Sleep inertia occurs when your body is fighting to stay asleep when you want it to wake up.

It generally feels like a temporary disorientation and drop in performance or mood after you wake up.

Here’s how to know if you’re affected by sleep inertia and what you can do about it.

With all those “Wake Up With Me” videos crowding your social media feeds, it’s easy to feel like everyone else just hops out of bed in the morning, bright-eyed, glowy, and ready to attack the day. And that can be an especially bitter pill to swallow when you’re someone who regularly struggles to pry your eyes open after your alarm goes off.

As it turns out, there’s a medical term for this: sleep inertia.

Sleep inertia generally occurs when your body is fighting to stay asleep while you’re trying to wake up. Despite what TikTok suggests, sleep inertia is very common. And, while this can be frustrating to deal with when you have to be somewhere (like, uh, work), doctors do consider sleep inertia a pretty normal phenomenon.

So, what causes sleep inertia and, more importantly, how can you fight it? Women’s Health tapped two sleep medicine specialists for more.

Meet the experts: W. Christopher Winter, MD, is a neurologist and sleep medicine physician with Charlottesville Neurology and Sleep Medicine and host of the Sleep Unplugged podcast; Beth Malow, MD, is the director of the Vanderbilt Sleep Division.

What is sleep inertia?

Sleep inertia is a temporary disorientation and drop in performance or mood after you wake up, according to the Centers for Disease Control and Prevention (CDC). “It’s when you can’t wake up in the morning without a major struggle,” explains Beth Malow, MD, director of the Vanderbilt Sleep Division.

It usually lasts between 30 to 60 minutes, but it can also stretch for as long as two hours after you get up in the morning, per the CDC.

The effect sleep inertia can have on different folks also ranges quite a bit. “For some people, they have little sleep inertia—they awaken and feel very awake [with] no drive to continue sleeping,” says W. Christopher Winter, MD, a neurologist and sleep medicine physician with Charlottesville Neurology and Sleep Medicine and host of the Sleep Unplugged podcast. “For others, the pull to go back to sleep is powerful and overwhelming.”

What are the symptoms and tell-tale signs?

Everyone’s experience with sleep inertia is slightly different, but Dr. Malow says some common symptoms include:

You feel groggy and disoriented when you wake up.

You can’t think clearly.

It takes a long time to respond to any stimulus.

Setting multiple alarms doesn’t help you wake up.

It feels like you can’t make the transition from sleep to a wakeful state.

Most people have some level of sleep inertia right after they wake up, which is why Dr. Winter says he usually disregards symptoms as long as they only last a few minutes. “If you feel good after you are up and showered and dressed, that’s probably normal,” he says. “If this is a feeling you can’t shake, it’s most likely abnormal.”

What causes sleep inertia?

One of the biggest causes is not getting enough sleep, Dr. Winter says. But sleep inertia is also linked to a range of sleep disorders. “Anything that affects the quality of amount of sleep,” can lead to sleep inertia, Dr. Malow says. “Even inconsistent sleep—going to bed and waking up at different times—can cause sleep inertia,” she adds.

How can I get over sleep inertia?

Dr. Winter explains that there are a few things you can do to try to get over your sleep inertia and prevent it from happening in the future:

Aim to get seven or more hours of sleep.

Try to adjust your circadian rhythm and observe the things that could be impacting your sleep schedule, like when you go to bed, when you’re exposed to bright light, and when you exercise. (In general, it’s better to limit exposure to bright light and exercise at night to allow your body to wind down for sleep, Dr. Winter explains.)

Try a light-based alarm.

Use the snooze button. “While the snooze button gets a bad rap, it can be a very useful tool according to research for helping those with significant sleep inertia awaken easier,” Dr. Winter says.

Keeping a consistent sleep and wake time can help, too, according to Dr. Malow. But if you’ve tried this and you’re still struggling, it may be time to rope in a medical professional. “See your healthcare clinician if you have trouble doing this or think you might have a sleep disorder,” Dr. Malow says.

