The Quest for Rest

Like many mothers of young children, Martha Yasso was tired all the time--so tired that whenever her 3-year-old son went down for a nap, she grabbed the chance to rest as well. But even with those precious extra minutes of sleep, she was still so exhausted by late afternoon that she could barely keep her eyes open. One day last fall, as her son played in the den of their New York home, Yasso's eyelids got heavier and heavier. Just before she nodded off completely, she felt her son's hands on her face. He was shouting, "Mama, Mama! Wake up!" That was the turning point. "I knew it was something more than just being tired because of everything a mother does as CEO of the family," says Yasso, 36. She called her doctor, who referred her to the NYU Sleep Disorders Center. After a night in the sleep lab, with electrodes monitoring her brain waves, breathing and movements, Yasso finally understood what was behind her overwhelming fatigue. NYU pulmonologist Ana Krieger told Yasso that during the eight hours she thought she was asleep, she had actually awakened 245 times. "That number shocked me," Yasso says. "But it also explained a lot."

Krieger gave her a diagnosis: she was suffering from recurrent episodes of hypopnea, which means her air flow decreases while she sleeps. Yasso's brain automatically rouses her whenever her impaired breathing reaches a critical point. That accounted for many of the awakenings. Krieger said the monitors also showed that Yasso has what's known as periodic limb-movement disorder. At night, her legs twitch involuntarily, which disturbs her sleep even more. Yasso was relieved. "It had a name and I was hopeful that it could be treated," she says. Several weeks later Yasso was back at NYU to be fitted with a machine called CPAP (for continuous positive airway pressure) that would keep her breathing steadily throughout the night. If CPAP resolves Yasso's hypopnea, as Krieger expects, the next step will be tackling the movement disorder. Already, Yasso says, she feels better just knowing that help is on the way.

Yasso is the grateful beneficiary of a radical rethinking of women's sleep problems. Until the early 1990s, the typical patient in a sleep lab might have been a middle-aged overweight man whose snoring was driving his wife crazy. But now those guys (and there are still plenty of them) are joined by more and more women of all ages who are also trying to figure out why they're among millions of people who suffer from sleep problems. In recent years, there has been a growing recognition--by doctors and patients--that what might seem like simple new-mom fatigue or menopausal angst could actually be a physical or psychological problem that can be relieved with changes in sleep routines, medication or devices like CPAP. In fact, says Dr. Barbara Phillips, professor of medicine at the University of Kentucky, "women are more likely than men to have insomnia and sleep complaints at every age" except childhood.

You can blame some of those yawns on the complexity of modern women's lives. They're workers, wives, mothers and caregivers to elderly parents--all of which add up to stress and anxiety that don't stop when the lights go out. Long-term sleeplessness takes a toll. "With lack of sleep, you're more likely to have a lower mood, less energy, more irritability," says sleep expert Eve Van Cauter, a professor of medicine at the University of Chicago. Women who are sleep-deprived are also at risk for depression, heart disease, even obesity. Researchers have found that lack of sleep disrupts the production of hormones that regulate feelings of hunger and satiety. Recent studies show that women (and men) who get less sleep are fatter.

The craving for sleep has fueled a huge demand for sleeping pills--with more than $2 billion in annual sales, according to IMS Health, a pharmaceutical information and consulting company. Expect more options in the next few years. Drug companies are working hard to target areas of the brain that induce sleep. But taking a sleeping pill can actually make it harder to find out what's really going on. "People are starting to think about these things as though they are painkillers you take for a headache," says Dr. Meir Kryger, author of "A Woman's Guide to Sleep Disorders." "I personally don't think it's a good development." Kryger says a patient should get a diagnosis before starting any treatment, and sleep medications should never be the first or only line of defense. Although the current generation of drugs--products such as Ambien, Lunesta and Rozerem--don't have the addictive potential of the older sleep medications, patients need to follow their doctors' instructions carefully. These drugs work best to help people get over short-term sleep problems, such as after the death of a family member or some other stressful event.

Sleeping pills don't resolve the underlying issue--whether it's stress, a physical disorder or hormonal changes. Women are most vulnerable to insomnia when they first begin menstruating, during pregnancy and around the time of menopause, says Dr. David Neubauer, a psychiatrist and associate director of the Johns Hopkins Sleep Disorders Center. Young girls just starting to menstruate have hormonal fluctuations and may have iron deficiency, which can affect sleep. Later on, hormone-related sleep problems become more common. According to a poll by the National Sleep Foundation, about 70 percent of menstruating women of all ages say that their sleep is disrupted during their periods by symptoms like tender breasts, bloating, cramps and headaches. Most of these are only temporary and can be treated with over-the-counter painkillers or by cutting down on caffeine.