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Insomnia is a sleep disorder that is defined by the inability to go to sleep, waking too early, or feeling unrested after sleep for at least 3 nights a week for at least 3 months. Most women need 7 or more hours of sleep a night to feel rested(1).

Woman are more likely to experience insomnia than men, in fact, their risk is 40% higher(2). Up to 67% of “just” have sleep problems. Women also experience insomnia differently, so it’s important we start to help them with their sleep health, as sleep is as conducive to thriving health and disease
prevention as exercise or eating well(3).

At least part of the reason for this discrepancy is hormonal, some direct, some indirect. Research has shown that elevated insomnia risk begins with the onset of menstruation at puberty(4). Other research has shown that the fall in hormones leading up to menstruation causes about 90% of women to experience mood or physical changes including sleep problems(5).

Pregnancy and menopause also carry their own unique challenges for sleep; some hormonal, some lifestyle, and some as a consequence of another issue (such as depression, hot flushes, or the physical challenges of sleeping when pregnant)(6).

Other barriers to sleep are different for women than men.
• Depression, anxiety, and stress will have a profound affect on sleep for women, as they are more likely to ruminate about their concerns(7).
• Urinary problems, like needing to go frequently at night (nocturia) and stress incontinence, affect women at twice the rate of men(8).
• Restless leg syndrome, where the urge to move your limbs while lying down is overwhelming affects more women that men and interrupts sleep.

So, that’s the bad news, and the reason why sleep is now a priority with our female clients! The good news is there is plenty we can do to help, and that’s what we will be discussing in the following weeks.

So these first tips are slightly different, but generally interconnected. If you want thriving sleep, you can start today with a :

• Sleep schedule – even on weekends!
It feels like the day I told you alcohol was bad for you! However if you want a healthy sleep cycle, then going to bed around the same time and waking around the same time is a big part of it. I’m not saying that you can’t stay up until midnight on New Years, or that you should just give up if you work shiftwork, but if you can get as close to regular sleeping hours as
often as possible, it will go a long way to establishing a solid sleep pattern.

• Sleep ritual – alongside a sleep schedule is a sleep ritual, and no, 4hrs in front of the TV isn’t going to cut it for those of you with disrupted sleep!!
For those trainers who finish work at 8pm or later, this becomes even more important, as we are often jacked up on endorphins and our brains are going at a million miles.

For mums, this is often your only time on your own, and then we often fill it with chores.

What your ritual will not include:
– exercise
– activities that challenge your brain
– blue screens such as TV or your phone
– activities that stress you
– stimulants like coffee or black tea

A sleep ritual includes habits that become ingrained, practised signals that prepare your body for sleep. Some of this ritual needs to be calming and soothing. Some ideas to include in your ritual include:
– enjoying a cup of herbal tea
– light yoga, stretch or movement
– breath practise
– turning all the lights in your house down

Limit alcohol and caffeine (9)
Alcohol is a central nervous system depressant that causes brain activity to slow down. Alcohol has sedative effects that can induce feelings of relaxation and sleepiness (10), but the consumption of alcohol – especially in excess – has been linked to poor sleep quality and duration, because it
suppresses REM. Generally, you need at least 2hrs REM sleep in a 24hrs period to consider your sleep “adequate”.
When using subjective measures, women report more sleep problems than men, including disrupted and insufficient sleep, poor sleep quality, difficulty falling asleep, frequent night awakenings, and time awake during the night(11, 12). Women also have a 40% greater risk of insomnia(13) and report earlier sleep timing (i.e. bedtime and wake time) than men. This, combined with alcohol’s REM suppressing mechanism, means that it’s not a good idea for women.
Instead, go for the soothing and calming herbal teas, dark, dark chocolate, or another ritual all together to wind down (like light yoga or a guided meditation)

alcohol and sleep quality infographic

Caffeine is not just in coffee, it is also found in many energy drinks and teas as well (including black and green tea). Caffeine promotes alertness by inhibiting chemicals in the brain that promote sleep(14). Caffeine is absorbed rapidly into the bloodstream and reaches peak levels within 30-70
minutes. It’s effects can then last 3 to 7 hours, but it may take up to 24 hours to fully eliminate. You may have become dependent on caffeine if taken regularly, so gradually cutting down on caffeine is better to avoid headaches, anxiety, and other symptoms.

