By Elise Skinner, Clinical Psychologist
Sleep is often framed as a personal habit — something we should optimise if only we were more organised or less stressed. Yet for many women, sleep difficulties are not a failure of effort. They reflect the interaction of biology, hormonal transitions, caregiving roles, and social expectations that quietly deprioritise women’s rest.
For a long time, women’s sleep has received less attention in research, similar to many areas of women’s health. Earlier sleep studies often focused on males and assumed the findings would apply to everyone, while the hormonal changes and life stages women experience were seen as too complex to study. As women’s health has become a higher priority, research has begun to better understand women’s sleep — while also revealing how much more there is still to learn (Sharkey, 2016).
Adequate sleep is a biological need that if not met can impact all bodily functions and lead to an array of adverse medical and psychiatric outcomes. Promisingly, just like physical activity and nutrition, sleep is a modifiable health behaviour we can adjust with the right knowledge and tools.
On International Women’s Day, it’s worth asking: what do we actually know about women’s sleep?
Women Experience Insomnia Differently
Globally, insomnia has a 40% higher prevalence in females compared to males across all ages (Benjafeild, 2025). Australian women are 1.4x more likely than males to be diagnosed by a doctor with insomnia (8.6% vs 6.2%; Reynolds, 2019). While women are more likely to seek help, they are also more likely to be told their sleep problems are “normal,” “just stress,” or something they need to tolerate.
Women frequently report experiencing difficulty falling asleep due to racing thoughts, night-time awakenings, and nightmares. Women’s insomnia is also more likely to be persistent and recurrent, especially during periods of hormonal changes (Lok, 2024).
An Australian report found women were much more likely than males to report having inadequate opportunity to sleep, primarily in the 25 to 44 year age group (Reynolds, 2019). This begs the question, why are women struggling with having an adequate opportunity to fall asleep?
Hormones, Circadian Rhythms, and Life Stages
Oestrogen and progesterone influence sleep depth, REM sleep, thermoregulation, and neurotransmitter systems linked to anxiety and mood (Abed, 2025; Lok, 2024). As a result, women’s sleep is particularly vulnerable during:
- Puberty
- The premenstrual phase of the menstrual cycle
- Pregnancy and the postpartum period
- Perimenopause and menopause (often independent of hot flushes)
The Invisible Load Women Bring to Bed
Beyond biology, many women carry a disproportionate burden of caregiving, emotional labour, and mental load. In Australia, 54% of families report the main carer of the children is a woman, 78% report a woman usually or always “plans or organises activities for the children.” Additionally, women are more likely to be primary carers for a relative or spouse (68% vs 32%, ABS, 2024).
Night-time planning/worry, motherhood, care giving, trauma exposure, shift work in caring professions, and gendered expectations to prioritise others’ needs all contribute to chronic sleep disruption (Meltzer, 2011; Hoyt, 2021; Brewster, 2021). For many women, sleep is treated as optional rather than essential.
Why Sleep Matters for Mental and Physical Health
Sleep and mental health have a bidirectional relationship. Insomnia increases the risk of anxiety and depression and often persists even when mood symptoms improve (Howarth, 2024). For women with trauma histories, sleep can feel unsafe due to hyperarousal, nightmares, or avoidance.
Chronic sleep disturbance is also linked to cardiovascular disease, metabolic changes, chronic pain, infertility, and worsening of conditions such as PCOS, endometriosis, autoimmune illness, and menopausal symptoms (Al-Farsi, 2025; Li, J., 2024). Sleep is a modifiable human need for long-term women’s health.
CBT-I and a More Realistic Approach to Women’s Sleep
Cognitive Behavioural Therapy for Insomnia (CBT-I) is the first-line treatment for chronic insomnia and is effective across ages and hormonal stages. When tailored for women, it allows flexibility for caregiving demands, perinatal periods, and fluctuating sleep needs, while addressing hyperarousal, rumination, and perfectionism around sleep (Zheng, 2023; Pardon, 2022;Nowakowski, 2019).
The goal is not perfect sleep, but resilient, sustainable sleep that fits real lives.
International Women’s Day: A Call to Rethink Women’s Sleep
Sleep is not just an individual responsibility — it is shaped by biology, healthcare systems, workplaces, and social roles. Improving women’s sleep improves families, workplaces, and communities (Caruso, 2015; Skuladottir, 2022).
To explore these issues in more depth, join our International Women’s Day seminar on women’s sleep and insomnia. This seminar will examine why women’s sleep is different, how life stages and mental health intersect with sleep, and how evidence-based approaches like CBT-I can be adapted to women’s real-world constraints. Women’s sleep matters — and it’s time we treated it that way.
