The sleep disturbances most common to young women include those associated with the menstrual cycle, pregnancy and motherhood. As a woman ages, physical and hormonal changes affect her sleep quality. Emotional components can also affect sleep patterns.

The Menstrual Cycle

Distinct changes in sleep patterns accompany the changing phases of the menstrual cycle. An increased number of awakenings and more sleep disturbances occur during the premenstrual period in some women. Dreams are more frequent and more vivid during this phase of the cycle. Some women report excessive daytime sleepiness, fatigue, and longer sleeping hours during the premenstrual period.

Sleep changes are often associated with other premenstrual signs, such as abdominal cramp-changes. These sleep problems generally disappear a few days after menstruation begins. Women who experience menstrual-related sleep disorders should pay careful attention to their sleep needs, maintain a regular sleep/wake schedule, eat a healthy diet, and try to reduce stress. If sleep problems interfere with daily functioning, medical advice should be sought.

Sleep During Pregnancy

Early in pregnancy, most women report feeling fatigued during the day and sleeping longer hours at night. This almost-universal change in sleep requirement is probably caused by increasing levels of the hormone progesterone during pregnancy.

Later in pregnancy, particularly during the last trimester, women often note poor sleep quality. Certain changes in sleep patterns have been confirmed by studies: the amount of slow-wave sleep (deep stages of sleep) decreases, and the number of awakenings increases. There are many causes for sleep disruption in the late stages of pregnancy: leg cramps, backache, heartburn, movements of the fetus, general discomforts of pregnancy, and increased frequency of urination.

Throughout pregnancy, women need to make sure they are getting enough sleep, maintaining regular sleep/wake schedules, and avoiding stress as much as possible. Because sleeping pills and alcohol should be avoided during pregnancy, other measures to improve sleep should be considered. Muscle relaxation techniques may be effective in promoting better sleep and reducing the discomforts of pregnancy. Maintaining a balanced diet and avoiding heavy meals and spicy foods within 2 or 3 hours of bedtime will help avoid provoking heartburn. After delivery, getting enough rest continues to be very important, as severely disturbed sleep can he tied to postpartum depression and child abuse.

Menopause

In the years surrounding menopause, sleep disturbances occur with increased frequency. Hot flashes and night sweats-associated with decreased levels of estrogen-may cause repeated awakenings associated with the sensation of heat and sweating, increased heart rate. and feelings of anxiety. Although hot flashes usually last only a few minutes, in severe cases a woman may wake up hundreds of times a night. The sleep disturbance and resultant sleep deprivation generated by these hot flashes may result in daytime fatigue, irritability and depression. These measures may help alleviate the sleep disturbances associated with hot flashes:

• Control the bedroom temperature: use light and comfortable (preferably cotton) bed linen.
• Eliminate caffeine, sugar and alcohol from the diet. Increase vitamin E intake in the diet, or take a vitamin E supplement.
• Estrogen replacement therapy can be helpful in relieving severe hot flashes and resultant significant sleep loss.

In the years following menopause, sleep grows lighter and more fragmented. It becomes more difficult to maintain long hours of uninterrupted sleep, and to maintain long hours of wakefulness during the day. Some sleep disorders occur more frequently in the postmenopausal years. For example, sleep apnea--is more common in postmenopausal women. This may he related to falling progesterone levels, since younger women who experience surgical menopause are also at increased risk of developing sleep apnea. Higher body weight and lower levels of physical activity are also risk factors for this syndrome.

To promote better sleep during the postmenopausal years, women should follow these guidelines:

• Maintain a comfortable, safe environment in the bedroom: reduce disturbing noise and extreme temperature.
• Go to bed and get up at the same time every day.
• Avoid staying in bed late in the morning to make up for sleep loss.
• Get up early in the morning and maintain structured daily activity.
• Consider an afternoon nap at a regular time.
• Stay away from fatty, spicy foods that are likely to cause indigestion or heartburn.

• Seek medical advice if following these measures does not alleviate excessive daytime sleepiness.

Depression

Insomnia is one of the most common symptoms of depression at any age. Women who are depressed tend to fall asleep fairly quickly but often awaken in the middle of the night, unable to go back to sleep. The insomnia may be interpreted as the cause of the depression, but getting professional help and treatment for the depression can often solve the insomnia problem.

Nocturnal Eating Syndrome

Some women wake up in the middle of the night and feel that they are unable to go back to sleep until they eat. Unless there is a medical cause (such as an ulcer), this type of problem is typically associated with dieting during the day.

When a sleep problem results in disruption in one of these areas, it may he wise to consult with a healthcare provider. Your healthcare provider will he able to refer you to a sleep disorders specialist for a comprehensive evaluation of your sleep difficulties.