April 07, 2011 12:00 AM

National Center on Sleep Disorders Research (of the National Institutes of Health), nhlbi.nih.gov/about/ncsdr/

American Insomnia Association, american

insomniaassociation.org

National Sleep Foundation, sleepfoundation.org

Whether you’re living parallel lives with the women of “Desperate Housewives,” “30 Rock” or even “Harry’s Law,” there’s a good chance you often feel tired — and with good reason.

When it comes to sleep habits, it seems women just aren’t model citizens. From careers to kids to family and social planning, life does indeed come first and, naturally, sleep comes secondary and, often, last.

Studies suggest that 40 percent to 60 percent of women have sleep disturbances of varying severity. these may be exacerbated by other medical conditions such as obstructive sleep apnea, periodic limb movements and mood disorders such as anxiety and depression.

Estrogen decreases frequent awakenings, while increasing total sleep time; thus women in perimenopause and menopause with undulating or lower estrogen levels may suffer from insomnia more frequently. some sleep problems are, however, independent of estrogen levels.

Throw more biology into the mix, such as a woman’s menstrual cycle, and insomnia becomes even more common. but you mustn’t lose sleep over the fact that you cannot sleep. Following are some of the common reasons why you may be burning that candle at both ends.

According to a poll conducted by the National Sleep Foundation, if you’re a single working woman you likely get the least amount of sleep — often less than six hours a night. And if you’re like many women in this survey, you also awaken feeling tired at least a few days a week.

Why aren’t you sleeping? it may be as simple as too much late-night socializing. According to experts, when this is the case, the solution may just involve a bit more self-discipline about retiring earlier a few nights a week. You’re likely to feel better.

Domestic engineers — moms who take care of the household full time — are a bit better off. The National Sleep Foundation survey found that up to three-quarters of the women in this category experience symptoms of insomnia. What may keep moms up at night? Maybe the kids or, worse, the dog bunking up with them. perhaps it’s the lack of quiet leisure activities to help them unwind and relax at the end of the day. when your time immediately before sleep is spent on chores or kids’ activities, this has been shown to lead to sleep trouble.

Last but not least are married women with school-age children who work full time. you know who you are, wonder Women. If you fall into this group, it’s a guarantee you aren’t getting enough sleep, according to Mark Rosekind, Ph.D., a board member of the National Sleep Foundation. these women, he says, routinely get fewer than six hours of sleep a night.

In addition to being overloaded with work, family, and social obligations, you may not have enough time or energy to exercise or relax or even have sex. often, the solution is as simple as making just a little time for yourself at the end of every day. which, I agree, can be difficult.

It may not just be your lifestyle that’s sabotaging your sleep but your own body — mainly, your hormones. it all starts with your monthly menstrual cycle. More than 70 percent of women complain of sleeping difficulty during menstruation, when hormone levels are at their lowest.

Not only does your period adversely affect your sleep quality, but the symptoms associated with your menstrual cycle, such as cramping and bloating, may be significant enough to disturb falling or staying asleep. If this rings true for you, speak with your gynecologist, as there are treatment options that may help with your menstrual-related symptoms, and thus may help solve your sleep problems.

Perimenopausal and menopausal women often suffer from sleep trouble and insomnia. The causes of sleep problems include hot flashes, mood disorders and sleep-disordered breathing like snoring and obstructive sleep apnea.

There are about 88 known sleep disorders. Apnea and restless leg syndrome are two of the major reasons why women lose sleep.

Sleep apnea is a pause in breathing during sleep; as a result, the body has to wake itself up in order to get the oxygen it needs. The longer the pauses in breathing and the more often they occur, the less sleep a patient gets. Studies suggest that sleep apnea is more prevalent in men than in women, but the National Sleep Foundation survey leads us to believe that apnea may be much higher in women than we realize.

What is key, though, is that most of the time, you are not aware of these momentary “wake-ups” during the night, so you end up feeling tired and you don’t know why.

Among the sleep disorders gaining more attention recently is a neurologic disorder known as restless leg syndrome (RLS). RLS causes an unpleasant sensation in the legs, such as burning or crawling, with an uncontrollable urge to move them to relieve the feelings. Lying down and trying to relax often make the feeling worse, making it difficult to fall and stay asleep.

The more frequent the episode, the more likely a woman is to experience insomnia, daytime sleepiness, and the use of caffeine and sleep aids.

First, an important change in mindset needs to happen: make sleep a priority. By doing this, everything else in your life will naturally fall into place more easily. make some changes to your nighttime routine such as:

• Recognize that stress, physical and mental, is a major cause of insomnia. If something is bothering you, try to deal with it during the day, rather than at night before bedtime when you’re likely to stay up worrying.
• Avoid alcohol after 6 p.m. and caffeine after mid-afternoon.
• keep your bedroom cool, dim and dry, rather than warm, bright and humid.
• make sure your bed is providing proper support and is the right size for you and your partner — you don’t want to be jostled by every move of your bedtime partner.
• Assure your pillow is comfortable. A pillow is just as important as the mattress. take the time and make the investment for one that suits you best.
• Don’t watch television right before going to bed, or worse, in bed. The brightness and flicker of lights adversely affects your brain’s ability to slow down and help you rest. rather, read a book in dim light or listen to soft, quiet music.
• try to avoid daytime napping.
• Avoid going to bed too hungry or overfed.

You should only use the bedroom for sleep, dressing and intimacy. you should try to keep a consistent sleep/wake schedule and exercise regularly. If you are not asleep within 20 minutes of lying down, get up and do something relaxing in another room until you feel sleepy. in this way, you will come to view the bedroom as a place to sleep, not a source of frustration.

Many patients may try alcohol or various over-the-counter medications to help them sleep; however, these have not been found to be effective. Antidepressants should not be used to help with sleep disturbance in the absence of depression. some prescription sleep aids have shown promise when taken short-term and close to bedtime. your physician may review these options with you.

Non-benzodiazepine hypnotic brands — drugs strictly designed for sleep assistance as opposed to anti-anxiety drugs sometimes prescribed to aid sleep — currently approved in the United States are:

• Zolpidem (Ambien, Ambien CR, generic) is one of the most commonly prescribed drugs for insomnia. it lasts longer than Zaleplon (below). Patients should not take it unless they plan on getting at least seven to eight hours of sleep.
• Zaleplon (Sonata) is the shortest-acting hypnotic available. because it is rapidly eliminated from the body, it may be best for people who have difficulty falling asleep, not those who wake up often throughout the night. The drug takes effect within 30 minutes and may be taken at bedtime or later, as long as the patient can sleep for at least four hours.
• Eszopiclone (Lunesta) may help improve both sleep maintenance and daytime alertness. Eszopiclone is related to Zopiclone (Imovane), which has been used for many years in Europe. unlike other sleep medications, Eszopiclone was the first sleep medication approved for long-term use.
• Ramelteon (Rozerem) is the newest type of sedative hypnotic but it is not technically a non-benzodiazepine hypnotic. unlike other prescription sleep drugs, Ramelteon works by targeting melatonin receptors. Ramelteon is not habit-forming and is the first sleep drug not designated as a controlled substance.

If your sleep problems persist despite your best efforts, it’s time to talk with your doctor. you may need to see a sleep specialist for a thorough evaluation. I know you’re thinking you don’t have the time for this, but your sleep is well worth it.

Dr. Christian S. Pope specializes in obstetrics and gynecology. he has offices in new Bedford and Mattapoisett and practices at St. Luke’s Hospital. he can be reached at 508-999-6245.

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