Editorial: Women in Insomnia

Darlynn Marie Rojo-Wissar^1,2*Jessica M. Meers³Patricia L. Haynes⁴

• ¹Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, United States
• ²Bradley/Hasbro Children’s Research Center, E.P. Bradley Hospital, East Providence, United States
• ³Department of Medicine, Baylor College of Medicine, Houston, United States
• ⁴Department of Health Promotion Sciences, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, United States

The first theme that emerged was the interest in examining the biological and social constructs unique to women that impact sleep health. Benge and colleagues summarized the current literature on sleep across the unique timepoints in a woman's biological life, including pregnancy, menopause, and in relation to gynecological conditions. 1 They also explored the role of social factors such as sleep health in women from racially and ethnically minoritized backgrounds and from LGBTQ+ populations. They described how each of these contextual factors increases risk for a range of sleep concerns, with a particular emphasis on the role of stress and affective conditions as precipitators of insomnia.Webster and colleagues examine a similar contextual variable that tends to impact women at greater rates than men, that of being a caregiver, particularly in those of advanced age. 2 Interestingly, their findings provide a degree of optimism, as caregiver status did not increase odds of insomnia symptoms, thereby suggesting there may be some protective value to being a caregiver at home. While caregiving may buffer against insomnia in some contexts, Bennaroch & Shochat found that the combination of shift work, stress, and eveningness poses a substantial risk to insomnia and mental health in female nurses. 3 Several other manuscripts in this research topic extend the theme that the social context is important for sleep. Giorgio Cosenzo and colleagues explores how Latinx men and women experience insomnia through social processes like stress, control, and support, and finds that Latina women specifically attribute their insomnia to their social identity as women, mothers, and caretakers. 4 The mini review by Lara & Nevarez-Brewster and colleagues shows how sleep disturbances can be deeply tied to social environments during childhood as well, summarizing the effects of early life adversity on sleep disturbances, and positing subsequent impairments in brain and language development. 5 Altier and colleagues connects gratitude, a socially embedded emotion, to better sleep via greater health selfefficacy, more adaptive health behaviors, and lower psychological distress in primary care patients. 6 Together, these three manuscripts demonstrate that the social context, through stress, support, identity and resilience, profoundly affects sleep health. Findings suggest that greater consideration of the social context in interventions targeting insomnia, versus a sole focus on individual behaviors, may boost treatment effectiveness.Last, three randomized controlled trials in this collection highlight the diversity of intervention modalities conducted by clinical researchers in the field. In their randomized controlled trial of post-9/11 veterans with PTSD, Bristol and colleagues highlighted the interpersonal benefits of service dog partnerships on sleep quality and sleep disturbances, as compared to a waitlist control group. 7 A key contribution of this work was identifying how the human-dog partnership may alleviate fear of sleep, underscoring the role these animals play in providing comfort with minimal nighttime disruption.Cromer and colleagues demonstrated that individual-level Cognitive Behavioral Therapy (CBT) for nightmares led to significant improvements in children after only five sessions. 8 The successful delivery of this intervention through a healthcare Zoom platform underscores its accessibility, offering an effective approach to overcoming barriers in behavioral sleep treatments access among children and their families.Using a robust sham condition, Huskey and colleagues found minimal direct effects of transcranial magnetic stimulation (rTMS) on insomnia-related cognitive impairment. 9 However, their research suggests a potential neurophysiological mechanism for mitigating the cognitive effects of sleep inertia through earlier timing and enhanced consolidation of slow-wave sleep (SWS) and REM sleep.These trials offer valuable insights into novel interventions that also deepen the understanding of intervention mechanisms at the social, individual, and physiological levels. Collectively, these studies showcase the innovative contributions of women researchers to insomnia research, emphasizing the need to further refine and expand opportunities for women scientists in the field.Author contributions: All authors contributed to writing the original draft, reviewing, and editing.Funding: DMR was supported by NHLBI 1K01HL169495 and NIGMS P20GM139767 (Stroud, Laura).