Help female clients sleep better to perform better

Getting adequate sleep is crucial for performing well in everything we do, but too many of your clients will struggle to achieve it. PT and women’s health educator Clare Hozack shares some key practices for promoting better sleep health.

Fitness professionals often cite sleep as the third part of the equation, along with exercise and nutrition¹, that clients need to focus on to optimise their health and wellbeing. For many people, however, getting some good shuteye is a lot harder than attending a BODYPUMP class or choosing the salmon poke bowl for lunch.

Insomnia is a sleep disorder that is defined by the inability to go to sleep, waking too early, or feeling unrested after sleep for at least three nights a week for at least three months. Most women need seven or more hours of sleep a night to feel rested².

Women are 40% more likely to suffer insomnia than men³ – and many that don’t quite meet the criteria to be considered insomniacs still experience some level of sleep problem (up to 67%). As fitness professionals, we are in a strong position to help our female clients improve their sleep health, and in doing so help them perform better in all areas of their life.

The Gender Factor

At least part of the reason for the insomnia discrepancy between the genders is hormonal, some direct, some indirect. Research has shown that elevated insomnia risk begins with the onset of menstruation at puberty⁴. Other research has shown that the fall in hormones leading up to menstruation causes about 90% of women to experience mood or physical changes, including sleep problems⁵.

Pregnancy and menopause also carry their own unique challenges for sleep; some hormonal, some lifestyle, and some as a consequence of another issue (such as depression, hot flushes, or the physical challenges of sleeping when pregnant)⁶.

Other barriers to sleep are different for women than men:

• Depression, anxiety and stress will profoundly affect sleep for women, as they are more likely to ruminate about their concerns⁷.
• Urinary problems, like needing to go to the bathroom frequently at night (nocturia) and stress incontinence, affect women twice as much as they affect men⁸.
• Restless leg syndrome, in which the urge to move your limbs while lying down is overwhelming, affects more women than men and interrupts sleep.

So, that’s the bad news, and the reason why sleep should now be a priority with your female clients in the year ahead. The good news is, there is plenty you can do to help them.

Tips to improve your clients’ sleep

1. Establish a sleep schedule (even at weekends!)

To develop a healthy sleep cycle, it’s very beneficial to go to bed around the same time and wake around the same time every day – even at weekends! This isn’t always possible, and you shouldn’t let it dictate your social life, but if you can get as close to regular sleeping hours as often as possible, it will go a long way to establishing a solid sleep pattern.

2. Follow a sleep ritual

Hand-in-hand with your new sleep schedule is a sleep ritual. And no, spending four hours bingeing the latest Netflix series isn’t going to cut it!

This advice isn’t just for your clients though – it’s just as valuable for you. As a trainer, you may well work until 8pm or later, and by the time you get home you’ll be wired with endorphins and your brain will be going at a million miles an hour.

For mums, evenings are often the only time they get on their own, and they will often fill it with chores. Sadly, the house elves won’t be attending to those, so they can’t always be avoided. However, in addition to domestic necessities, at least some time should be carved out to relax and prepare the brain for rest.

What a sleep ritual should NOT include:

• exercise
• activities that challenge the brain (do Wordle at breakfast instead)
• blue screens such as TV or phone
• activities that cause stress
• stimulants like coffee or black tea.

A sleep ritual should include habits that become ingrained; practised signals that prepare your body for sleep. Some of this ritual needs to be calming and soothing.

What a sleep ritual can include:

• enjoying a cup of herbal tea
• light yoga, stretch or movement
• breath practise
• turning all the lights in your house down

Limit alcohol and caffeine

You may use alcohol and caffeine to relax or stimulate you, but you should do so with care⁹. Alcohol is a central nervous system depressant that causes brain activity to slow down. It has sedative effects that can induce feelings of relaxation and sleepiness¹⁰, but the consumption of alcohol – especially in excess – has been linked to poor sleep quality and duration, because it suppresses REM (rapid eye movement) sleep, sometimes called ‘the good sleep’. Generally, you need at least two hours REM sleep in a 24-hour period for your sleep to be considered adequate.

When using subjective measures, women report more sleep problems than men, including disrupted and insufficient sleep, poor sleep quality, difficulty falling asleep, frequent night awakenings, and time awake during the night^11,12. Considering these factors, and women’s 40% greater risk of insomnia¹³, limiting or avoiding alcohol in the evening makes sense for women if sleep is a problem.