To work out whether you’re having too much, Moderate single doses of caffeine of up to 200mg, and a daily intake of less than 400mg do not seem to have negative health effects in healthy adults. This might be around 5 cups of regular strength black tea or 2 cups of brewed coffee (not too
strong) per day, ideally, this is consumed in the first half of the day with at least 7 hours until bedtime.

caffeine in food and drinks table

So, as sorry as I am to be the bearer of bad news, there’s no harm in going for a few weeks to see if your sleep health improves. Sleep needs to be one of our priorities, as women, especially mid-life women. Alternatively, rather than going cold-turkey, you could also simply cut down what you consume – dropping from two glasses of wine a night to one glass, or using a smaller glass, for example.

Light
There are numerous studies that demonstrate the health detriments of a desynchronized circadian rhythm, including premature aging, increasing the risk of breast and other cancers, increase in the risk of heart disease, metabolic syndrome; even the risk of poor dental hygiene and dental caries are increased by desynchronized circadian rhythms(15). So, not to put a too fine a point on it… your sleep is important!!

Here’s how to use light to your advantage:
1. Get plenty of light in to your eyes each day. This means getting outdoors without sunglasses on (in a sun safe way). Bright light in the morning, shortly after waking up, will help you fall asleep earlier that evening, and the opposite is true in the evening – bright light within 2hrs of your sleep time will keep you up longer and make it harder to fall asleep(16). If you
walk everyday (for example), try to do it in the morning, or anytime before mid-afternoon, for best results on your circadian rhythm.
2. Sunrises and sunsets are particularly potent circadian rhythm cues, and have the biggest impact on the brain centres that regulate our circadian clock, mood, and alertness(17). Try to be present for at least one of these events each day, and your sleep health will thank you!
3. Avoid blue light before bed. At best, blue light will affect your sleep, at worst, research shows that it may contribute to the causation of cancer, diabetes, heart disease, and obesity. While light of any kind can suppress the secretion of melatonin, blue light at night does so more powerfully, suppressing melatonin by twice as much as other coloured lights(18).
So keep the lights low, and wear glasses that filter blue light (or use the filter feature on your screen, computer, ipad, and some TV’s).

Exercise 
Exercise has been shown to improve total sleep time, sleep efficiency, and wake after sleep onset after 12 weeks of training(19). However, there is conflicting research regarding what type of exercise is best(20), and the rest of what I am going to say is from my 20 years of training women and 10 years of educating personal trainers…

If you don’t have great sleep regularly, here are my top tips for using exercise to improve it:
1. If you’re going to exercise hard, do it in the morning, and keep it under 20min: this is to avoid an excessive stress response which may contribute to sleep disruptions.
2. If you only have time to exercise in the evening, make sure it’s either:
– gentle, wind-down style movement (like yoga, tai chi, or slow walking)
– something that brings you joy
– aerobic (preferably under 6/10 intensity)
– heavy weights with a long rest period (ie. Sets of 6 with 3 minutes break minimum)
3. If you’re going through a stressful period, and your sleep is suffering, keep your exercise intensity as low as possible (but plenty of movement), do it outside, and make it joyful (ie. With friends, or on the beach, whatever floats your boat)
4. HIIT and endurance training will have a positive effect on sleep providing:
– you’ve eaten enough calories, nutrients, vitamins
– you’re hydrated
– you’re not stressed
– you’re not injured
– you’re well rested

So i think i have communicated how important sleep is! Now, if only we started asking our clients about it, practicing good sleep hygine ourselves, and perhaps even start guiding our clients towards the literal and metaphorical light!!!

