1. Insomnia is More Prevalent in Women than in Men Canadian survey (2011): 1 Insomnia criteria met by 15.6% of women and 11.0% of men (odds ratio 1.5) French study (2000): 2 Insomnia prevalence was 63% higher in women than in men (22.8% vs. 14%; P < 0.0001) U.S. Penn State Sleep Cohort (2012): 3 Incidence of insomnia in women (12.9%) more than twice that in men (6.2%) Meta-analysis (2006): 4 relative risk ratio for insomnia of 1.41 for women compared with men 1. Morin CM et al. Can J Psychiatry. 2011;56(9):540-548. 2. Leger D et al. J Sleep Res. 2000;9(1):35-42. 3. Singareddy R et al. Sleep Med. 2012;13(4):346-353. 4. Zhang B, Wing Y-K. Sleep. 2006;29(1):85-93.

2. Significant Increase in Risk with Age Relative risk for the development of insomnia* –Young adults (15–30 years)1.28 –Middle-aged (31–64 years)1.46 –Elderly (≥65 years)1.73 Increased incidence occurs long before menopause * Compared with men Zhang B, Wing Y-K. Sleep. 2006;29(1):85-93.

3. Factors Contributing to the Predominance of Insomnia in Women Mood disorders 1-4 Family and social roles Hyperarousal 5 Circadian influences: phase 6,7 and period 8 Body mass and sleep duration 9-11 1. Hartz A et al. Sleep Med. 2012 Oct 4. [Epub ahead of print] 2. Singareddy R et al. Sleep Med. 2012;13(4):346-353. 3. Salo P et al. Sleep Med. 2012;13(3):278-284. 4. Baglioni C et al. Sleep Med Rev. 2010;14(4):227-238. 5. Bonnet MH, Arand DL. Sleep Med Rev. 2010;14(1):9-15. 6. Mongrain V et al. J Biol Rhythms. 2004;19(3):248-257. 7. Cain SW et al. J Biol Rhythms. 2010;25(4):288-296. 8. Duffy JF et al. Proc Natl Acad Sci U S A. 2011;108(suppl.3):15602–15608. 9. Lallukka T Sleep Med. 2012 Jul 24. [Epub ahead of print] 10. Vgontzas AN Sleep Med Clin. 2009;4(1):65-75. 11. Fernandez-Mendoza J et al. Sleep. 2012;35(5):689-697.

4. General Sleep Comparisons Between Women and Men Women: Generally sleep for longer periods –Sleep time per night: 7.0 hrs (women), 6 hrs 42 mins (men) 1 Have a higher subjective sleep need Are ”larks” and morning-types –Typically self-select earlier bedtimes 2,3 Are more likely to have shorter intrinsic circadian period 4 1. National Sleep Foundation. 2002 “Sleep in America” Poll. 2. Mongrain V et al. J Biol Rhythms. 2004;19(3):248-257. 3. Cain SW et al. J Biol Rhythms. 2010;25(4):288-296. 4. Duffy JF et al. Proc Natl Acad Sci U S A. 2011;108(suppl.3):15602–15608.

5. Hormonal Influences Menstrual cycle 1,2 Pregnancy 2,3 Menopause 4-7 Hormone replacement and alternative therapy 6 1.Baker FC, Driver HS. J Psychosom Res. 2004;56(2):239-243. 2.Parry BL et al. Sleep Med Rev. 2006;10(2):129-144. 3.Sloan EP. Sleep Med Clin. 2008;3(1):73-80. 4.Kravitz HM et al. Arch Intern Med. 2005;165(20):2370-2376. 5.Kravitz HM et al. Menopause. 2003;10(1):19-28. 6.Polo-Kantola P. Sleep Med Clin. 2008;3(1):121-131. 7.Pien GW et al. Sleep. 2008;31(7):991-999.

6. Practical Strategies to Improve Sleep 1.Regular sleep/rise routine 2.Dark bedroom 3.Avoid the supine position if pregnant, overweight/obese, prone to snoring/OSA, and for comfort 4.Snoring and OSA should be assessed and treated 5.Avoid caffeine, especially after midday OSA = obstructive sleep apnea

7. 6.Assess and treat restless leg syndrome 7.Smoking cessation 8.Practice exercises such as yoga 9.Management options: Cognitive behavioural therapy Benzodiazepine receptor agonists (short-term or intermittent use) Practical Strategies to Improve Sleep (cont.)