Indian Journal of Sleep Medicine

Register      Login

VOLUME 18 , ISSUE 4 ( October-December, 2023 ) > List of Articles


Sleep Disorders in Women

Shweta Anand, Dipti Gothi, Nipun Malhotra

Keywords : Insomnia, Pathophysiology, Symptomatology

Citation Information : Anand S, Gothi D, Malhotra N. Sleep Disorders in Women. Indian Sleep Med 2023; 18 (4):66-68.

DOI: 10.5005/jp-journals-10069-0124

License: CC BY-NC 4.0

Published Online: 29-12-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Women are more likely to have sleep-related illnesses than men. However, the diagnosis is frequently missed since the symptoms are often atypical in women. Hormonal cycles and changes during life impact the symptomatology and severity. Women are more likely to have an atypical presentation of obstructive sleep apnea (OSA) and a higher prevalence of insomnia and restless leg syndrome (RLS). We present the gender-based differences in pathophysiology and presentation of sleep illnesses. We also present the treatment differences to keep in mind while managing sleep illnesses in women. Awareness of these differences can help improve sleep health and overall quality of life in women.

  1. Mullington JM, Haack M, Toth M, et al. Cardiovascular, inflammatory, and metabolic consequences of sleep deprivation. Prog Cardiovasc Dis 2009;51(4):294–302. DOI: 10.1016/j.pcad.2008.10.003.
  2. Depner CM, Stothard ER, Wright KP Jr. Metabolic consequences of sleep and circadian disorders. Curr Diab Rep 2014;14(7):507. DOI: 10.1007/s11892-014-0507-z.
  3. Mallampalli MP, Carter CL. Exploring sex and gender differences in sleep health: A society for women's health research report. J Womens Health 2014;23(7):553–562. DOI: 10.1089/jwh.2014.4816.
  4. Krishnan V, Collop NA. Gender differences in sleep disorders. Curr Opin Pulm Med 2006;12(6):383–389. DOI: 10.1097/01.mcp.0000245705.69440.6a.
  5. Lee KA, Kryger MH. Women and sleep. J Womens Health 2002 2008;17(7):1189–1190. DOI: 10.1089/jwh.2007.0574.
  6. Silva A, Andersen ML, De Mello MT, et al. Gender and age differences in polysomnography findings and sleep complaints of patients referred to a sleep laboratory. Braz J Med Biol Res 2008;41(12):1067–1075. DOI: 10.1590/s0100-879x2008001200005.
  7. Mehta N, Shafi F, Bhat A. Unique aspects of sleep in women. Mo Med 2015;112(6):430–434. PMID: 26821442.
  8. Lee J, Han Y, Cho HH, et al. Sleep disorders and menopause. J Menopausal Med 2019;25(2):83–87. Erratum in: J Menopausal Med 2019;25(3):172. PMID: 31497577.
  9. Polo-Kantola P. Dealing with menopausal sleep disturbances. Sleep Med Clin 2008;3:121–131. DOI:
  10. Welton AJ, Vickers MR, Kim J, et al. Health related quality of life after combined hormone replacement therapy: Randomised controlled trial. BMJ 2008;337:a1190. DOI: 10.1136/bmj.a1190.
  11. Kruijver FPM, Swaab DF. Sex hormone receptors are present in the human suprachiasmatic nucleus. Neuroendocrinology 2002;75(5):296–305. DOI: 10.1159/000057339.
  12. Bonsignore MR, Saaresranta T, Riha RL. Sex differences in obstructive sleep apnoea. Eur Respir Rev 2019;28(154):1–11. DOI: 10.1183/16000617.0030-2019.
  13. Leech JA, Onal E, Dulberg C, et al. A comparison of men and women with occlusive sleep apnea syndrome. Chest 1988;94(5):983–988. DOI: 10.1378/chest.94.5.983.
  14. Exar EN, Collop NA. The upper airway resistance syndrome. Chest 1999;115(4):1127–1139. DOI: 10.1378/chest.115.4.1127.
  15. Shepertycky MR, Banno K, Kryger MH. Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome. Sleep 2005;28(3):309–314. PMID: 16173651.
  16. Young T, Hutton R, Finn L, et al. The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? Arch Intern Med 1996;156(21):2445–2451. PMID: 8944737.
  17. Tamanna S, Geraci SA. Major sleep disorders among women: (women's health series). South Med J 2013;106(8):470–478. DOI: 10.1097/SMJ.0b013e3182a15af5.
  18. Young T, Evans L, Finn L, et al. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997;20(9):705–706. DOI: 10.1093/sleep/20.9.705.