Our seminar will be located on site at Darlinghurst Psychologists on the evening of Thursday 5th March 2026 – to get your free ticket follow this link!
https://www.eventbrite.com/e/how-do-we-sleep-a-womens-focus-tickets-1982415776954?aff=oddtdtcreator
Or, if you’d like to explore seeing one of our psychologists take a look at The Team or Contact Us directly
References
Al-Farsi, H. Y., Al-Fahdi, E. Y., Al-Balushi, M. A., Al-Jahwari, A. N., Al-Maskari, A. M., & Das, S. (2025). Sleep Disturbances Associated with Different Systems of the Body: Underlying Mechanisms Involved and Consequences. Current Medicinal Chemistry.
Abed, A. R., & Hussein, I. M. (2025). Psychological and Behavioral changes in women and their relationship to age: A Comprehensive Review. Current Clinical and Medical Education, 3(7), 13-19.
ABS (Australian Bureau of Statistics) (2024) Disability, Ageing and Carers, Australia: Summary of Findings, 2022,– external site opens in new window ABS website, accessed 26 November 2024.
Benjafield, A. V., Kuniyoshi, F. S., Malhotra, A., Martin, J. L., Morin, C. M., Maurer, L. F., … & Wickwire, E. M. (2025). Estimation of the global prevalence and burden of insomnia: a systematic literature review-based analysis. Sleep Medicine Reviews, 102121.
Brewster, G., McPhillips, M., Yeager, K., Epps, F., Johnson, K. B., Hepburn, K., & Bliwise, D. (2021). Gender-specific predictors of poor sleep quality and insomnia among caregivers of persons living with dementia. Innovation in Aging, 5(Suppl 1), 811.
Caruso, C. C. (2015). Reducing risks to women linked to shift work, long work hours, and related workplace sleep and fatigue issues. Journal of women’s health, 24(10), 789-794.
Howarth, N. E., & Miller, M. A. (2024). Sleep, sleep disorders, and mental health: a narrative review. Heart and Mind, 8(3), 146-158.
Hoyt, M. A., Mazza, M. C., Ahmad, Z., Darabos, K., & Applebaum, A. J. (2021). Sleep quality in young adult informal caregivers: understanding psychological and biological processes. International Journal of Behavioral Medicine, 28(1), 6-13.
Li, J., Huang, Y., Xu, S., & Wang, Y. (2024). Sleep disturbances and female infertility: a systematic review. BMC Women’s Health, 24(1), 643.
Lok, R., Qian, J., & Chellappa, S. L. (2024). Sex differences in sleep, circadian rhythms, and metabolism: Implications for precision medicine. Sleep medicine reviews, 75, 101926.
Meltzer, L. J., & Montgomery-Downs, H. E. (2011). Sleep in the family. Pediatric Clinics of North America, 58(3), 765.
Nowakowski, S., & Meers, J. M. (2019). CBT-I and women’s health: Sex as a biological variable. Sleep medicine clinics, 14(2), 185.
Padron, A., McCrae, C. S., Robinson, M. E., Waxenberg, L. B., Antoni, M. H., Berry, R. B., … & Pereira, D. B. (2022). Impacts of cognitive behavioral therapy for insomnia and pain on sleep in women with gynecologic malignancies: a randomized controlled trial. Behavioral sleep medicine, 20(4), 460-476.
Reynolds, A., Appleton, S. L., Gill, T. K., & Adams, R. (2019). Chronic insomnia disorder in Australia: A report to the Sleep Health Foundation. Flux Visual Communication. https://www.sleephealthfoundation.org.au/news/special-reports/chronic-insomnia-disorder-in-australia.html
Sharkey, K. M., & Wolfson, A. R. (2016). A Quarter Century of Research Progress Leads to Answers and New Questions for Women’s Sleep Health. Current sleep medicine reports, 2(4), 181–182. https://doi.org/10.1007/s40675-016-0061-0
Skuladottir, A., Sigurdardottir, A. O., & Svavarsdottir, E. K. (2022). The ‘Better sleep better well-being’intervention for parents of infants with moderate sleep problems: A quasi-experimental study. Nordic Journal of Nursing Research, 42(2), 85-92.
Zheng, X., Zhu, Z., Chen, J., He, J., Zhu, Y., Zhang, L., & Qu, F. (2023). Efficacy of cognitive behavioural therapy for insomnia or sleep disturbance in pregnant women: a systematic review ad meta‐analysis. Journal of sleep research, 32(2), e13808.