REFERENCES

1 Office of Women’s Health (2020) Insomnia womenshealth.gov, retrieved 28th November 2022 from https://www.womenshealth.gov/a-z-topics/insomnia
2 Suni, Eric (2022) Insomnia and Women sleepfoundation.org, retrieved 28th November 2022 from https://www.sleepfoundation.org/insomnia/insomnia-women
3 Office of Women’s Health (2020) Insomnia womenshealth.gov, retrieved 28th November 2022 from https://www.womenshealth.gov/a-z-topics/insomnia
4 Suni, Eric (2022) Insomnia and Women sleepfoundation.org, retrieved 28th November 2022 from https://www.sleepfoundation.org/insomnia/insomnia-women
5 Office of Women’s Health (2020) Premenstrual Syndrome womenshealth.gov, retrieved 28th November 2022 from https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome
6 Suni, Eric (2022) Insomnia and Women sleepfoundation.org, retrieved 28th November 2022 from https://www.sleepfoundation.org/insomnia/insomnia-women
7 Nolen-Hoeksema S, Larson J, Grayson C. Explaining the gender difference in depressive symptoms. J Pers Soc Psychol. 1999 Nov;77(5):1061-72. doi: 10.1037//0022-3514.77.5.1061. PMID: 10573880.
8 Office of Women’s Health (2020) Urinary Incontinence womenshealth.gov, retrieved 28th November 2022 from https://www.womenshealth.gov/a-z-topics/urinary-incontinence
9 https://www.sleepfoundation.org/nutrition/alcohol-and-sleep
10 Park SY, Oh MK, Lee BS, Kim HG, Lee WJ, Lee JH, Lim JT, Kim JY. The Effects of Alcohol on Quality of Sleep. Korean J Fam Med. 2015 Nov;36(6):294-9. doi: 10.4082/kjfm.2015.36.6.294. Epub 2015 Nov 20. PMID: 26634095; PMCID: PMC4666864.
11 Lindberg E, Janson C, Gislason T, et al. Sleep disturbances in a young adult population: Can gender differences be explained by differences in psychological status? Sleep. 1997;20(6):381-387. https://doi.org/10.1093/sleep/20.6.381
12 Zhang B, Wing YK. Sex differences in insomnia: A meta-analysis. Sleep. 2006;29(1):85-93. https://doi.org/10.1093/sleep/29.1.85.
13 Mong JA, Cusmano DM. Sex differences in sleep: Impact of biological sex and sex steroids. Philos Trans R Soc Lond B Biol Sci. 2016;371(1688):20150110. https://doi.org/10.1098/rstb.2015.0110
14 https://www.sleephealthfoundation.org.au/caffeine-and-sleep.html
15 https://sunlightinstitute.org/circadian-rhythms-and-the-critical-importance-of-sunlight-how-to-get-back-in-sync/
16 https://www.cdc.gov/niosh/emres/longhourstraining/light.html
17 https://www.sciencedaily.com/releases/2020/02/200220141731.htm
18 https://www.health.harvard.edu/staying-healthy/blue-light-has-a-dark-side
19 Jurado-Fasoli L, De-la-O A, Molina-Hidalgo C, Migueles JH, Castillo MJ, Amaro-Gahete FJ. Exercise training improves sleep quality: A randomized controlled trial. Eur J Clin Invest. 2020 Mar;50(3):e13202. doi: 10.1111/eci.13202. Epub 2020 Feb 12. PMID: 31989592.
20 Banno M, Harada Y, Taniguchi M, Tobita R, Tsujimoto H, Tsujimoto Y, Kataoka Y, Noda A. Exercise can improve sleep quality: a systematic review and meta-analysis. PeerJ. 2018 Jul 11;6:e5172. doi: 10.7717/peerj.5172. PMID: 30018855; PMCID: PMC6045928.