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 < ) 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): Leger D et al. J Sleep Res. 2000;9(1): Singareddy R et al. Sleep Med. 2012;13(4): Zhang B, Wing Y-K. Sleep. 2006;29(1):85-93.

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.

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 Hartz A et al. Sleep Med Oct 4. [Epub ahead of print] 2. Singareddy R et al. Sleep Med. 2012;13(4): Salo P et al. Sleep Med. 2012;13(3): Baglioni C et al. Sleep Med Rev. 2010;14(4): Bonnet MH, Arand DL. Sleep Med Rev. 2010;14(1): Mongrain V et al. J Biol Rhythms. 2004;19(3): Cain SW et al. J Biol Rhythms. 2010;25(4): Duffy JF et al. Proc Natl Acad Sci U S A. 2011;108(suppl.3):15602– Lallukka T Sleep Med Jul 24. [Epub ahead of print] 10. Vgontzas AN Sleep Med Clin. 2009;4(1): Fernandez-Mendoza J et al. Sleep. 2012;35(5):

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 “Sleep in America” Poll. 2. Mongrain V et al. J Biol Rhythms. 2004;19(3): Cain SW et al. J Biol Rhythms. 2010;25(4): Duffy JF et al. Proc Natl Acad Sci U S A. 2011;108(suppl.3):15602–15608.

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): Parry BL et al. Sleep Med Rev. 2006;10(2): Sloan EP. Sleep Med Clin. 2008;3(1): Kravitz HM et al. Arch Intern Med. 2005;165(20): Kravitz HM et al. Menopause. 2003;10(1): Polo-Kantola P. Sleep Med Clin. 2008;3(1): Pien GW et al. Sleep. 2008;31(7):

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

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.)