Anna and her husband go to bed at the same time. That’s the only part of their sleep routine that they have in common.
"We have very distinct sleep patterns and sleep issues," says Anna, 42, who asked that her last name be withheld for privacy. “My husband tends to fall asleep easily but he wakes up incredibly early. I have trouble falling asleep."
The couple, who teach at the University of Virginia in Charlottesville, have learned various coping strategies so that they can both get enough sleep. Before they go to bed, for example, Anna’s husband sets out next day’s clothes downstairs. That way, when he gets up at 5 a.m., he can dress without waking Anna, who not only has trouble falling asleep but also finds it nearly impossible to get back to sleep once she has awaken.
What no one has yet learned, however, is precisely how and why women and men differ in the ways that they sleep -- or don’t sleep. Right now, we don’t even know whether men need more sleep than women, or vice versa.
“There’s no nationally representative data [on gender differences],” says Michael Twery, PhD, director of the National Center on Sleep Disorders Research, a division of the National Institutes of Health.
Twery says that national health surveillance surveys have recently started to ask questions related to sleep. Such surveys will eventually help researchers break down responses along gender lines, potentially providing more insight into how men and women sleep -- and sleep differently.
Still, there are a few things that we do know now. According to Twery, women suffer from insomnia at two to three times the rate that men do. Men, on the other hand, are twice as likely to have their slumber spoiled by sleep apnea, a chronic condition characterized by brief episodes of restricted breathing.
But, Twery points out, the gap in those rates could partly be due to doctors who don't fully understand the disorder. Women, he says, may experience symptoms of sleep apnea differently than men, and they don’t describe their symptoms in the same terms as men.
“This could be influencing the process of diagnosis,” Twery says.
In fact, obstructive sleep apnea in women is commonly mistaken for depression, diabetes, hypertension, hypochondria, or a host of other conditions, according the National Sleep Foundation.
Whatever the rates, there are certain conditions unique to women that raise their risk for the disorder. One of them is polycystic ovary syndrome, the most common cause of infertility in women. Another is pregnancy.
“Some pregnant women begin to snore and have difficulty breathing while sleeping,” Twery says.
“What is the danger [to the health of the mother and child]?" Do disturbances in breathing [caused by sleep apnea] affect the cardiovascular health of mother and child? What is the impact for future cardiovascular health? Does sleep apnea resolve after pregnancy?" Experts don’t know.
Better Sleep, Better Health
Each night, people commonly pass through several stages of sleep, during which the brain undergoes repairs and restoration. The bulk of those repairs, which include the promotion of cell growth and fixing cells damaged due to stress, occurs during deep sleep, which also may promote emotional well-being.
For people with sleep disorders, entering and maintaining deep sleep -- if they can sleep at all -- is a challenge.
Woman or man, getting an insufficient amount of sleep on a regular basis increases the risk of additional health problems, such as diabetes, depression, cardiovascular disease,and other conditions. Such risks are higher in men than in women, and they are more likely to strike men at an earlier age. Why? Again, we don’t know, though Twery speculates that hormonal differences may protect women until they are older.
If hormones do play a protective role, they have also been implicated in sleep problems.
“Growth and stress hormones disturb our patterns of sleep,” says Twery, “but how they affect men and women differently has not been studied.”
Whatever the gender differences may be, says Twery, they appear to play less of a role in sleep as men and women age. For example, postmenopausal women and men of the same age have the same rate of obstructive sleep apnea.
Sharing Sleep -- and Sleep Problems
One thing we do know is that, for couples who share a bed, one partner’s sleeping problem can easily become a problem for both.
“Even when one partner is not sleep disturbed, that can be a problem,” she says. “When the one who cannot sleep looks at his or her significant other, there’s often resentment or jealousy, as well as feelings of loneliness.”
In many cases, resolving the sleep issues -- which Garfinkel is often able to accomplish in six to 12 sessions of cognitive behavioral therapy -- allows the couple to explore other issues that may have contributed to the poor sleep in the first place, such as depression or marital difficulties.
“Resolving insomnia allows other things to be addressed calmly,” says Garfinkel.
Despite all that’s unknown, there is at least one clear gender difference: When a sleep problem is disturbing a couple, it’s the woman who makes the appointment with the physician or therapist. That is no surprise. Men are notoriously reluctant to see a doctor for any reason. In Garfinkel’s practice, men often come in only at their partner’s insistence.
“Women are much more willing to seek help, to ask directions,” Garfinkel says.
Anna, who has had trouble sleeping since she was a child, says that the sleep problems she and her husband have became much more urgent matters once they had children.
“Before the kids, I could make up for lost sleep by taking naps, but you just can’t do that with a full time job and little kids running around,” she says. “When our first child was born, we were both saying this is so much harder because we are not great sleepers to begin with.”
“I don’t get sick like I used to now that I am sleeping better,” she says.
“I feel like I’ve struggled with sleep for my entire life,” Anna says. “If you don’t figure out what the problem is, it just becomes what your body does.”