If you can train yourself to swap out your evening glass of wine for a soothing herbal tea and dark chocolate, your brain will thank you for it.

Caffeine is not just found in coffee, it’s also present in most energy drinks as well as black and green tea. Caffeine promotes alertness by inhibiting chemicals in the brain that promote sleep¹⁴. It is absorbed rapidly into the bloodstream and reaches peak levels within 30-70 minutes. Its effects can last for three to seven hours, but it may take up to 24 hours to be fully eliminated. You may have become dependent on caffeine if taken regularly, so rather than go cold turkey, gradually cutting down on it may help reduce withdrawal-induced headaches, anxiety and other symptoms.

Moderate single doses of caffeine (up to 200mg), and a daily intake of less than 400mg, do not seem to have negative health effects in healthy adults. This translates to around five cups of regular strength black tea or two cups of brewed coffee (not too strong) per day, ideally consumed in the first half of the day and not within seven hours of bedtime.

If you can, try to make these changes to your alcohol and caffeine consumption (if applicable) and see if it affects your sleep quality. Alternatively, if elimination isn’t feasible, try cutting down what you consume, dropping from two glasses of wine a night to one glass, for example.

Light

Numerous studies have demonstrated the health detriments of a desynchronised circadian rhythm (i.e. not sleeping when it’s dark), including premature ageing, increased risk of breast and other cancers, increased risk of heart disease and metabolic syndrome, and even the risk of poor dental hygiene and cavities¹⁵.

Here’s how to use light to your advantage:

1. Get plenty of light into your eyes each day. This means getting outdoors without sunglasses on (in a sun safe way). Bright light in the morning, shortly after waking up, will help you fall asleep earlier that evening, and the opposite is true in the evening – bright light within two hours of your sleep time will keep you up longer and make it harder to fall asleep¹⁶. If you walk everyday, for example, try to do it in the morning, or any time before mid-afternoon, for the best effect on your circadian rhythm.
2. Sunrises and sunsets are particularly potent circadian rhythm cues, and have the biggest impact on the brain centres that regulate our circadian clock, mood, and alertness¹⁷. Try to witness at least one of these events each day.
3. Avoid blue light before bed. At best, blue light will affect your sleep, at worst, research shows that it may contribute to the causation of cancer, diabetes, heart disease and obesity. While light of any kind can suppress the secretion of melatonin, blue light at night does so more powerfully, suppressing melatonin by twice as much as other coloured lights¹⁸. So, keep the lights low, and wear glasses that filter blue light, or use the filter feature on your screen, computer, ipad and some TV’s.

Exercise 

Now we’re really back in our wheelhouse. Exercise has been shown to improve total sleep time, sleep efficiency, and wake after sleep onset after 12 weeks of training¹⁹. However, there is conflicting research regarding what type of exercise is best²⁰, so the information that follows is informed by my personal experience of training women for over 20 years and educating personal trainers for more than a decade.

If you don’t have great sleep regularly, here are my top tips for using exercise to improve it:

1. If you’re going to exercise hard, do it in the morning, and keep it under 20 minutes: this is to avoid an excessive stress hormone response which may contribute to sleep disruptions.
2. If you only have time to exercise in the evening, make sure it’s either:
   1. gentle, wind-down style movement (like yoga, tai chi or slow walking)
   2. something that brings you joy
   3. aerobic (preferably under 6/10 intensity)
   4. heavy weights with a long rest period (i.e. sets of 6 with 3 minutes break minimum).
3. If you’re going through a stressful period, and your sleep is suffering, keep your exercise intensity as low as possible (but with plenty of movement), do it outside, and make it joyful (i.e. with friends, on the beach, or whatever makes you happy).
4. HIIT and endurance training will have a positive effect on sleep as long as:
   1. you’ve consumed enough calories, nutrients and vitamins
   2. you’re hydrated
   3. you’re not stressed
   4. you’re not injured
   5. you’re well rested.

Sleep is not a luxury, it is critical. Ask your clients – particularly your female ones – if they sleep well. I guarantee you that many will laugh at the mere suggestion. For these clients, make practicing good sleep hygiene a priority by encouraging them to adopt some or all of the practices above. When they start enjoying the elusive feeling of waking up refreshed and well rested, they will thank you for it.