  19. Johns MW. Daytime sleepiness, snoring, and obstructive sleep apnea. The Epworth Sleepiness Scale. Chest 1993;103(1):30–36. DOI: 10.1378/chest.103.1.30.
  20. Baldwin CM, Kapur VK, Holberg CJ, et al. Associations between gender and measures of daytime somnolence in the Sleep Heart Health Study. Sleep 2004;27(2):305–311. DOI: 10.1093/sleep/27.2.305.
  21. Phillips B, Collop N, Drake C, et al. Sleep disorders and medical conditions in women. Journal of Women's Health 2008;17(7);1191–1199. DOI: 10.1089/jwh.2007.0561.
  22. Netzer NC, Eliasson AH, Strohl KP. Women with sleep apnea have lower levels of sex hormones. Sleep Breath Schlaf Atm 2003;7(1):25–29. DOI: 10.1007/s11325-003-0025-8.
  23. Schneider BK, Pickett CK, Zwillich CW, et al. Influence of testosterone on breathing during sleep. J Appl Physiol Bethesda Md (1985) 1986;61(2):618–623. DOI: 10.1152/jappl.1986.61.2.618.
  24. Tasali E, Van Cauter E, Ehrmann DA. Polycystic ovary syndrome and obstructive sleep apnea. Sleep Med Clin 2008;3(1):37–46. DOI: 10.1016/j.jsmc.2007.11.001.
  25. BaHammam AS, Pandi-Perumal SR, Piper A, et al. Gender differences in patients with obesity hypoventilation syndrome. J. Sleep Res 2016;25(4):445–453. DOI: 10.1111/jsr.12400.
  26. Atwood CW. Sleep-related hypoventilation: The evolving role of leptin. Chest 2005;128(3):1079–1081. DOI: 10.1378/chest.128.3.1079.
  27. Pierce AM, Brown LK. Obesity hypoventilation syndrome: Current theories of pathogenesis. Curr Opin Pulm Med 2015;21(6):557–562. DOI: 10.1097/MCP.0000000000000210.
  28. Rajagopal KR, Abbrecht PH, Derderian SS, et al. Obstructive sleep apnea in hypothyroidism. Ann Intern Med 1984;101(4):491–494. DOI: 10.7326/0003-4819-101-4-491.
  29. Almeneessier AS, Nashwan SZ, Al-Shamiri MQ, et al. The prevalence of pulmonary hypertension in patients with obesity hypoventilation syndrome: A prospective observational study. J Thorac Dis 2017;9(3):779–788. DOI: 10.21037/jtd.2017.03.21.
  30. Resta O, Bonfitto P, Sabato R, et al. Prevalence of obstructive sleep apnoea in a sample of obese women: Effect of menopause. Diabetes Nutr Metab 2004;17(5):296–303. PMID: 16295052.
  31. Zhang B, Wing YK. Sex differences in insomnia: A meta-analysis. Sleep 2006;29(1):85–93. DOI: 10.1093/sleep/29.1.85.
  32. Nowell PD, Buysse DJ, Reynolds CF, et al. Clinical factors contributing to the differential diagnosis of primary insomnia and insomnia related to mental disorders. Am J Psychiatry 1997;154(10):1412–1416. DOI: 10.1176/ajp.154.10.1412.
  33. Moline ML, Broch L, Zak R, et al. Sleep in women across the life cycle from adulthood through menopause. Sleep Med Rev 2003;7(2):155–177. DOI: 10.1053/smrv.2001.0228.
  34. Curry DT, Eisenstein RD, Walsh JK. Pharmacologic management of insomnia: Past, present, and future. Psychiatr Clin North Am 2006;29(4):871–893. DOI: 10.1016/j.psc.2006.09.006.
  35. Cubała WJ, Wiglusz M, Burkiewicz A, et al. Zolpidem pharmacokinetics and pharmacodynamics in metabolic interactions involving CYP3A: Sex as a differentiating factor. Eur J Clin Pharmacol 2010;66(9):955. DOI: 10.1007/s00228-010-0854-x.
  36. Manconi M, Govoni V, De Vito A, et al. Restless legs syndrome and pregnancy. Neurology 2004;63(6):1065–1069. DOI:
  37. Berger K, Luedemann J, Trenkwalder C, et al. Sex and the risk of restless legs syndrome in the general population. Arch Intern Med 2004;164(2):196–202. DOI: 10.1001/archinte.164.2.196.
  38. Akintomide G, Rickards H. Narcolepsy: A review. Neuropsychiatr Dis Treat 2011;7:507–518. DOI:
  39. Chabas D, Foulon C, Gonzalez J, et al. Eating disorder and metabolism in narcoleptic patients. Sleep 2007;30(10):1267–1273. DOI: 10.1093/sleep/30.10.1267.
  40. Dauvilliers Y, Neidhart E, Billiard M, et al. Sexual dimorphism of the catechol-O-methyltransferase gene in narcolepsy is associated with response to modafinil. Pharmacogenomics J 2002;2(1):65–68. DOI: 10.1038/sj.tpj.6500088.
  41. Billiard M, Bassetti C, Dauvilliers Y, et al. EFNS guidelines on management of narcolepsy. Eur J Neurol 2006;13(10):1035–1048. DOI:
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.