Pillow Talk: Women's Sleep and Mental Wellbeing
Ever tell someone they "woke up on the wrong side of the bed"? While this is just a saying (and the side of the bed we find ourselves on in the morning has little to do with our mood!), sleep, in general, greatly impacts our mental health. This is especially true for women.
Sleep and mental health have a bidirectional relationship: poor sleep affects the mood and can exacerbate mental health disorders, and an existing mental health condition can affect sleep quality.
Traditionally, sleep troubles were viewed as an outcome of depression. Yet, increasing evidence suggests that poor sleep could also trigger or worsen depression. Sleep problems and depressive symptoms seem to mutually amplify each other, forming a reinforcing loop. For those struggling with anxiety, the hyperarousal, or "racing mind," associated with an anxiety disorder is a key contributor to insomnia.
During the night, the body enters the rapid eye movement (REM) stage of sleep. Here, the brain is given the opportunity to process emotional information, analyzing thoughts and memories from the day. Without enough sleep, the body misses out on crucial REM time and the synthesizing of important positive emotional content (Suni & Dimitriu, 2023).
Women are more likely than men to have insomnia disorder and sleep disturbances. In a survey conducted by the National Sleep Foundation, 71% of women said menstrual symptoms like bloating, headaches, and cramps impacted their sleep. In another study, sleep quality and efficiency tended to be poorer during the menstrual and premenstrual phases than other phases of the cycle. This is attributed to the fluctuating levels of steroid hormones (like progesterone) released during the premenstrual and menstrual phases. Progesterone is the hormone that facilitates pregnancy and has a slight sedative effect. Following a woman's luteal phase, progesterone levels drop dramatically during menstruation, hence the reason for sleep difficulties (Baker & Driver, 2004).
Cognitive-behavioral therapy (CBT) can prove beneficial if you're struggling with sleep disturbances or insomnia. CBT can help you manage your mood and the thinking processes that impact sleep, as well as providing concrete strategies to support your sleep.
What Do YOU Think About It All?
One of my favorite holidays is New Year’s Day. It’s a contemplative, peaceful day for me, and I typically spend time reviewing the past year, and setting my intentions for the new year. This year I’ve been thinking a lot about the quote “Other people’s thoughts are not your business”, ascribed to everyone from the Buddha to Marcus Aurelius to Lisa Nichols, Regina Brett, and Steve Harvey to name just a few!
Regardless of the original source, there is wisdom in this concept. From a cognitive-behavioral perspective, one of the reasons it holds up is because other people don’t have “all of the data” included in your life and decisions, so how can they accurately judge your situation at any given moment? And with the hundreds of people we encounter in the world each year, there are just too many people we encounter to give each of them that kind of influence. We simply can’t afford our perspective to be pulled in every direction possible by someone else’s thoughts or perspective.
And I don't know about you, but the opposite is also true: I wouldn't want all of MY thoughts to be made other people's business arbitrarily!
People pleasing is one of the ways we make other people's thoughts our business. At its core, people pleasing simply means “I let go of my center, needs, and perspective in service of what I assume are your needs and perspective”. The motivations for people pleasing can range from hoping other people will like us or take care of us more if we please them, to misperceiving people pleasing as a form of true caretaking. But regardless of the motivation, excessive people pleasing ultimately becomes an impossible task because frankly, there are simply too many people to please them all. And most importantly, people pleasing pulls us off of focus because we are no longer paying attention to our own perspective, needs, and values. In this way, people pleasing disrupts intimacy as it prevents others from actually knowing us.
One of my intentions for 2024 is to not expend ANY energy on mind reading or adjusting to people’s unexpressed thoughts, concerns, or opinions. That doesn’t mean I won’t consider other people’s expressed opinions, with the caveat that they come from someone who has earned my trust. But in order to take better emotional care of myself in 2024, I will remind myself daily that other people’s thoughts are truly none of my business.
Hidden In Plain Sight: The Female ADHD Experience
Between 2020 and 2022, the population of adult women diagnosed with ADHD nearly doubled. Often considered a “boys disorder,” girls are significantly less likely than boys to be diagnosed with ADHD. But this is by no means saying there is a lower prevalence of attention disorder in girls or women. Instead, girls with ADHD tend to present differently than boys and teachers and practitioners often overlook their symptoms.
From a young age, women face difficulties receiving a diagnosis of ADHD. Disorders that go hand-in-hand with ADHD in girls, like anxiety and depression, can overshadow ADHD symptoms and lead physicians to misdiagnose their young female patients. Inward behaviors, like inattentiveness, are more common in girls with ADHD than outward behaviors, such as hyperactivity. In the classroom, hyperactive boys are noticed and dealt with by teachers, while inattentive female students remain ignored because their behavior is manageable. As a result, women learn strategic coping skills for their ADHD throughout their lives, further mitigating the external appearance of their disorder. Researchers Arcia and Conners (1998) determined that the self-perception of adult women with ADHD is poorer than that of men with ADHD or women without an ADHD diagnosis. Learn more
Studies have shown differences in dopamine release, cognitive function, and sensation seeking between men and women in response to stimulant drugs like amphetamine, often used to treat ADHD (Quinn & Madhoo, 2014). The effects of amphetamine in women vary based on their menstrual cycle, with greater euphoric and stimulating effects observed during the follicular phase, when estrogen levels are higher, compared to the luteal phase. This research suggests that the response to ADHD medications might need to be adjusted throughout the menstrual cycle for better symptom control for women.
