The first difference is manifested in all its evidence in the bedroom. If a man has the habit of snoring, perhaps due to what with the technical term are called Osas (Obstructive Sleep Apnea Syndrome, sleep apnea, interruptions in breathing during sleep due to obstruction of the upper airways), the woman cohabiting in most cases she will stay awake and look at the ceiling for hours, in vain waiting to fall asleep: sleep is too fragile, that noise is too annoying.
Snoring: different for women and men
If the phenomenon is repeated frequently, the woman will look for a solution to find peace at night, for example by taking the man to the doctor. If, on the other hand, the woman snores, the man will probably not blink: he will turn away and fall asleep without problems. The result is that women arrive at the diagnosis with a good delay compared to men, with repercussions on health. When they go to the doctor, men and women report different symptoms. The former say they snore, pant, snort, while the latter remain generic: they feel fatigued and depressed. Probably because no one tells them what really happens when they sleep.
Difficulty falling asleep
This is one of the many faces of insomnia, which – as the Diagnostic and Statistical Manual of Mental Disorders (Dsm-5) describes well – is not only the difficulty in falling asleep, but also that of staying asleep continuously and restfully, or having a sleep characterized by early awakenings more than 3 times a week for more than 3 months.
And it is a disorder that women suffer from significantly more than men. “10% of the world population suffers from chronic insomnia, with a prevalence in women that increases with age until reaching a ratio of 1 to 3 after menopause,” he explains. Rosalia Silvestrineurologist and head of the Sleep Medicine Center of the University of Messina.
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Men take less time to fall asleep
But when it comes to sleep, there are many differences between men and women: in the quality of sleep, in its duration, in its latency (i.e. the number of minutes it takes to fall asleep, which in women is longer). Not only that: there is a discrepancy between what people perceive, with respect to the quality of their sleep, and what the objective measures say, for example polysomnography, the test that allows you to identify sleep disorders thanks to some sensors applied to the skin and connected to a computer capable of detecting various parameters. So it happens that women complain about the poor quality of their sleep even when objective tests show the opposite.
Women go to bed earlier
“It is true – confirms Silvestri – in general women suffer more from insomnia. And yet, paradoxically, throughout their lives they have a better sleep: first of all because they are generally anticipatory, that is, they go to bed earlier and do not easily incur phase delay, typical instead of men. Secondly, they maintain deep sleep for longer, which is the noble sleep. However, they are more prone to anxiety and depression, and their sleep deteriorates in relation to the different phases of the cycle. reproductive, for example, for premenstrual dysphoria, pregnancy and following menopause “.
Slow waves, those of deep sleep
In women, says a Chinese study that appeared on Frontiers in Psychiatry dedicated to gender differences in insomnia, the traces show a predominance of slow waves, those that characterize deep sleep and that allow the brain to solidify the experiences in memory. With age, this pattern of electrical activity appears to decrease in men while it would remain almost unchanged in women.
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Narcolepsy and those bad dreams that make us wake up
Other major differences relate to the prevalence of sleep disorders: Narcolepsy, for example, a chronic neurological disease manifested by accentuated daytime sleepiness, may have a slight male predominance, as well as REM sleep behavior disorder (Rbd), a so-called parasomnia associated with the risk of developing neurodegenerative diseases, and which appears in relation to unpleasant dreams or nightmares, which are “acted out” with screams, even violent gestures in sleep, up to falling out of bed, and unconscious aggression to the partner. Idiopathic hypersomnia, on the other hand, is more prevalent in women.
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Progesterone and estrogen: the role of hormones
One of the causes of this disparity between men and women in the prevalence of sleep disorders is to be found in hormonal differences, which also explain the variations in prevalence over the course of life. “Progesterone, for example, has a sedative and anxiolytic effect. This – adds Silvestri – means that in menopause, when the levels of this hormone are reduced, women are more exposed to sleep disturbances. Estrogens, on the other hand, have a slight effect on slow-wave sleep and REM sleep, but they have a great impact on cognitive functions, so much so that we have long known the relationship between early menopause and an increased risk of Alzheimer’s. “
Hormones in pregnancy
And even in pregnancy, hormones play a role in sleep: progesterone is a strong stimulant of respiratory activity, and this reduces the risk of sleep apnea, so much so that, explains Silvestri: “Before the diffusion of night ventilation devices, which improve the influx of air to the lungs, drug therapy proposed the administration of medroxyprogesterone. Although this, in the presence of an increase in estrogen which causes edema of the mucous membranes of the upper airways, enhances the pressure response to apneas, making them more dangerous ” .
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The apneas that torment women
From menopause onwards, the risk of apnea increases among women and, conversely, decreases with age in men. And it keeps them awake, much more than men. Often, in fact, women with Osas do not cure themselves, and moreover they also have a bad adherence to therapy with ventilators, which cause them insomnia, in an endless vicious circle.
Then there is another element that distinguishes the two sexes: if women sleep little and badly, they are much more exposed than men to cognitive damage. Lurking is memory loss, reduced attention span, a greater risk of dementia. We now know that Alzheimer’s disease is more widespread among women, and among the associated causes there is certainly chronic insomnia, which on the other hand has a clear correlation with cognitive impairment.
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Anxiolytics and increased incidence of Alzheimer’s
“Some – continues Silvestri – suspect that this association is also linked to the drugs that women take for insomnia, especially in old age, when the chronic use of benzodiazepines and other agonists of the Gaba receptor spreads”.
Another big difference is that relating to the so-called “restless legs syndrome” (Rls), a neurological disorder characterized by tingling, itching or pain in the legs, associated with an urgent and irresistible need to move them, which arises at rest, especially in the evening and ends with the voluntary movement. The prevalence of the disorder in women is approximately double that of men, and is associated with specific cardio and cerebrovascular comorbidities.
The role of children
Well, women who do not have children have a similar prevalence to men, but the risk of Rls gradually increases with the number of pregnancies. Women with three or more children have a three times greater risk than men or women without children. Furthermore, over the course of life, women’s risk of having this disorder increases twice from pregnancy to menopause, and those who suffer from it have a greater risk of comorbidities, and are also slightly more likely to complain of symptoms related to the sleep compared to men.
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Medicines act differently on men and women
Men and women are also different when it comes to therapies for sleep disorders. “In general, women are more sensitive to drugs, in the sense that they metabolize them more quickly and therefore respond well even to lower quantities than the standard dosage, defined for men,” explains Silvestri.
Not long ago the U.S. Food and Drug Administration, for example, halved the recommended dose of a non-benzodiazepine hypnotic for women. This is the first time that a regulatory body has issued gender-specific guidelines in relation to a drug, which shows how important it is to assess gender differences in sleep disorders and related therapies.
The treatment? Gender
The new frontier of insomnia treatment is therefore that relating to gender. “One of the new molecules to have received a positive opinion from the CHMP, the Committee for Medicinal Products for Human Use, belongs to the class of psycholeptics, and appears to be more promising for women than for men,” adds the neurologist.
It is a drug that acts on orexin, a neurotransmitter that plays an important role in the sleep-wake rhythm, and which seems effective above all on the forms of insomnia that affect women, those with frequent awakenings (as happens for example in menopause ). Not only that: acting on orexin also means reducing the concentration of tau and amyloid proteins, among the causes of dementia. When sleep is impaired, the brain cannot cleanse itself of these toxins in prolonged wakefulness. And, since the risk of cognitive degeneration is greater in women, the mechanism of action of the new drug looks very promising for women.
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