A recent study suggests that women who habitually push back their bedtime by one or two hours are at increased risk of heart disease. Photo / 123RF
A recent study suggests that women who habitually push back their bedtime by one or two hours are at increased risk of heart disease. Photo / 123RF
It is 4am and I’ve already woken three times. I adjust my neck support pillow, trying not to disturb my partner. One of the nicer things about a mature relationship – we met when I was 58, Mike 60 – is you can be grown-up about things like snoring and fluctuating body temperature.
But I’m not sure if Mike realises how much less sleep I get than him. Most nights I average five hours, in fits and starts. You’ll often find me roaming around the house (in one of the nightdresses Mike would happily torch), working or communing with the cat.
We live apart, so on weekends we stay up drinking and chatting. Mike falls asleep bang at 1am, while I toss and turn for hours. I often wonder what this staccato sleeping pattern is doing to my health.
Sometimes when I hint that, perhaps, we could retire earlier and “you know, just sleep tonight”, he looks puzzled. What happened to Fun Liz? But I’m worried that Fun Liz may not make old bones, because suffering mild long-term lack of sleep is serious.
According to a new study, women who habitually push back their bedtime by one or two hours are at increased risk of heart disease.
Long-term mild sleep deprivation in women can lead to cardiovascular diseases such as atherosclerosis and high blood pressure. Photo / 123RF
Research by Columbia University Irving Medical Center suggests there really is a gender sleep gap. Scientists at the university examined the effect of long-term mild sleep deprivation on women’s blood vessels and compared it with those who slept adequately.
Examining the participants’ endothelial cells (the layer of cells that makes up the inner lining of blood vessels), they found that oxidative stress levels increased by 78 per cent after sleep restriction in healthy women. Over time, this can lead to cardiovascular diseases such as atherosclerosis and high blood pressure.
Heart health is terrible in my family. My father and all my grandparents died of heart attacks early in life, so I need to be careful.
A major function of healthy sleep is the prevention of oxidative stress. Experts recommend adults have between seven and nine hours. But compared to men, women more frequently report sleep disturbances.
“Insomnia is a female-dominant disorder: our clinic is 65 per cent women, 35 per cent men,” says Dr Guy Meadows, a sleep physiologist who has been running workshops for chronic insomnia sufferers since 2011.
And yet we play it down – and override our biological need for sleep. “As women, we often put our own health aside and just cope and cope,” says Dr Swapna Mandal, a consultant respiratory, sleep and ventilation physician at the Cleveland Clinic London. “But we’ve known for a long time that interruption of sleep causes systemic inflammation, which makes inflammatory markers rise, and that predisposes you to things like plaque formation that block up your arteries.”
Women often put their own health aside, cope and override their biological need for sleep. Photo / 123RF
She explains that our constant wakefulness is not a full arousal from sleep, but a series of micro-arousals that are enough to disrupt the quality of sleep.
“As we age, we find it harder to fall and stay asleep due to reductions in the release of melatonin, the sleep-promoting hormone,” says Dr Meadows. “But women get a worse deal.”
“One of the primary reasons is the fluctuations in powerful female hormones,” he says. “Progesterone and oestrogen play such an important role in sleep and fluctuate on a monthly basis. They fluctuate with pregnancy and then, of course, they fluctuate and then decline with menopause.”
Bearing the brunt
Women are also likely to experience more stress and anxiety, says Dr Meadows. “You wake in the middle of the night, mind racing,” he says. “Your body is flooded with cortisol and adrenaline, pushing you closer towards insomnia. And then women bear the brunt of looking after children and elderly parents, which means less time for prioritising sleep and self-care activities.”
Not only do midlife women experience broken sleep, those declining hormones can leave us feeling like we’re going crazy.
“Progesterone plays a really important role in the production of gamma-aminobutyric acid (GABA) – one of the inhibitory transmitters in the brain and spinal cord that helps us to fall asleep – but also helps us to feel relaxed, and when progesterone decreases in menopause, you’re getting reduced capital,” explains Dr Meadows.
“Meanwhile you’re losing oestrogen, which plays a key role in serotonin production, which is really important in management of mood. And the more sleep-deprived you are, the more you knock out the rational emotional regulator of the brain, your prefrontal cortex, and get pushed into your amygdala, the more reactive part of your brain, which again leads to more hyper-arousal.”
