities between the sexes. Renske Lok, PhDpostdoctoral fellow at Stanford Center for Sleep and Circadian Rhythm Sciences.
“We’re trying to move away from the one-size-fits-all solution,” she says. Fortune. “(Medicine) needs to be more responsive.”
Understanding how and why biological sex affects various sleep disorders is a crucial step toward individualized treatment. However, the continued lack of inclusion of women in biomedical and behavioral research poses a barrier. The National Institutes of Health has not required studies to take into account sex as a biological variable until 2016.
“The biggest takeaway is that we absolutely need to do better at including women in our research designs,” Lok says. “Historically, women have not been included as much as men, in part because it has always been assumed that men’s results would automatically translate to women. And we’re starting to find out more and more that that’s not the case.”
Sex and circadian rhythm
The mental, physical, and behavioral changes your body experiences over a 24-hour period are called circadian rhythms. Almost all of your organs and tissues have their own rhythms and together form a sort of master biological clock that is particularly sensitive to light and darkness.
At night, your brain produces more melatonin, sleep hormone, which makes you tired. In a study examined by Lok and colleagues, women secreted melatonin earlier in the evening than men. This corresponds to other research showing that men are generally later chronotypes; that is to say, they go to bed and wake up later than women. As such, men tend to experience more social jet lag, when their body clock does not align with the traditional schedule of societal demands, such as working 9 a.m. to 5 p.m.
Another study showed that core body temperature – which is highest before sleep and lowest a few hours before waking – also peaked earlier in women. Other research found that women’s circadian periods were about six minutes shorter than men’s: 24.09 hours versus 24.19.
“Even though this difference is small, it is significant. The lag between the central body clock and the sleep/wake cycle is approximately five times greater in women than in men,” Lok said in a statement. Press release on the work of his team. “Imagine if someone’s watch was constantly running six minutes faster or slower. Over days, weeks, and months, this difference can cause a noticeable misalignment between the internal clock and external signals, such as light and darkness.
“Disruptions to circadian rhythms have been linked to various health problems, including sleep disorders, mood disordersAnd impaired cognitive function. Even minor differences in circadian periods can have significant implications for overall health and well-being.
Cognitive behavioral therapy is an option for restoring your circadian rhythm, especially if your biological and social clocks don’t match, says Alaina Tiani, Ph.D.clinical psychologist at Cleveland Clinic Sleep Disorders Center.
“It differs from patient to patient, but we ask them to take melatonin (supplements) earlier in the evening and then we ask them to expose themselves to bright light in the morning,” says Tiani. Fortunein reference to night owls who need to wake up earlier. “Those two things help anchor their sleep window while they work to make a difference.”
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Stress at work and in personal life can influence women’s insomnia
You have probably experienced episodes of acute insomnia, periods of stress throughout your life in which you had difficulty falling asleep, staying asleep, or getting good quality sleep. They may have lasted a few days or a few weeks. Chronic insomnia, however, occurs when you experience these sleep disturbances at least three times a week for more than three months, according to the National Heart, Lung, and Blood Institute. Additionally, chronic insomnia cannot be explained by other health problems you may have.
Insomnia concerns 1.5 times more common in women, previous research has shown. Lok and colleagues hypothesized that this might be due to certain risk factors that are more prevalent in women, such as anxiety and depression.
Dr. Eric Sklar is a neurologist and medical director of Inova Sleep Disorders Program in northern Virginia. Insomnia is one of the most common sleep disorders he treats, and he wasn’t surprised by the study’s findings.
“There is a strong correlation between underlying psychiatric disorders and insomnia,” says Sklar. Fortune. “Some of the underlying societal stressors for men and women may be different.”
Women are still often confined to the role of family caregivers while moving up the career ladder, Sklar notes, not to mention recruiting. other life stressors. Additionally, evening downtime is essential for maintaining healthy circadian rhythms and women sometimes have to fight harder to achieve it, he says. And when the so-called “get revenge for bedtime procrastination” involves spending time in front of a screen, women can further disrupt their biological clock.
By some objective measures, women sleep better than men, the review shows. Women have more sleep efficiencywhich refers to the percentage of time spent in bed I actually spent sleeping. The women entered the dream rapid eye movements (REM) sleep phase earlier and spent about eight minutes longer non-REM sleep. However, the women said poorer quality of sleep only men.
As new parents face various sleep disruptions, says Tiani Fortune a portion of its postpartum patients and women with young children report decreased sleep quality.
“It’s almost like their brains are half-listening to their kids in the middle of the night, in case they need something,” Tiani says. Patients who are caregivers in other capacities reported the same thing, “listening at night.”
Why do men and women sleep differently?
Women have successfully caught a break from a common sleep disorder: obstructive sleep apnea, when the upper airway is repeatedly blocked during sleep. The disorder is almost three times more common in menhowever, it is only associated with one increased risk of heart failure in womennotes the review.
“It is well known that men are at higher risk,” Sklar says. Fortune, adding that biological sex is used in sleep apnea risk assessment. “Men tend to have wider necks, and neck size is also a risk factor.”
Lok’s analysis also noted these gender sleep differences, among others:
One key factor remained inconsistent in the nearly 150 studies analyzed by Lok and colleagues: women’s menstrual phases. Menstruation is correlated with many changes that impact sleep, such as elevated body temperature during the sleep period. luteal phase of the cycle. Additionally, some research did not take into account subjects’ use of oral contraception, which may have skewed the results.
“It’s tricky because, for example, if someone doesn’t use hormonal contraceptives, that means you have to include women in the same menstrual phase,” says Lok. Fortune. “Otherwise you get all sorts of variations due to changes in hormonal levels.”
Having overcome some of the obstacles that stood in his team’s way, including scant evidence of some biological differences between the sexes, Lok is hopeful about future research.
In some cases, “we’re not sure there are gender differences because, quite simply, no one has ever looked at it,” Lok says. “At the same time, this is a very encouraging article because it clearly identifies the gaps that remain.”
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