Insomnia in Women

Medically Reviewed by Neha Pathak, MD on February 09, 2023
4 min read

Insomnia makes it hard to fall asleep or stay asleep. Women are much more likely to live with this sleep disorder than men. About 1 in 4 women have it, compared to 1 in 5 men. Studies show that in general, women tend to take longer to fall asleep, sleep for shorter periods, and feel more tired once they’re up than men.

Women also typically have more than one symptom of insomnia, such as trouble falling asleep, trouble staying asleep, and waking up too early in the morning. Men, on the other hand, tend to complain of only one.

Why does this sleep disorder hit women harder than men? Experts say it’s a combination of hormone differences and health conditions that are more common in women.

Most women need at least 7 hours of sleep at night to feel rested. But certain hormone-related issues can get in the way, such as:

Your period. It’s most common to face sleep issues in the days leading up to your period. This is when progesterone levels dip and premenstrual syndrome (PMS) symptoms hit. You’re even more likely to struggle with sleep if you have premenstrual dysphoric disorder (PMDD), a more severe type of PMS.

What you can do: Make sure you get exercise in the days before your period, so you feel more tired at bedtime. Prioritize your wind-down routine on those nights, so your body gets the message that it’s time for sleep.

Pregnancy. Your hormones are in constant flux during the first trimester of pregnancy. You may actually be drowsier -- and even sleep more -- than usual at this time. By the third trimester, your estrogen and progesterone levels calm down right as your physical discomfort is at its highest. It’s this discomfort that can keep you up at night. You may have to pee more often; have restless legs; or just feel too uncomfortable to sleep well.

What you can do: You can’t control your hormones during pregnancy, so you may have to just wait it out. But you can try pregnancy pillows to help cradle your belly. You could also try to sleep with your head elevated if snoring or reflux is your problem.

Menopause. Most women go through menopause, when they stop having periods, by their early 50s. Perimenopause is when your body starts the transition to menopause. You can start it as early as your 30s, but it’s more common in your 40s. Both perimenopause and menopause involve big shifts in estrogen and progesterone. These hormone changes cause night sweats and hot flashes, which can keep you up.

What you can do: Your doctor may recommend hormone replacement therapy to help relieve your symptoms. You can also try boosting your soy intake. Soy mimics estrogen. You can get soy from edamame (soybeans) or soy-based dairy alternatives like milk and yogurt. Skip spicy foods, which can trigger hot flashes. Also wear lightweight, breathable clothes to sleep in.

Women are more likely to have certain health conditions that make sleep difficult. These include:

PCOS. Polycystic ovary syndrome causes irregular periods. It also leads to higher testosterone and lower progesterone levels. These hormone imbalances make sleep woes worse. If you have PCOS, you’re also at higher risk for sleep apnea, a sleep disorder that makes you stop breathing for short periods while you sleep. This can wake you multiple times throughout the night.

Fibromyalgia. More women than men have fibromyalgia, a disorder that causes muscle pain all over your body and makes it hard to sleep.

Urinary incontinence. Twice as many women as men have urinary incontinence, or the loss of bladder control. This is because of the many changes to the reproductive system during menstruation, pregnancy, childbirth, and menopause. The urge to go to the bathroom can wake you several times a night.

Depression and anxiety. Women are more likely to have symptoms of depression than men. Trouble getting to sleep or staying asleep is one of those symptoms. On the flip side, if you have insomnia, you’re 10 times more likely to have depression and 17 times more likely to have anxiety. To top it off, these conditions can make insomnia worse. And insomnia can make these conditions worse.

If you can’t sleep, talk to your doctor about whether one of these causes could be behind it. Your doctor can help you find solutions to the specific cause or help treat the insomnia itself. Treatments may include cognitive behavioral therapy (CBT), or “talk therapy”; prescription medications; or lifestyle changes to help you get better sleep.