REFERENCES

1. Office of Women’s Health (2020) Insomnia womenshealth.gov, retrieved 28th November 2022 from https://www.womenshealth.gov/a-z-topics/insomnia
2. Office of Women’s Health (2020) Insomnia womenshealth.gov, retrieved 28th November 2022 from https://www.womenshealth.gov/a-z-topics/insomnia
3. Suni, Eric (2022) Insomnia and Women sleepfoundation.org, retrieved 28th November 2022 from https://www.sleepfoundation.org/insomnia/insomnia-women
4. Suni, Eric (2022) Insomnia and Women sleepfoundation.org, retrieved 28th November 2022 from https://www.sleepfoundation.org/insomnia/insomnia-women
5. Office of Women’s Health (2020) Premenstrual Syndrome womenshealth.gov, retrieved 28th November 2022 from https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome
6. Suni, Eric (2022) Insomnia and Women sleepfoundation.org, retrieved 28th November 2022 from https://www.sleepfoundation.org/insomnia/insomnia-women
7. Nolen-Hoeksema S, Larson J, Grayson C. Explaining the gender difference in depressive symptoms. J Pers Soc Psychol. 1999 Nov;77(5):1061-72. doi: 10.1037//0022-3514.77.5.1061. PMID: 10573880.
8. Office of Women’s Health (2020) Urinary Incontinence womenshealth.gov, retrieved 28th November 2022 from https://www.womenshealth.gov/a-z-topics/urinary-incontinence
9. https://www.sleepfoundation.org/nutrition/alcohol-and-sleep
10. Park SY, Oh MK, Lee BS, Kim HG, Lee WJ, Lee JH, Lim JT, Kim JY. The Effects of Alcohol on Quality of Sleep. Korean J Fam Med. 2015 Nov;36(6):294-9. doi: 10.4082/kjfm.2015.36.6.294. Epub 2015 Nov 20. PMID: 26634095; PMCID: PMC4666864.
11. Lindberg E, Janson C, Gislason T, et al. Sleep disturbances in a young adult population: Can gender differences be explained by differences in psychological status? Sleep. 1997;20(6):381-387. https://doi.org/10.1093/sleep/20.6.381
12. Zhang B, Wing YK. Sex differences in insomnia: A meta-analysis. Sleep. 2006;29(1):85-93. https://doi.org/10.1093/sleep/29.1.85.
13. Mong JA, Cusmano DM. Sex differences in sleep: Impact of biological sex and sex steroids. Philos Trans R Soc Lond B Biol Sci. 2016;371(1688):20150110. https://doi.org/10.1098/rstb.2015.0110
14. https://www.sleephealthfoundation.org.au/caffeine-and-sleep.html
15. https://sunlightinstitute.org/circadian-rhythms-and-the-critical-importance-of-sunlight-how-to-get-back-in-sync/
16. https://www.cdc.gov/niosh/emres/longhourstraining/light.html
17. https://www.sciencedaily.com/releases/2020/02/200220141731.htm
18. https://www.health.harvard.edu/staying-healthy/blue-light-has-a-dark-side
19. Jurado-Fasoli L, De-la-O A, Molina-Hidalgo C, Migueles JH, Castillo MJ, Amaro-Gahete FJ. Exercise training improves sleep quality: A randomized controlled trial. Eur J Clin Invest. 2020 Mar;50(3):e13202. doi: 10.1111/eci.13202. Epub 2020 Feb 12. PMID: 31989592.
20. Banno M, Harada Y, Taniguchi M, Tobita R, Tsujimoto H, Tsujimoto Y, Kataoka Y, Noda A. Exercise can improve sleep quality: a systematic review and meta-analysis. PeerJ. 2018 Jul 11;6:e5172. doi: 10.7717/peerj.5172. PMID: 30018855; PMCID: PMC6045928.

• Bio

Clare Hozack

A former athlete and strength and conditioning coach, Clare applies this experience to her work training and educating pre- and post natal women to help them develop ‘next level’ fitness for parenting. A trainer with IntoYou studio on Sydney’s Northern Beaches, she is also the Australian and NZ Master Trainer for Burrell Education, which delivers a range of women’s health and pregnancy-related courses. You can download Burrell Education’s free Pre-Screening tools for pregnant women here and post natal women here. into-you.com.au / burrelleducation.com