What Causes Insomnia in Women

Insomnia is more common in women, and sleep apnea is more likely to be underrecognized in women, sometimes leading to a diagnosis of insomnia instead.123 Why insomnia is more common in women isn't settled.

Pregnancy

A 2024 analysis found that the overall prevalence of insomnia symptoms during pregnancy was 43.9%.5

Pregnancy brings physical discomfort, nocturia, and a set of legitimately new things that could increase worry, stress, and anxiety. Some sleeping medications are discouraged during pregnancy, so it can be hard to manage insomnia symptoms.

Sleep apnea

More men than women meet the criteria for obstructive sleep apnea (OSA). That gap may reflect that OSA in women is underdiagnosed — up to 75% of cases in women go unrecognized.3

Loud snoring, gasping, witnessed pauses in breathing, and daytime sleepiness are classic OSA behaviors. However, up to 40% of women with OSA don't report snoring, choking, or witnessed pauses in breathing.3 A woman with untreated sleep apnea may describe to her provider trouble falling asleep and trouble staying asleep.4 In this case, they may be diagnosed with chronic insomnia when they actually have OSA.

That matters because the treatments are different. Insomnia treatment alone may not fix a breathing problem. The two also frequently coexist, called comorbid insomnia and sleep apnea.

Here are signs worth raising with your doctor:

• If your sleep looks adequate on paper but you wake unrefreshed;
• if you have morning headaches;
• if you wake gasping;
• if anyone has ever mentioned your breathing at night.

The most accurate diagnosis is through a sleep study; in-laboratory polysomnography is the gold standard diagnostic test for sleep apnea. Home testing may be an appropriate alternative.4

Menopause

Sleep problems often begin in perimenopause and can continue through the transition and after it. Disrupted sleep is common during this stage.6

The night sweats seem like an obvious cause for insomnia. Research finds that the same changes in the brain that trigger a hot flash may also wake you just before it starts.6

CBT-I and menopause

The top recommended treatment for chronic insomnia, cognitive behavioral therapy for insomnia (or CBT-I), has been shown to help adults, and women specifically.8

A randomized trial enrolled 106 perimenopausal and postmenopausal women aged 40 to 65 who had insomnia (Insomnia Severity Index score of 12 or higher) and at least two hot flashes a day. Half received six CBT-I sessions by telephone over eight weeks; half received only telephone-based menopause education. At eight weeks, insomnia severity scores had fallen by 9.9 points with CBT-I compared with 4.7 points with education. At twenty-four weeks, four months after the sessions had ended, 84% of the participants in the CBT-I group scored in the no-insomnia range, versus 43% in the control group.7