Cognitive therapy can be a helpful tool in your ADHD arsenal. Some cognitive therapists specialize in working behaviorally with clients to improve executive functioning skills which may be helpful for aspects of ADHD. While we here at CTWPS do not specialize in executive functioning coaching, we do support our clients in managing the anxiety and isolation that often surrounds their ADHD experience. If that is something that you’d like to explore more in depth, reach out to us to learn more!
References
Arcia, E., & Conners, K. C. (1998). Gender Differences in ADHD? Journal of Developmental & Behavioral Pediatrics, 19(2), 77. https://journals.lww.com/jrnldbp/Abstract/1998/04000/Gender_Differences_in_ADHD_.3.aspx
Quinn, P. O., & Madhoo, M. (2014). A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls. The Primary Care Companion for CNS Disorders, 16(3). https://doi.org/10.4088/pcc.13r01596
Russell, J., Franklin, B., Piff, A., Allen, S., & Barkley , E. (2023). Number of ADHD Patients Rising, Especially Among Women. Epic Research.
The Sex-Mind Connection
Understanding how your sexual and mental health are interconnected is integral to taking care of your well-being. Research has shown that sexual activity has a direct impact on mental well-being. A healthy sex life can improve the way you feel and express emotions. But what happens when menopause, illness, pain, or other factors get in the way?
Sexual dysfunction and other issues related to sexual health can often lead to common mood disturbances in women. Many women may experience feelings of anxiety, low self-esteem, or depression. These symptoms usually appear in a cycle; sexual dysfunction impacts the mood, and mood disturbances further impact sexual health. Link here
Common sexual health concerns in women include a low sex drive (aka hypoactive sexual desire disorder), painful intercourse, difficulty reaching orgasm, and menopausal changes. Women facing these concerns should speak with their healthcare provider or gynecologist. Many of these issues are treatable, but can still be frustrating.
Stress and anxiety even have a biological impact on the body that can affect one’s sexual health. Your body is programmed to react to stressful environments by producing a hormone called cortisol. Usually, it provides you with a short burst of energy to tackle an immediate problem in front of you. But, importantly, when your body is producing cortisol, it cannot release the essential hormones needed for sexual arousal. In a population study conducted by researchers Dunn et al. (1999), sexual concerns were affected by psychological issues in women more than men. Problems with arousal, inhibited enjoyment, and painful sex were strongly related to anxiety and depression measures in women. For men, sexual health concerns were connected to age and physical health more significantly than emotional issues.
Your gynecologist, a sex therapist, and a cognitive behavioral therapist can each be critical resources for women experiencing sexual dysfunction. The role of cognitive therapy can be to promote a healthy change in attitude around sex, reduce anxiety relating to sex, and improve a woman’s self-image in the context of dysfunction.
We are not separate from our bodies. Sexual health is crucial to your overall health. Despite the stigma surrounding sexual dysfunction, please don’t go it alone.
Schemas of aging: how they might actually impact how we age
If I were to say “close your eyes and picture a college dorm,” what image would your mind paint for you? You’d probably visualize a pretty nondescript room with twin beds, posters on the wall, a desk with a computer sitting on it, etc. But what if I were to say “close your eyes and picture a person in middle age.” Or, “picture a person in their 70s.” Now what do you see?
For a lot of us, thinking about aging usually evokes images and beliefs related to loss. Loss of mobility, health, beauty, or of feeling care-free. These beliefs and images are called “schemas,” and they can have a very powerful impact on how we move through life. Sometimes these schemas can be useful; like when my dorm room schema pops in my head and reminds me to buy the right sized sheets before move-in day, for instance.
But what effects might these loss-heavy age-related schemas be having on us? Well, as Dr. Becca Levy details in her book “Breaking the Age Code,” research shows a significant relationship between such schemas and medical illnesses like high blood pressure, Alzheimer’s dementia, and heart disease (to name just a few). Simply put, those who endorsed more fatalistic beliefs about aging were statistically much more likely to experience actual health problems in older age.
In contrast, Dr. Levy found that those with more favorable attitudes towards aging were also more likely to recover from disability at a quicker rate, have better memory performance, and yes, even live longer. In other words, these individuals are living a self-fulfilling prophecy that is actually fulfilling!
How did they do it, you ask? According to Dr. Levy, this process involves three stages:
Developing a greater awareness of harmful aging schemas- as they exist in both ourselves and in our external environments.
Tracing these schemas to their original source: a society that conditions us to fear aging as a means of profit. ($75 wrinkle cream, anyone?)
Disrupting and replacing these beliefs the moment they pop into our heads