Insomnia and sleep disorders
Insomnia, sleep apnea, restless legs syndrome
Chronic conditionTrouble falling asleep, staying asleep, or waking rested, at least 3 nights a week for 3 months or more. Other sleep disorders, such as sleep apnea, are often missed in women.
What happens
Insomnia often starts with stress, illness, or hormone changes and then continues because of a 'wired' nervous system and habits that develop around poor sleep. Sleep apnea causes repeated pauses in breathing at night. In women it may show up as insomnia, fatigue, morning headaches, or low mood rather than loud snoring. Restless legs syndrome is linked to low iron. Hot flashes, night sweats, and an overactive thyroid can also disrupt sleep.
Who gets it
Insomnia is more common in women, especially during pregnancy, postpartum, and perimenopause. Sleep apnea becomes much more common after menopause. Anxiety, depression, chronic pain, and thyroid disease all raise the risk.
Common signs
- Trouble falling asleep or staying asleep
- Waking too early and not getting back to sleep
- Daytime fatigue, irritability, or brain fog
- Snoring, gasping, or pauses in breathing at night
- Morning headaches or a dry mouth
- An urge to move your legs in the evening
- Night sweats or hot flashes that wake you
Labs to ask about
- A 2-week sleep diary
- A sleep study (home or lab) if you snore, gasp, or wake unrefreshed
- Ferritin and CBC, especially with restless legs
- TSH
- A review of medicines, caffeine, and alcohol use
How it's usually treated
- Cognitive behavioral therapy for insomnia (CBT-I), which is the first-line treatment
- CPAP or an oral appliance for sleep apnea
- Iron replacement and other treatments for restless legs when iron is low
- Treating hot flashes, pain, or mood problems that disrupt sleep
- Short-term sleep medicine in some cases
Supportive steps to discuss with your provider
- Wake up at the same time every day, even after a bad night.
- Limit caffeine after midday, and avoid alcohol near bedtime.
- Get morning daylight and keep the bedroom cool and dark.
- Get out of bed if you can't sleep, and return when you feel sleepy.
- Ask whether melatonin fits your situation. It's best for timing problems.
See a doctor promptly if you have
- Thoughts of suicide or harming yourself: call or text 988, or call 911 if you're in immediate danger
- Falling asleep while driving or at other unsafe times
- Someone sees you stop breathing or gasp during sleep
- Acting out dreams, or sudden muscle weakness with strong emotions
Related conditions
Anxiety
Worry, fear, or physical tension that's out of proportion to the situation and gets in the way of daily life. Physical causes such as thyroid or hormone changes can drive or worsen it.
Learn more →Depression
A persistent low mood or loss of interest that lasts at least 2 weeks and affects how you think, feel, and function. It's a medical condition, not a weakness, and it's treatable.
Learn more →Perimenopause and menopause
Menopause is the point 12 months after your last period, when the ovaries have stopped releasing eggs. Perimenopause is the years of shifting hormones before it, when most symptoms begin.
Learn more →Fatigue and chronic fatigue
Ongoing exhaustion that limits daily life. It can come from a treatable cause, or it can be ME/CFS, a serious illness in which effort makes symptoms worse.
Learn more →
Wondering if your symptoms fit a pattern?
Dr. Lesher is a naturopathic doctor who specializes in women's autoimmune and chronic conditions. Since 2020, she has helped more than 900 patients overcome and heal from their conditions.