**Rachel Bush’s Personal Revelation on Women’s Health**

In a poignant revelation, Rachel Bush—the wife of NFL star Jordan Poyer—has pierced the silence surrounding a crucial yet frequently ignored aspect of women’s health: the long-term repercussions of birth control. Her heartfelt expression on social media, prompted by a message from nurse S. Clovinson, resonates deeply with countless women who have encountered similar challenges in their reproductive health journeys.

Bush’s candidness sheds light on the numerous potential side effects attributed to prolonged birth control use, such as mood swings, gastrointestinal disturbances, and exceptionally heavy menstrual cycles. These issues not only disrupt everyday life but are often trivialized or overlooked in mainstream health conversations. By sharing her experience, Bush highlights the importance of acknowledging these symptoms and their profound impact on women’s overall quality of life.

**Understanding the Hormonal Impact**

Diving deeper into the topic, Bush explores the physiological ramifications of hormonal birth control, particularly its function in suppressing ovulation and subsequently reducing progesterone levels. This hormone plays a vital role in regulating various bodily functions; its deficiency can manifest in a host of distressing symptoms. By emphasizing these hormonal intricacies, Bush contributes to the broader conversation around the complex interplay between contraceptive methods and women’s well-being, illuminating a topic that is rarely addressed in detail.

Her initiative not only raises awareness but also cultivates a supportive community for women who may feel alienated by their struggles. It serves as a powerful reminder that discussions surrounding reproductive health are essential, significantly influencing emotional and physical well-being.

**Empowering Conversations Around Women’s Health**

Bush’s moving insights act as a catalyst for more candid dialogues about women’s health issues. They underline the critical need for women to advocate for themselves while making informed choices regarding birth control. In a world where these conversations often carry an unspoken stigma, Bush’s openness encourages others to share their narratives and seek the support they deserve.

As women deliberate their reproductive decisions, the long-term effects of these choices become ever more significant. Through her post, Bush not only educates but also empowers women, urging them to engage proactively with their healthcare providers to identify the most suitable options tailored to their unique needs.

**Reflecting on the Broader Implications**

Rachel Bush’s willingness to divulge her personal insights on the effects of birth control underscores the necessity for a comprehensive understanding of women’s health issues. It serves as a poignant reminder that health transcends the mere absence of illness—it should encompass a holistic state of emotional, mental, and physical well-being.

As discussions surrounding women’s health continue to progress, the courage to openly share personal experiences will undoubtedly pave the way for heightened awareness and understanding. Such dialogue is not only vital for individual empowerment but also for advancing a society that sincerely values and prioritizes the health and lived experiences of women.

Social media ‘more likely to suppress women’s health content over men’s’, young people say

A study of 4,000 people found while three quarters of those aged 18-34 are turning to social media to educate themselves about male and female health, many struggle to find what they need.

Social media platforms are more likely to suppress women’s health content. (Image: PinPep )

A survey of 4,000 people has revealed that while three quarters of those aged between 18 and 34 use social media for information on both male and female health, many struggle to find what they’re looking for. Among users aged 18-24, 34 per cent admit they find it challenging to source information on women’s health – a sentiment echoed by 21 per cent of those aged 25-34.

It was found that 77 per cent of those aged 18-34 are aware of ‘shadow banning’ – when a user’s content is restricted, decategorised or hidden on a social media platform, limiting reach or engagement. Platforms such as Instagram and Facebook have been found to incorrectly remove content around women’s menstrual and sexual health, classifying it as adult content despite the use of anatomical terms.

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Three in 10 young adults spend over five hours a day using social media as an essential place to communicate, read and learn more about health topics such as periods, menopause, incontinence and erectile dysfunction. However, 33 per cent of those aged 18-24, and 22 per cent of 25-34 year olds believe content related to women’s health in particular can often be restricted or hidden on social media.

