Sleep and Its Disorders in Women

There are clear sex based physiological differences in both normal sleep and the pathogenesis of sleep disorders. The hormonal changes that occur during a woman’s life span significantly impact both normal sleep patterns and risk and presentation of sleep disorders. The prevalence of sleep disorders and its symptomatology exhibit clear sex based differences. For instance, chronic insomnia and sleep disordered breathing (SDB) both sex specific incidences and variable presentations. The impact of restless legs syndrome (RLS) on pregnancy health and fetal outcomes has only been recently explored. Recent data has also shown increased risk of endometrial cancer in shift working women. The incidence of comorbidities and the therapeutic responses to various pharmacological and non-pharmacological interventions also show gender and sex differences. The doses of some sleep aids such as zolpidem are different for women and men as is the prevalence of depression and its association with CPAP noncompliance. A fair amount of these sex differences remain unknown and under-recognized. Complex reproductive endocrine changes that a woman’s body goes through, from puberty to menopause and with pregnancy, affect her sleep and the presentation of sleep disorders significantly. Some of this uniqueness is due purely to sex hormones but there are also some other physiological elements that make the specificity of a woman’s sleep patterns and the pathophysiology of some of the disorders multifactorial. This chapter will explore some of the normal sleep differences in women compared to men and will also discuss individual disorders and how they impact women at different points in their life span.