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Sweet dreams – sleep and your health

Women's Health Week 8 Sep 2021
Girl sleeping with her dog on pillow

Are you one of those people that bound out of bed in the morning, bright-eyed and perfectly refreshed? Lucky you!

While some of us are happy with how much sleep we get, many of us drag ourselves out of bed in the morning feeling like we needed a couple more hours of kip. One thing is clear though – lack of sleep not only affects your energy and mood each day, but can have a significant impact on your health.

How much do we really need?

Specialist sleep physician Dr David Cunnington says that sleep is a restorative process, which is why it is important for maintaining physical and mental health.

“The general recommendation from the professional sleep associations is seven to nine hours of sleep each night for people of working age,” says Dr Cunnington. “If we look at all the data across westernised cultures as well as data from the late 19th century and even in rural Mozambique, seven hours of sleep a night is about the average amount that people get.”

And while how much sleep you get matters, quality is just as important as quantity.

“It’s possible for people to get quantity of sleep, but have a problem with sleep quality, which means they’re not going to feel refreshed when they wake up,” says Dr Cunnington.

He says the most common sleep disorders that affect the quality of sleep are hyper arousal – also known as ‘busy brain’ – and sleep apnoea, a condition in which breathing stops and starts repeatedly while you sleep.

Lack of sleep and poor sleep – there’s a difference

Respiration and sleep physician Dr Ali Aminazad says the health impacts of lack of sleep and poor sleep quality are different.

“Lack of sleep is associated with poor concentration, depression, anxiety, and insomnia,” he says. “However, poor-quality sleep, that’s disturbed by low oxygen levels caused by sleep apnoea, actually affects the body’s physiology and is associated with heart attack, stroke and some hormonal changes.

“What also happens is that after experiencing low oxygen levels, there’s a sudden increase in the amount of oxygen when you breathe in. This causes chronic inflammation, which is associated with atherosclerosis (hardening of the blood vessels), high blood pressure, production of a hormone called leptin, which is associated with weight gain, and memory decline.”

Sleep apnoea and women

Dr Aminazad says that while men are three times more likely to have sleep apnoea, the health consequences for women are a lot worse than in men.

“Women with a diagnosis of sleep apnoea compared to women with no sleep apnoea are more likely to develop asthma,” he says. “Rates of reflux, gastritis, cardiovascular disease, high cholesterol and type 2 diabetes are also a lot higher in women with sleep apnoea than in men. Sleep apnoea has also been significantly associated with cardiovascular death in women.”

According to Dr Aminazad, the symptoms of sleep apnoea in men and women are also different. Women present with fatigue, lack of energy, insomnia symptoms, morning headaches, some mood disturbances and nightmares, while men mostly report snoring and stopping breathing at night.

However, women are more likely to think their symptoms are due to hormonal changes related to menstruation, pregnancy or menopause than sleep apnoea.

Don’t assume it’s your hormones

Dr Aminazad says the latest research indicates that 93% of women with moderate to severe sleep apnoea are not being diagnosed, which has repercussions for their long-term health.

“In my clinic I see women who clearly have symptoms of sleep apnoea but a lot of them say: ‘I’m going through the same thing I did when I had my menstrual period, and when I was pregnant, and I’m going through that now during menopause, so it’s just normal’,” he says. “But in a lot of cases, it’s not normal.”

While hormonal changes associated with menopause can contribute to disturbed sleep, Dr Aminazad says it’s important to note that menopause also increases the risk of sleep apnoea.

“We know that in women who are being treated with hormone replacement therapy, the incidence of sleep apnoea is significantly reduced compared to postmenopausal women who are not treated with hormone replacement therapy,” he says.

Give sleep a chance

Sleep apnoea is of course not the only cause of sleep problems. Stress and anxiety, pain, chronic health conditions, medications, what you eat and drink before bedtime, whether you smoke, and even your bedtime environment can all take their toll on your sleep.

However, one of the biggest problems Dr Cunnington sees is people trying too hard to improve their sleep.

Unfortunately, sleep is one of the very few domains in health that we can’t improve by paying attention to it and trying to manage it. In fact, by doing this you make it worse. We almost have to let sleep be.

Dr David Cunnington, Specialist sleep physician

“Often people … become very task-oriented about it. But we need to approach it in a non-task-oriented way. We need to trust that if we’re maintaining other areas of our physical and mental health, that our body will take the sleep it needs, if we create the adequate opportunity for it. We need to take a more passive approach.”

To give yourself the best chance of getting the ideal seven hours of sleep, Dr Cunnington recommends spending at least eight hours in bed, to allow for time to fall asleep, waking up in the night and resettling. He says it’s also important to allow time to wind down before bed, rather than being busy right up until bedtime.

“Sleep is just a mirror of our day. If you’re so busy keeping everything running like a well-oiled machine all day, how can you switch off at night?”

He says allowing at least nine hours in the day for rest – which includes some down-time during the day – and sleep can greatly increase the opportunity for a good night’s sleep.

Tips for sleeping better

While Dr Cunnington warns against approaching sleep as a tick-box exercise, there are some things you can do to give yourself the best chances of a good night’s sleep. These include:

  • having a set bedtime and waketime, and sticking to these as much as possible
  • exposing yourself to natural light during the day
  • reducing blue light (from electronic devices) at night
  • exercising regularly, but not before bedtime
  • avoiding caffeine in the afternoon and alcohol at night
  • avoiding large meals before bed or late in the evening
  • creating a sleep routine that helps you relax before bed
  • creating a restful environment to sleep in with adequate ventilation.

When to see a doctor about your sleep

If you’re having trouble sleeping or you regularly wake up feeling tired, moody, or with a headache in the morning, speak to your doctor. Don’t assume your sleep problems are normal or part of menopause. They may be related to a sleep disorder, such as sleep apnoea, or a medical condition that requires proper diagnosis and treatment.

“Throughout their life, women go through a lot of sleep disturbances during puberty, periods, pregnancy and menopause, so they’re probably more used to sleep disturbances compared to men,” says Dr Aminazad.

But women shouldn’t assume that poor sleep or lack of sleep is a normal thing they have to live with.

Dr Ali Aminazad, Respiration & sleep physician

So, the good news is, a good night’s sleep doesn’t have to be something you can only dream about! A doctor’s visit may be the only thing between you and a bright-eyed morning.