Women experience sleep differently to men - are you getting enough?
Sleep plays an important role in physical health, emotional wellbeing, learning, memory, recovery and immune function. Here's what every woman needs to know...
By Stephanie Romiszewski, Sleep Physiologist and Behavioural Sleep Medicine Specialist
Twenty years ago, as a young woman entering a field where many established voices had built their careers around traditional sleep advice, challenging some of those assumptions was not always popular. I started to question the growing tendency to treat sleep as something that can be engineered through increasingly complicated rules, routines and rituals.
Through my work as a Sleep Physiologist and Behavioural Sleep Medicine Specialist in the NHS, private practice, research and education, I’ve helped thousands of people navigate sleep difficulties ranging from occasional disruption to long-standing insomnia. My background is in Psychology and Behavioural Sleep Medicine and I spent time at Harvard Medical School’s Division of Sleep Medicine early in my career, which sparked my passion for the field. I am the founder of Sleepyhead Clinic and author of Think Less, Sleep More.
My work has focused on helping people step away from the fear, pressure and misinformation that surrounds sleep and understand the biological systems that drive it. That means looking beyond sleep hygiene checklists, beyond the pursuit of the perfect bedtime routine and beyond the assumption that women’s sleep difficulties can always be explained by hormones.
Sleep problems exist and women’s sleep can look different at different stages of life. But sleep is innate. It will always be there, even when it does not match our expectations of what a “good sleeper” should look like.
The only difference between me and many of the people I work with is not that I sleep perfectly. I don’t. My sleep has changed during stressful periods, night shifts, pregnancy and parenting a sleepless baby, just as it does for everyone else. The difference is that I do not worry about it. Over-analysing sleep the way we have started to do is making sleep worse, not better.
Sleep plays an important role in physical health, emotional wellbeing, learning, memory, recovery and immune function. Most adults need somewhere between seven and nine hours of sleep, but I genuinely find it unhelpful to become too focused on the numbers.
Some people naturally need more, some less, and sleep needs change throughout life. The bigger question is whether you are allowing yourself the opportunity for sleep when you need it and whether your sleep, on average, is supporting your life reasonably well.
The Sleep Gender Gap
Women often experience sleep differently to men, but too often conversations about women’s sleep focus entirely on hormones while overlooking the reality of modern life. Women are still more likely to carry a larger share of childcare, household management, emotional labour and caring responsibilities. Increasingly, I also see women becoming the primary financial breadwinner without a corresponding shift in family responsibilities at home. This matters for sleep. When you are the person responsible for remembering school trips, organising childcare, booking appointments, managing family logistics and responding to everybody else’s needs, it becomes much harder to prioritise your own sleep. Sleep can start to feel like a luxury rather than a biological necessity. This is where sleep can fall down – when we actively can’t have the same opportunity as the non default carer. Not because our biology wont allow us.
Hormone sleep havoc
Hormones of course, do play a role. Many women notice changes in sleep around their menstrual cycle due to pain, temperature changes, mood shifts or physical discomfort. Pregnancy commonly brings disrupted sleep through discomfort, reflux, frequent urination, vivid dreams and anxiety about becoming a parent. Perimenopause and menopause can bring night sweats, hot flushes, mood changes and fragmented sleep. But this is normal and in all these cases our bodies are doing something remarkable! Our sleep is adaptable – this doesn’t mean it’s not difficult, or that it can’t be improved, but over focusing on sleep and expecting so much rigidity from it is actually making sleep worse for a lot of women right now.
Sleep changes throughout life. It changes with age, illness, stress, neurodiversity, caring responsibilities and major life transitions. Sleep at 50 should not look exactly like sleep at 25 and that is not necessarily a problem to solve. Women are remarkably adaptable. We do not need to pathologise every change or view every difficult period of sleep as evidence that something is broken that we must fix – we need to give ourselves a break, and add in some flexibility.
Sleep myths
One of the most common myths I hear is that mothers are biologically designed to wake for babies while fathers sleep through. There is some evidence that primary caregivers become more responsive to infant cues, but this is not exclusive to women. Fathers, adoptive parents and same-sex partners who take on primary caregiving roles show many of the same adaptations. Framing night-time caregiving as purely female biology risks overlooking the huge influence of learning, experience, expectation and family roles.
Another myth is that women need dramatically more sleep than men. The evidence simply does not support this idea. There may be small average differences between groups, but nowhere near enough to justify the idea that women are biologically programmed to need substantially more sleep than men. Sleep needs vary far more between individuals than between sexes.
Women going through perimenopause and menopause are often given endless lists of sleep tips: lavender sprays, herbal teas, warm baths, avoiding screens and having perfectly curated evening routines. While these things may help someone feel relaxed, the evidence that they reliably resolve significant sleep difficulties is surprisingly limited. This can leave women feeling as though they have failed when they are already doing everything “right”. But we are not taught that the foundations of sleep are often much more powerful than the finishing touches. And whilst sleep may need to change, we can still have a strong sleep baseline that works for us by focusing on this instead.
Many women describe feeling physically exhausted but mentally alert at bedtime. The body is ready for sleep but the mind is still replaying conversations, planning tomorrow or worrying about not sleeping. Bedtime is often the first quiet moment of the day. Others find themselves lying awake calculating hours, checking the clock or analysing every awakening during the night. Increasingly, one of the biggest sleep problems I see is not sleep itself but anxiety about sleep.
The science behind sleep
Sleep is driven primarily by two biological processes: sleep drive, which builds throughout the day the longer we are awake, and our circadian rhythm, our internal body clock. This is why I encourage women to focus less on creating the perfect evening and more on strengthening their mornings. Consistent wake times (but flexible bed times – go to bed when sleepy only), morning light exposure, regular movement and regular meals often have a far greater impact on sleep than adding another product, supplement or bedtime ritual. And there is real evidence-based treatment out there to help re-train you to sleep if it’s not something you can solve by yourself at home.
For women experiencing menopause-related sleep difficulties, addressing symptoms such as hot flushes, pain or mood changes can absolutely help. Hormonal treatments can be transformative for some women. But we also should not overlook the basics that support sleep regardless of age or hormones – focus on creating a good sleep baseline with the morning routine and listening to your body.
Healthy sleepers are usually flexible sleepers. They can have a poor night, carry on with their day and trust that sleep will recover naturally without changing their behaviour dramatically or fretting about it. The goal is not eliminating every wake-up, every difficult night or every period of change. Women’s sleep changes throughout life, but that does not mean women are destined to struggle with it. Understanding the biology that drives sleep and the real factors that we can influence, while recognising the social and practical realities that shape it is often far more helpful than chasing perfect routines or blaming our own biology for every poor night. Women already carry enough pressure, and I would really like for sleep to stop being one of them!
Whatever stage of life you may be at, there is evidence-based support available for sleep struggles. If you’d like to learn more, Stephanie’s book ‘Think Less, Sleep More’, BBC Maestro course ‘Sleep Better’ and personalised 1:1 support through Sleepyhead Clinic are all designed to help you better understand your sleep and overcome sleep difficulties.
