The cost of sleep deprivation: Why women pay a steeper price
This article explores new research uncovering how a lack of sleep uniquely affects women, from metabolic and hormonal changes, to weight regulation and cardiovascular effects. Nearly 20% of women struggle to get adequate rest each night, almost double the rates seen in men. While the reasons for this gender disparity in sleep patterns are not entirely clear, emerging research has revealed that sleep deprivation has a distinct impact on women’s long-term health. This blog examines how chronic tiredness affects women, how poor sleep undermines health over time, and highlights practical, evidence-based strategies to help foster restorative sleep, supporting your overall well-being.
Understanding the burden of sleep deprivation in women
Sleep deprivation is a serious and often overlooked health issue, with clear evidence that younger women, particularly between the ages of 20 to 40, are among the most affected. Recent data from the CDC has shown that 17% of women struggle to fall asleep while over 21% find it difficult to stay asleep, compared to only 11% of men. While the long-term consequences of poor sleep are widely recognised, the specific impact of sleep loss on women’s metabolism, weight regulation, and cardiovascular health are less well known.
The biology behind women's sleep struggles
Research demonstrates that women have an almost twofold greater risk of developing insomnia compared to men. While the precise underlying mechanisms are multifactorial and complex, the causes do largely appear to involve hormonal fluctuations as well as the unique mental load many women carry.
Across the menstrual cycle, shifting levels of estrogen and progesterone significantly influence sleep quality. Evidence suggests that a decrease in progesterone such as during the luteal phase before menstruation is linked to lighter and more fragmented sleep. While estrogen levels themselves do not appear to be associated with better sleep quality in premenopausal women, reductions in estrogen during perimenopause and menopause contribute meaningfully to poor temperature regulation including hot flashes and night sweats, which significantly disrupt rest. Some evidence also suggests that postmenopausal women may produce lower levels of melatonin, a key hormone involved in regulating sleep-wake cycles. As a result, many women experience diminished sleep quality and increased daytime fatigue during this life stage, highlighting the importance of hormones in maintaining both temperature regulation and restful sleep.
Beyond monthly cycles, recent studies have demonstrated that psychosocial and social factors play a key role in sleep health. A higher prevalence of women experience anxiety and ruminate more than men. Moreover, women often shoulder a larger portion of household or caregiving responsibilities leading to a greater cognitive load. Scientists have shown increased stress and anxiety levels in women balancing multiple roles, resulting in elevated levels of cortisol and epinephrine, the body’s main stress hormones.
In the short-term, high levels of stress hormones can delay or disrupt melatonin release, making it harder to fall or stay asleep. In the longer-term, chronically elevated stress can alter the production of the reproductive hormones themselves, further dysregulating the ability to rest. Since estrogen also helps reduce the body’s response to stress, reduced levels can create a self-reinforcing cycle, where stress disrupts sleep, and disrupted sleep increases stress. Together, these factors help explain why women uniquely have more trouble sleeping than men.
The metabolic risks and consequences of lost sleep for women
Emerging evidence has shown that sleep also plays a significant role in regulating the body's metabolic systems and impacts the levels of key hormones that control hunger and fullness. Indeed, research suggests that sleep deprivation not only causes an increased appetite but also a preference for calorie-dense food. Over time, this can contribute to substantial weight gain and increased fat storage. Large-scale studies highlight this risk. The Nurses’ Health Study, which followed over 68,000 middle-aged women for 16 years, found that women sleeping less than five hours each night were 32% more likely to gain substantial weight (≥33 pounds) compared to women sleeping seven hours or more.
A similar study conducted by Columbia University in 2023 also demonstrated that women with 90 minutes less sleep each night had a 15% increase in insulin resistance (a key risk factor for Type 2 Diabetes), and the risk was even greater (20%) in postmenopausal women. Insulin resistance was observed despite stable blood sugar levels, and independent of body fat, demonstrating how even a modest sleep deficit can impact the body’s metabolic systems, and have a significant impact on long-term health.
Cardiovascular implications: A compounding risk
Metabolic disruptions caused by sleep loss extend beyond weight gain, independently affecting cardiovascular health. Results from the SWAN study (Study of Women’s Health Across the Nation), which tracked women’s health through midlife for more than two decades, provided substantial evidence that women with persistent insomnia and shorter overall sleep had a 75% higher risk of cardiovascular events, including heart attacks, strokes, and heart failure.
The combination of sleep-dependent hormonal disturbances, impaired appetite regulation, increased insulin resistance and elevated cardiovascular risk in women, highlighting the importance of sleep for maintaining health overall.
Conclusion: Why sleep matters for women
Sleep-related difficulties affect nearly twice as many women than men, and is driven by multiple factors including biology, life-stage and cognitive load. While many of these influences are linked to gender and are therefore difficult to control, understanding the risks associated with sleep loss is essential. It not only helps build awareness of the importance of sleep, and particularly the impact sleep loss has on women, but it enables you to seek support to improve your sleep if necessary.
This might mean talking to a clinician about persistent insomnia, or exploring how hormonal changes throughout the month are affecting your sleep. It could involve considering how your diet plays a role in both hormone balance and sleep quality, or embracing relaxing routines like meditation, deep breathing, or a warm bath.
Improving the comfort of your sleep space can also be a simple and meaningful step. Ensuring your mattress supports your spinal alignment can enhance circulation for example, while breathable, natural fabrics including latex pillows can help regulate body temperature supporting more stable sleep.
While these changes are rarely the whole answer, research shows that small gentle adjustments to your sleep environment can accumulate over time, improving sleep and protecting your health on multiple fronts.
References
https://www.cdc.gov/nchs/products/databriefs/db436.htm
https://journal.restorativemedicine.org/index.php/journal/article/download/154/177
https://onlinelibrary.wiley.com/doi/full/10.1155/ije/7863420
https://pmc.ncbi.nlm.nih.gov/articles/PMC5611767/
https://pmc.ncbi.nlm.nih.gov/articles/PMC3135672/
https://pmc.ncbi.nlm.nih.gov/articles/PMC3786159/
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2793303
https://pubmed.ncbi.nlm.nih.gov/38284249/