S l e e p a n d Wo m e n ’s M e n t a l

Health
Meredith E. Rumble, PhDa,*, Paul Okoyeh, MD
b
,
Ruth M. Benca, MD, PhDb

KEYWORDS
 Women  Sleep  Mental health  Insomnia  Restless legs syndrome
 Obstructive sleep apnea  Depression  Alzheimer disease

KEY POINTS
 Sleep disturbances and mental health concerns are common among women.
 Women are more likely to experience insomnia and restless legs syndrome (RLS), and, as
women age, sex differences in obstructive sleep apnea (OSA) decrease.
 Hormonal transitions are of importance when considering sleep disorders in women
(onset of menses, pregnancy, and menopause for insomnia; heavy menstrual bleeding
and pregnancy for RLS; pregnancy and menopause for OSA).
 Insomnia, OSA, and RLS are related to increased risk of depression.
 Insomnia and sleep-disordered breathing are related to increased risk of Alzheimer
disease.

INTRODUCTION

Starting as early as adolescence and persisting across women’s remaining lifetimes, both
sleep disturbance and mental health concerns disproportionally affect women over men.
Although the importance of sleep in relation to physical health has long been accepted, it
has only been more recently that the complex, bidirectional, and critical relationship be-
tween sleep and mental health has been recognized. Given that women have higher risks
for both sleep disturbances and psychiatric disorder, in this article, the authors consider
the crucial relationship between sleep and women’s mental health.
This article starts by first providing an overview of sleep, normative age-related
changes in sleep, and sex-specific differences in sleep. Then, the article considers
common sleep disorders in women as well as the relationships between sleep distur-
bances and mental health more broadly. Finally, the authors discuss the relationships

a
Department of Psychiatry, University of Wisconsin, 6001 Research Park Boulevard, Madison,
WI 53719, USA; b Department of Psychiatry and Behavioral Medicine, Wake Forest School of
Medicine, 791 Jonestown Road, Winston-Salem, NC 27103, USA
* Corresponding author.
E-mail address: rumble@wisc.edu

Psychiatr Clin N Am 46 (2023) 527–537

https://doi.org/10.1016/j.psc.2023.04.008 psych.theclinics.com
0193-953X/23/ª 2023 Elsevier Inc. All rights reserved.