Sleep dysfunction in women and its management

Women generally have more complaints about sleep, compared with men of the same age. At various stages of reproduction, the reasons for these complaints become rather obvious--menstrual cramps and discomfort, pregnancy and postpartum factors, and menopausal hot flashes can fragment sleep. In addition, there are lifestyle factors, such as going to bed late and getting up early in order to attend to various family responsibilities, restricting the time allowed for sleep. Factors outside a woman's control, such as caregiving for sick family members during the night, can also result in disrupted sleep patterns, with little opportunity to make up for the lost sleep on weekends or days off. This article discusses the types of insomnia commonly experienced by women during key reproductive stages of life and proposes gender-specific assessment and management strategies. Pharmacologic management of sleep problems is useful for brief episodes of insomnia, but not usually desirable during pregnancy and lactation, or for management of chronic insomnia. For most women, regardless of reproductive stage, nonpharmacologic strategies that involve behavioral therapies, or short-term focused use of hypnotics at key time points, are more effective for quality of life than is long-term use of pharmacologic interventions.