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Essity, a hygiene and health company, has teamed up with CensHERship and the Period Equity Alliance to launch a campaign against shadow banning on social media, aiming to create a fairer environment for women’s health content. Kate Prince, spokesperson for Essity, the firm behind brands like Bodyform and Modibodi, commented: “Social media plays a pivotal role as a resource for young people to educate themselves, research and discuss their health and their bodies.

“But unfortunately for many, unaccountable algorithms that ultimately decide what they do and don’t see, mean that young people are being denied access to information that is crucial to understand their bodies and to empower them to seek the help they may need. Medically and anatomically correct language related to health should not be censored. We want to work with social media companies to put this right, and will be calling on the Government to help us find solutions.”

A study conducted by OnePoll revealed that 52 per cent of all adults believe shadow banning can be justified on social media in certain cases – especially content that could incite violence or abuse (74 per cent), sexually explicit material (67 per cent), and posts containing foul and abusive language (55 per cent). Nevertheless, 45 per cent say there should be no restrictions on posts that use correct medical or anatomical terms to describe the human body.

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Concurrently, 44 per cent support the idea that anyone ought to be able to share information about women’s health, including topics on menstrual well-being and breast cancer awareness. What’s more, 41 per cent concur that key messages regarding men’s health must be accessible online – touching on subjects such as erectile dysfunction or prostate cancer education.

A significant majority of adults, standing at 77 per cent, believe terms such as ‘vagina’ or ‘periods’ should not face restrictions on social platforms when mentioned for educational purposes. Moreover, among platform users, 29 per cent of young adults aged 18-24, compared with 28 per cent of those aged between 25 and 34, expressed they would like to see an increase in content about periods on social media.

77% said words like ‘vagina’ or ‘periods’ should not be restricted on social media. (Image: PinPep )

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Yet, discussing menstrual health publicly is met with obstacles, as the experience of period product brand Bodyform indicates. The spokesperson for Bodyform, Nuria Antoja, commented: “Bodyform has been at the forefront of breaking barriers around menstrual health but it has not been without its challenges.”

She elaborated: “Our advertising on some of the most popular social media platforms has been frequently held back after triggering automated censorship. Often this is simply because we have used words like period or vagina. If we’re serious about breaking taboos and encouraging conversations about women’s health that in some instances can save lives, then we’ve got to have the freedom to have open discussions on social media without censorship.”

Research has shown that social media users aged between 25 and 34 are the most engaged with health and wellbeing content, with a notable 55 per cent searching for information on topics such as mental health, sex, cancer, menopause, and periods. This demographic is also the most active in sharing health and wellbeing advice online, with 30 per cent posting such information.

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Yet alarmingly, 34 per cent of 25-34 year olds, who are conscious of shadow banning and post content either personally or professionally, believe that their posts have been unduly restricted. From those thinking they’ve experienced shadow banning, a significant portion – one fifth – were distributing information related to women’s health, and 27 per cent on general health and wellbeing subjects.

Charlotte Emily, an influencer with a notable following of 91.6k on Instagram, has been vocal about her encounters with censorship on the platform, particularly when discussing topics deemed as ‘taboo’ such as women’s health, menstrual cycles, and body positivity. She commented: “I’ve noticed a significant difference in engagement with my content when I discuss topics often considered ‘taboo’ – specifically women’s health, periods, or body image struggles – despite these being important and everyday conversations that shouldn’t be seen as controversial.

“A few years ago, content visibility was particularly limited if I used words like ‘period’ instead of euphemisms like ‘time of the month’ or ‘Aunt Flo’. While things have definitely improved since I first started speaking openly about women’s health online, I still find that these posts don’t get pushed out as widely as my more light-hearted fashion or lifestyle content.”

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Clio Wood, co-founder of CensHERship, which aims to tackle social media censorship of women’s health and sexual wellbeing content, said: “Social media is such a powerful and engaging way for people to learn about their health – and the knowledge being shared can help break down taboos and in some cases be lifesaving.

