If there is one thing more frustrating than not being able to sleep, it is not being able to sleep while someone is in a deep, peaceful slumber beside you. Particularly if that person drifts off easily night after night, while you toss and turn next to them on a regular basis. And when it is a woman sleeping in the same bed as a man, it tends to be a certain way around.
A 2024 review of research evidence published in Sleep Medicine Reviews highlights the crucial role sex plays in sleep, finding that women consistently rate their sleep quality lower.
“There is no doubt that women seem to experience poorer sleep, on average, than men,” says sleep scientist Dr Sophie Bostock. “This is something we have seen for a long time through self-reported studies. But also, we know that women have quite a significant increased risk of insomnia relative to men, which is the struggle to fall asleep, waking up in the middle of the night, or waking up feeling unrefreshed.”
Meanwhile, despite the fact we are all told to get eight hours of sleep each night, women may in fact need more shut-eye than their male counterparts. “Research indicates that women need a bit more sleep than men,” says Dr Bostock, “and yet the recommendations are just of blanket average.”
So, for women who are struggling to get the right amount of sleep, here are three reasons why – and how to fix them.
Mental health
Anxiety and depressive disorders are twice as common in women as in men. Another factor is thought to be stress, often exacerbated by the burden of care – be it for children or elderly parents – still landing predominantly on women. All of which is a problem for our sleep.
“If you have poor mental health, you are going to have poor sleep,” says Dr Bostock. “The two are interlinked in more ways than we first thought. 20 years ago, there was an assumption that if you have poor mental health, poor sleep is a symptom of that mental health condition. But now we know it can also be the other way round: lack of sleep prompting worse mental health outcomes.”
What to do about it
“The worst thing that you can do if you start to have disrupted sleep is try and make up for it by going to bed early,” says Dr Bostock. “Going to bed when you are not actually tired, then just lying there worried about the fact that you can’t fall asleep, is only going to make it harder to drift off. This is because it kicks in a stress response, which causes tension and anxiety to spike.”
Instead, seek help. “The number one treatment for insomnia is a talking therapy called cognitive behavioral therapy for insomnia, which shares a lot of the ingredients for CBT for anxiety or depression,” she says. “You can now also get a great CBT programme called Sleepio, available for free on the NHS across the UK.”
Hormones
Every stage of a woman’s life seems to bring with it different challenges to sleep. “It seems that any time women get a fluctuation in their hormones, it can disrupt sleep,” Dr Bostock says. “So this starts with puberty, where adolescent girls are more than two times more likely to suffer from insomnia as adolescent boys. Around pregnancy, women report massive sleep issues, which isn’t surprising; there is the actual mechanics of carrying a baby which can be uncomfortable, but pregnancy also causes a massive surges in hormones, which are thought to be responsible. And then when you get to perimenopause and menopause, then you also have these big fluctuations.”
Meanwhile, even a woman’s cycle can cause issues with sleep. “For a lot of women, sleep can be disrupted on a monthly basis because of hormonal fluctuations during menstrual cycles,” Dr Bostock. “It seems to occur particularly in the second half of their cycle. So while a lot of women report headaches, migraines, aches and pains at this time, some women will report insomnia then as well. This is thought to be because there is a slight increase in body temperature at that time of a cycle, and we know that you need to cool your core body temperature in order to be able to get into a deep sleep.”
What to do about it
The first step is simply to be conscious of it. “Until recently, I think a lot of women didn’t realize that their poor sleep might be associated with their hormones,” says Dr Bostock. “So they just got anxious about it, and that can fuel a cycle of insomnia where people are using caffeine, for example, to keep going during the day, or drinking alcohol in the evenings, when both exacerbate the problem overnight.”
As such, she recommends keeping a sleep diary. “Tracking patterns in order to understand what times of the month things seem to be getting worse can be a massive help, as it gives you that bit more confidence when it comes to dealing with it. Also, when you anticipate sleep issues, you can start to bank a little bit of extra sleep in the days ahead. Research tells us we are more resilient to future sleep loss we have got a little bit extra in the bank.”
And if it is the perimenopause or menopause disrupting women’s sleep, they may get woken by hot flushes. “We may not be able to do very much about the hot flush itself, but we know that if you get very anxious about them, you’re going to find much harder to fall asleep,” she says. “So just be prepared; use nice light covers, sleep on a towel if you need to, and have a glass of water ready on your beside table.”
Body clock misalignment
“Women tend to have an earlier chronotype then men,” says Dr Bostock. “This means they get tired earlier in the evening and wake up earlier in the morning on account of their internal body clock.” Also, research has found their circadian rhythms, responsible for that body clock, are shorter than men’s by around six minutes. This in itself is not a problem; the issue tends to arise when you don’t pay attention it.
As Dr Renske Lok from Stanford University, who led the Sleep Medicine review, explained: “While this difference may be small, it is significant. The misalignment between the central body clock and the sleep/wake cycle is approximately five times larger in women than in men.
“Imagine if someone’s watch was consistently running six minutes faster or slower. Over the course of days, weeks, and months, this difference can lead to a noticeable misalignment between the internal clock and external cues, such as light and darkness.”
Disruptions in circadian rhythms have been linked to various health problems, including sleep disorders, mood disorders and impaired cognitive function. “Even minor differences in circadian periods can have significant implications for overall health and well-being,” he added.
What to do about it
First and foremost, get to know your chronotype. “For some people, this might be obvious: those with a really early bird chronotype will typically wake up between 5.30am and 7am, then get really tired by nine o’clock at night. Those with the later chronotype will struggle to get out of bed before 10 o’clock; they’re not hungry in the morning, they certainly don’t want to exercise first thing, and they do some of their best work well after the usual work day finishes.”
However, our chronotype is on a spectrum, and many of us are somewhere in the middle. “So if you are not sure, there is something called the Munich Chronotype Questionnaire, or the MCQ, than can help.” Once you know what yours is, the key is to listen to it – and that might mean your better-sleeping partner needs to compromise on what time you get into bed.