Women are also likely to experience more stress and anxiety. Photo / Getty Images
Going to bed late adds to the hormonal disadvantage. By going to bed later than 11pm (and ideally, it should be 10pm), I’m seriously compromising my sleep.
“If the brain doesn’t get enough REM sleep (the deepest stage, known as rapid eye movement sleep), it makes you feel awful the next day, but there are also implications for diseases such as Alzheimer’s later on,” says Alison Francis, who has worked for 25 years as a sleep specialist.
“Past midnight is quite late. We go into the bigger cycles of deep sleep when the body is physically refreshed, during the first three hours of sleep, and then as the night goes on you move into the lighter cycles of sleep, including REM sleep, which refreshes the brain.”
The main trigger for falling asleep is a drop in core body temperature. But, during menopause, hormones go into free-fall resulting in night sweats and hot flushes.
This is the time when many long-term married couples decide on separate rooms, including Dr Meadows and his wife. “As a couple, we recognise how important a good night’s sleep is for our ability to be nice to each other the next day.”
The trick is to explore our beliefs about what time we go to bed and whether we should or shouldn’t share a bed every night.
Ultimately, sleep is a trainable skill, says Dr Meadows. “Through the cultivation of simple positive sleep habits, over time, you can train yourself to sleep better. It’s like learning a language. The problem is we’re impatient. We expect to flick a switch and for it to improve. But you need to learn the grammar and put it into practice. You can train yourself to be a better sleeper, no matter how desperate you may be at the moment.”
“This is a very physical problem that needs to be managed,” stresses Dr Mandal of the gender sleep gap. It’s not a mental health issue, and if we can frame it that way, it gives women more power to say: ‘Actually, this is what I need to do to achieve good sleep’.”
Sleep is like learning a language - you can train yourself to sleep better. Photo / 123RF
Eight strategies to try if you’re not getting enough sleep
Switch off screens two hours before bedtime
“It’s so easy to just be on Instagram or Pinterest because you think it’s relaxing, but it activates the mind, induces stress; you delay going to bed and you’re thinking about what you saw,” says Dr Mandal. “We should be doing relaxing things – yoga, mindfulness – to wind down the brain to help you sleep.”
Go to bed and get up at the same time
“I don’t think people really understand why a regular rhythm is so important. It helps keep your internal body clock on time, including telling the brain when to sleep and wake, but also helps with your appetite hormones and energy level,” says Dr Meadows.
Try a temporary sleep divorce
“If you’re having night after night of bad sleep, you’re going to be very tired and, in the end, quite resentful. In an ideal world, of course, you want to sleep together, it’s all part of being in a relationship. But if it’s at the expense of your wellbeing, that’s no good,” says Alison Francis.
if sleeping together is at the expense of your wellbeing, try a temporary sleep divorce. Photo / 123RF
Keep a sleep diary for a few months
“A diary can help women to identify the points in their cycle when sleep is worse – or better. In a good phase, you want to be banking good sleep. If you’ve got a lot of work on, or social activities, make sure you’re managing your sleep debt with daily 20-minute power naps or a catch-up night once a week,” says Dr Meadows.
Engage in activities such as meditation, mindfulness and self-compassion when you’re going through challenging times. “This can act as a balance to the harsh narrative that emerges when you’re sleep-deprived and serotonin and self-confidence are low,” says Dr Meadows.
Check your hormone levels
Women in midlife shouldn’t suffer broken sleep in silence, stresses Dr Ghazala Aziz-Scott, a specialist in bioidentical hormone balancing therapy at the Marion Gluck Clinic. “If people really understand why they’re getting their symptoms, we can usually get them sleeping beautifully again.”
Go outside every day
We spend huge amounts of time indoors where the design of our offices and houses means we are largely cut off from natural light. So 10 minutes of morning sunlight, or investing in a light therapy lamp will help synchronise your body clock to seasonal light cycles, boost serotonin, and improve mood and sleep.
Transform your relationship with wakefulness
It’s perfectly normal to wake in the night, says Dr Meadows. “We’ve evolved to sleep in cycles, so we can check for danger. The problem is we believe that we should put our head on the pillow and wake up eight hours later. So that sets us up for failure.” Instead, he says, we should ask ourselves: “Can I give myself permission to lie in quiet wakefulness?” because we still get a lot of benefits from resting in bed.
