Sleep patterns, disorders differ between women and men

Women are more likely to experience insomnia and report poorer quality sleep. Men are more likely to suffer from sleep apnea.

Women’s circadian rhythms run earlier than men’s, and such disruptions have been linked to worse health outcomes. Men tend to overeat, and male shift workers are at higher risk of type 2 diabetes when sleep deprived.

These and other major differences in sleep are highlighted in a new review of ongoing research on sleep and gender and have implications for how women and men might be treated for sleep-related disorders. The analysis by researchers at the University of Southampton, Stanford University and Harvard University is published in Sleep Medicine Reviews.

“Depending on your gender, should you take a different type of treatment, a different type of medication or a different dosage of medication, for example,” said Renske Lok, a postdoctoral researcher in psychiatry and behavioral sciences at the University of Stanford, who led the study. .

An estimated 50 to 70 million Americans suffer from chronic or persistent sleep disorders, according to the National Institutes of Health. One in three adults in the United States suffers from sleep deprivation, according to the Centers for Disease Control and Prevention.

Women report poorer quality sleep

The analysis revealed that women are more prone than men to lower sleep quality, which is associated with anxiety and depressive disorders.

Women’s sleep quality in terms of quantity of deep sleep and sleep duration, as measured by brain activity, is good. But women complain of insomnia far more than men, researchers found.

“Women are perhaps a little more open about the psychological consequences and the fact that they sleep poorly, whereas men are more likely to keep that to themselves,” Lok said.

A 2021 study, not included in the review, suggested a different reason. Researchers at Lausanne University Hospital looked at women’s sleep habits to try to understand why they complained of waking up throughout the night even though sleep measurements showed they had a good night’s sleep.

Researchers stuck 256 electroencephalographic, or EEG, electrodes to the scalp and face to get a more in-depth readout of brain activity during sleep. They then woke the women at different times of the night and asked them whether they felt asleep or awake.

They found that women who felt like they were awake frequently during the night, even though they appeared to be asleep, experienced high-frequency, almost wake-like brain activity in a small part of their brain , while the remaining 95 percent. of their brain was at rest. This activity is not detected in standard sleep studies where only a handful of electrodes are used.

“Now we know that we understand what they are feeling, because we see that in this small part of the brain, they still have activity that makes them aware of being here, even though 95 percent of the brain is at rest “, said Raphael Heinzer, director of the Center for Investigation and Research on Sleep at Lausanne University Hospital in Switzerland. “We never make fun of our patients, but we didn’t believe them. »

Women have an earlier circadian rhythm

Sleep disorders such as insomnia in women may also be due to the fact that their circadian rhythm tends to be faster and start a little earlier in the day than men. A woman’s cycle lasts 24.09 hours, plus or minus 0.2 hours, while a man’s lasts 24.19 hours, plus or minus 0.2 hours.

Although the discrepancy may seem small, the cumulative effect over days, weeks or months could cause a misalignment between the internal clock and external signals such as light and darkness, which could disrupt the sleep.

The earlier cycle in women corresponds to an earlier timing of melatonin and cortisol secretion, the researchers said. Melatonin is a natural hormone that signals our body that it is time to sleep.

The finding is consistent with previous studies, said Christian Cajochen, director of the Center for Chronobiology at the University of Basel, who was not involved in the study. For example, differences in circadian rhythm – associated with hormones secreted during puberty – may explain differences in sleep between younger men and women.

After getting their period, girls start sleeping 20 minutes later each year until they reach their early 20s, just at the end of puberty.

Men experience a similar phenomenon in adolescence, but it doesn’t end until their late 20s, said Cajochen, whose research includes age-related changes in circadian regulation of sleep.

When children sleep and wake up “later, later, later, later, and then there’s this tipping point, it’s the end of puberty. And it happens later in men than in women,” Cajochen said. “When you see in your children they are starting to age earlier, so there is hope that puberty is over.”

Risk of sleep apnea and type 2 diabetes in men

The study found that men, because of the way their upper airways are constructed, are three times more likely to develop sleep apnea, making them more susceptible to health problems such as sleep apnea. hypertension, diabetes, heart disease and stroke.

Additionally, men tend to overeat than women when they are sleep-deprived, according to the study. And among shift workers, who are considered sleep deprived due to their unusual schedules and are therefore not aligned with their natural circadian rhythm, both men and women have a higher risk of type 2 diabetes, but the risk was much higher among men. , noted the researchers.

Gender differences are significant

With such profound health implications, there is a need to better understand sex differences in sleep and circadian biology, the researchers said. And yet, historically, biomedical research on sleep didn’t even include women, because it was thought that hormonal events such as menstruation and menopause had so many confounding variables that they made research useless, Lok said.

If women were included, researchers typically only used women who were at the same point in their menstrual cycle or those who were taking oral contraceptives because they suppressed the normal ovarian cycle.

The prevailing view was that sleep patterns were fundamentally gender neutral, Lok said. But new studies have shown distinct differences in sleep quality, duration and latency between men and women and that these discrepancies may be caused by differences in the sexes’ circadian rhythms and the physiological changes that accompany them, such as core body temperature and melatonin levels. , she says.

“In general, women have just been excluded,” Lok said. “And it’s more or less assumed that the results seen in men translate to women as well, and we’re increasingly starting to understand that that’s not quite true.”

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