Sleep through life’s changes
Sleep changes across a life. Some of those changes are normal and expected, and some are worth a closer look. This covers four times when sleep often shifts, what tends to happen, and how these tools fit.
During pregnancy
Sleep often gets harder in pregnancy, especially in the first months and again near the end. Needing to pee at night, nausea, heartburn, back and hip pain, leg cramps, and the baby moving can all break up the night. Restless legs, an urge to move the legs in the evening or at night, is more common in pregnancy too.
Some things to know:
- Talk with your provider before starting the sleep window. It can leave you very sleepy during the day, and your provider knows your pregnancy. The other tools, like stimulus control, the diary, the wind-down routine, and the exercises, are gentler places to start.
- Mention new or louder snoring. It can go along with problems your provider will want to check, like high blood pressure.
- Check before taking anything for sleep, including supplements and medicines you can buy without a prescription.
- Many providers suggest sleeping on your side later in pregnancy. Pillows between the knees and under the belly can help you get comfortable.
CBT-I can be used in pregnancy. In a 2020 trial with 208 pregnant women, those who used a digital CBT-I program had fewer insomnia symptoms than those who got usual care.
After a baby
Feeding and caring for a newborn at night breaks up everyone’s sleep. That isn’t insomnia, and the sleep window isn’t meant for the months when you’re up with a baby at night. Sleep when you can, share night care if that’s possible, and let other things wait.
Insomnia can still show up in this time, though. Lying awake when the baby is asleep and you have the chance to sleep is a sign worth taking seriously. So is low mood, worry that won’t let up, or feeling disconnected from your baby. These can be signs of postpartum depression or anxiety, which are common and treatable. Talk with your provider.
In the United States, the National Maternal Mental Health Hotline is free and open any time, in English and Spanish. Call or text 1-833-852-6262. If you have thoughts of harming yourself or your baby, call or text 988 now, or call 911 in an emergency.
Around menopause
Insomnia becomes more common in the years around menopause. Hot flashes and night sweats can wake you over and over, and changing hormones affect sleep on their own. Sleep apnea also becomes more common after menopause, so loud snoring or waking up gasping is worth bringing up with a doctor.
CBT-I works here too. In a trial of women with hot flashes, a version of CBT-I given over the phone improved sleep more than education about menopause did. A cool bedroom, light layers you can take off without fully waking, and a fan nearby can make hot flashes less disruptive. A doctor can talk with you about treatments for the hot flashes themselves.
Later in life
Sleep usually gets lighter with age. There’s less deep sleep, more waking in the night, and the body clock tends to shift earlier, so people get sleepy earlier in the evening and wake earlier in the morning. Some of this is a normal part of aging, not insomnia.
What often turns normal changes into insomnia is time in bed. After retirement, or with fewer reasons to get up, it’s easy to spend nine or ten hours in bed for seven hours of sleep. The extra time fills up with lying awake. This is the pattern the sleep window is designed around, and studies of CBT-I in older adults have found it helps.
A few things matter more at this age:
- Pain, needing to pee at night, and many medicines can affect sleep. A doctor can help sort out what’s changeable.
- Use a small light when you get up at night. Getting out of bed is part of stimulus control, and a clear, lit path makes it safer.
- Talk with a doctor before the sleep window if you’ve fallen before, or if you take medicine that makes you drowsy.
- Get some daylight, especially in the morning or early afternoon. It helps keep the body clock steady.
References
- Ohayon, M. M., Carskadon, M. A., Guilleminault, C., & Vitiello, M. V. (2004). Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: Developing normative sleep values across the human lifespan. Sleep, 27(7), 1255–1273. doi.org/10.1093/sleep/27.7.1255
- Felder, J. N., Epel, E. S., Neuhaus, J., Krystal, A. D., & Prather, A. A. (2020). Efficacy of digital cognitive behavioral therapy for the treatment of insomnia symptoms among pregnant women: A randomized clinical trial. JAMA Psychiatry, 77(5), 484–492. doi.org/10.1001/jamapsychiatry.2019.4491
- McCurry, S. M., Guthrie, K. A., Morin, C. M., Woods, N. F., Landis, C. A., Ensrud, K. E., Larson, J. C., Joffe, H., Cohen, L. S., Hunt, J. R., Newton, K. M., Otte, J. L., Reed, S. D., Sternfeld, B., Tinker, L. F., & LaCroix, A. Z. (2016). Telephone-based cognitive behavioral therapy for insomnia in perimenopausal and postmenopausal women with vasomotor symptoms: A MsFLASH randomized clinical trial. JAMA Internal Medicine, 176(7), 913–920. doi.org/10.1001/jamainternmed.2016.1795
- Morin, C. M., Colecchi, C., Stone, J., Sood, R., & Brink, D. (1999). Behavioral and pharmacological therapies for late-life insomnia: A randomized controlled trial. JAMA, 281(11), 991–999. doi.org/10.1001/jama.281.11.991
- Riemann, D., Espie, C. A., Altena, E., Arnardottir, E. S., Baglioni, C., Bassetti, C. L. A., Bastien, C., Berzina, N., Bjorvatn, B., Dikeos, D., Dolenc Groselj, L., Ellis, J. G., Garcia-Borreguero, D., Geoffroy, P. A., Gjerstad, M., Gonçalves, M., Hertenstein, E., Hoedlmoser, K., Hion, T., . . . Spiegelhalder, K. (2023). The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. Journal of Sleep Research, 32(6), e14035. doi.org/10.1111/jsr.14035
Helpful links
Everyday Insight’s tools are for education and personal reflection. They are not therapy or medical care, and they are not for emergencies. In an emergency, call 911. If you are in crisis in the United States, call or text 988.