We've read that women are more prone to anxiety-based insomnia. Can you talk a little about why women struggle with this more than men?
Women are indeed more likely than men to suffer from insomnia. We see equal rates of insomnia (trouble falling asleep, staying asleep and awakening too early) in kids before puberty sets in, but once adolescence hits, hormonal and life/social changes lead to key differences in trouble with sleep.
On top of all the hormonal fluctuations & changes that can easily disrupt sleep, women are busier than ever and have way more demands than before. We are pulled in too many directions; from working outside the household to then coming home and working in the house to care for a family, children, and often older parents. It is becoming harder and harder in today’s society to find time to eat right, exercise, and just find balance between work, home and relaxation... with relaxation falling far behind.
As a result, women find getting to bed at a reasonable hour much more challenging, and once they do, they frequently report trouble with being able to turn their brains off since sleep is not an “on/off switch.” Continuing to stay in bed, trying to force sleep to happen while also problem solving, going through to do lists and thinking about everything that hasn’t been done is only a recipe to train the brain and body that the bed is a place to stay awake, night after night.
Can you elaborate on the hormonal challenges women face here?
Hormonal changes can negatively affect sleep in some adolescent girls (lasting for many years into adulthood) every month just before menstruation due to changes in estrogen and progesterone. Women also experience discomfort and anxiety about pregnancy, hormonal fluctuations immediately following birth, and the eventual existing newborn with all the associated stressors (feeding, further disrupted sleep, postpartum anxiety and depression).
At the other end of the hormonal shift spectrum is perimenopause (menstruation begins to space out, hot flashes and night sweats occur) and menopause (the complete cessation of menstruation for at least one year). This typically leads to a more activated brain and trouble returning to sleep after a hot flash. Perimenopause can often last for 5-7 years and typically begins in the late 40s or early 50s, but I’ve seen it start even in the early 40s for many women where estrogen levels fluctuate dramatically, and then gradually even off at a lower level than before.
What are some of the tried and tested methods that you find work best to combat insomnia?
Don’t try to force sleep in bed if you’re not sleepy. It only trains the brain and body that the bed is a place to lay awake and worry. Instead, if you’re just unable to sleep after approximately (DO NOT LOOK at the clock, just guesstimate) 20 minutes in bed, get up and go to a different space. Once there, do something quiet, calm, and relaxing in dim light WITHOUT a screen. Sleep will come when it comes, sitting outside the bedroom isn’t meant to make you sleepy - it is just meant to help break the association that the bed is for worrying, tossing, and turning. Only return to bed when sleepy and if you don’t fall asleep, repeat the process.
Eventually it works- this is one of the MOST effective strategies in insomnia treatment, with research behind it going back to the early 1970s. It is just hard to do! And you must be consistent with it.
Can you tell us more about mindfulness and the correlation between more mindful living and sound sleep?
We use mindfulness meditation in insomnia work as a way to strengthen the mental muscle and help one recognize when the brain is worrying about anything/everything, including being unable to sleep. Practicing mindfulness during the day helps make us stronger - to be able to recognize these worry thoughts and let them go. A common mistake that we actually don’t love in the sleep field is that many people use meditation (EG apps) to fall asleep. In my opinion, that’s not the point of meditation. It isn’t to fall asleep to. The bed is for sleep only and we shouldn’t need to rely on many other things to quiet our brain. However, practicing mindfulness earlier (even during wind down an hour before bed) is a great way to strengthen the brain.
As a way of training the brain, mindfulness meditation works through simple exercises done regularly - to be able to be present and refocus on the moment when the brain wanders. Many people think the goal of mindfulness is to be able to focus nonstop, but that’s not the case. It is the ability to notice when your brain goes off track, and then to refocus it back into the task at hand.
Anything can be made into a mindfulness exercise. I started with just focusing on the feel of the soap and water for one minute while doing the dishes. My mind would often wander to being annoyed at how many dishes there were, and I would then gently refocus back on the feeling of the water and suds.
What are five basic habits anyone/everyone could change to improve their sleep?
- Do some short term deep breathing or visualization in bed for a little. But if you’re awake for a while (20ish minutes no clock watching!) get up and go elsewhere.
- Go to bed at the same bed and wake time every day. Don’t compensate for a bad night's sleep- this will help make you hungrier for sleep the next night.
- Avoid all screens and blue light for at least 1 hour before bed. YES, I said it. Blue light reduces our brain's natural melatonin production and can make it harder to fall asleep and stay asleep. And no, don’t take over the counter melatonin to make up for this!
- Prioritize what must be done before bed and what would be nice to get done before bed. Work on letting go of not having to have everything checked off before tucking in for the night.
- Avoid caffeine 8 hours before bed and alcohol 3 hours before bed.