Sleep Disorders in Women: Why Sex-Specific Diagnosis and Treatment Matter
A new review from researchers at Almazov National Medical Research Centre in St. Petersburg consolidates the evidence for sex-specific differences in sleep disorders, arguing that diagnostic and therapeutic approaches must account for the physiological changes women experience across their lifespan.
Women are significantly more likely than men to report insomnia, restless legs syndrome, and other sleep complaints, yet sleep medicine has historically been built on research conducted predominantly in male subjects. The review, published in the Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova, aims to bridge that gap.
What they found
The authors identify three major domains where sex and reproductive stage influence sleep:
Sleep architecture and circadian rhythms: Women generally have more slow-wave sleep (deep sleep) and higher sleep efficiency than men in young adulthood, but this advantage narrows with age. Their circadian rhythms typically run slightly shorter than men’s, which may contribute to a tendency toward earlier bedtimes and wake times. These baseline differences mean that the same sleep disorder may present differently in women versus men and may require different diagnostic thresholds.
Reproductive stage effects: The menstrual cycle, pregnancy, and menopause each impose distinct sleep challenges. During the luteal phase, progesterone elevation can increase sleepiness but also disrupt sleep continuity. Pregnancy brings a progressive increase in nighttime awakenings, particularly in the third trimester, driven by hormonal changes, physical discomfort, and increased respiratory instability. Menopause is associated with a sharp rise in insomnia prevalence, driven by vasomotor symptoms (hot flashes and night sweats) that fragment sleep architecture.
Disorder-specific considerations: The review covers how sex and reproductive stage modify the presentation and management of:
- Insomnia, more common in women at every age, with higher risks during perimenopause and postpartum
- Restless legs syndrome, approximately twice as prevalent in women, often worsening during pregnancy
- Obstructive sleep apnea, less common in premenopausal women but often underdiagnosed because women present with atypical symptoms (fatigue, insomnia, mood disturbance) rather than classic snoring and witnessed apneas
- Hypersomnias and parasomnias, less studied, but emerging evidence suggests sex differences in prevalence and presentation
Why it matters
When clinicians apply diagnostic criteria and treatment protocols developed primarily from male patients, women’s sleep disorders are systematically underdiagnosed and undertreated. The review highlights several concrete examples: women with sleep apnea are less likely to be referred for polysomnography, women with insomnia are more likely to be prescribed sedatives rather than referred for cognitive behavioral therapy, and medication dosing during pregnancy and lactation requires careful adjustment that general sleep guidelines do not address.
The authors call for personalized, interdisciplinary approaches that involve sleep specialists, gynecologists, and primary care physicians working together, particularly during reproductive transitions.
Limits
The review draws heavily on epidemiological and observational data; large-scale interventional trials specifically designed for women at different reproductive stages remain scarce. Some of the proposed mechanisms linking hormonal fluctuations to sleep disruption remain hypothetical. The paper also does not address transgender populations or hormonal therapy effects on sleep, which represents a gap in the current literature.
Bottom line
Sleep disorders in women are not simply the same as in men with slightly different statistics. Hormonal, anatomical, and circadian differences across the lifespan fundamentally alter how sleep disorders present, how they should be diagnosed, and how they respond to treatment. A one-size-fits-all approach is insufficient.
Source
Bochkarev MV, Sviryaev YuV. Narusheniya sna u zhenshchin: osobennosti diagnostiki i lecheniya [Sleep disorders in women: diagnostic and treatment considerations]. Zh Nevrol Psikhiatr Im S S Korsakova. 2026;126(5. Vyp. 2):34-41. DOI: 10.17116/jnevro202612605234