“But our own data shows that too often it’s women’s health content that is restricted or removed because it is incorrectly classified as ‘adult content’ simply for referring to a female body part. This is a broken system and women deserve better – they deserve equal, uncensored access to health information about their bodies.”

May is Women’s Health Month, and it’s time to shine a light on a topic that many women face but few discuss openly: hormonal imbalance. From mood swings to fatigue, these symptoms are more common than you might think, yet they often remain misunderstood.

Dr. Amy Shah, a double board-certified MD and Metagenics brand expert, explained the importance of recognizing these symptoms as a first step toward addressing them.

When it comes to supporting hormone health naturally, Dr. Shah suggested practical approaches and lifestyle changes can make a significant difference in how women feel.

Dr. Shah also highlighted the role of supplements, like , in managing hormonal fluctuations.

For those seeking more information and advice, Dr. Shah recommended visiting reputable health websites and consulting with healthcare providers to tailor solutions to individual needs.

ADHD is a neurological disorder characterized by a persistent pattern of inattention — with or without hyperactivity and impulsivity — that interferes with daily functioning. While the prevalence rates are increasingly similar by gender, the diagnosis rate among American men is nearly 69% higher than it is among American women (5.4% of men in the U.S. have an ADHD diagnosis vs. just 3.2% of women.1)

Why? ADHD in women does not comply with stereotypes. Its distinct symptom presentation is skewed toward inattentiveness – a feature that explains, in part, why ADHD in women is still largely misunderstood, overlooked, and inadequately studied.

Despite improved ADHD awareness in general, science still stands to learn and untangle much about ADHD in women — particularly the influence of biology, neurology, and gender constructs on the condition’s appearance, trajectory, and treatment course.

ADHD in Women: Historical Perspectives

Our understanding of ADHD has evolved significantly. Once considered a condition defined by measures of hyperactivity in children, ADHD is now understood to include inattentiveness and to potentially last a lifetime. Still, many outdated ADHD stereotypes persist both in and outside the medical community, hampering the study, detection, and treatment of ADHD in women today. Recent research predicts serious mental and physical health outcomes for women who are inadequately evaluated and treated due to noxious ADHD myths like the following:

ADHD is a male disorder. Hyperactive boys, deemed disruptive and unmanageable, were the ones referred to clinics. Early studies were based on the behaviors of these white hyperactive boys; these findings helped shape the diagnostic criteria and assessment scales still in use today.

Hyperactive boys, deemed disruptive and unmanageable, were the ones referred to clinics. Early studies were based on the behaviors of these white hyperactive boys; these findings helped shape the diagnostic criteria and assessment scales still in use today. ADHD is a childhood disorder. ADHD was long classified as a Disruptive Behavior Disorder of Childhood, based on the hallmark of hyperactivity. Over time, it has become clear that ADHD does not resolve at puberty, and that inattentive symptoms persist longer than hyperactive symptoms.

[Checklist of ADHD Symptoms in Women]

ADHD Symptoms in Women

ADHD in women primarily means a greater likelihood for the following:

inattentive symptom presentation, including, per the DSM-5 failing to give close attention to details or making careless mistakes in activities trouble holding attention on tasks not following through on instructions and failing to finish duties (e.g., losing focus, getting side-tracked) trouble organizing tasks and activities getting easily distracted forgetfulness in daily activities

internalizing symptoms, including mood and anxiety.

ADHD Symptoms in Women: Gender Role Expectations

ADHD in women is complicated by gender role expectations. Society’s long list of expectations for women — managing the self, the family, and the home — requires consistent coordination of executive functions.

Women with ADHD are not well-wired for these demands. But in seeking social acceptance, they are often determined to meet them, typically by masking symptoms and problems. Shame and self-blame fuel the dynamic interplay between societal expectations and ADHD’s executive dysfunction. To understand women with ADHD, clinicians cannot underestimate the extent to which women measure their self-worth and self-esteem according to their success in conforming to gender expectations.

ADHD in Women: Social Deficits

Women with ADHD, compared to men with ADHD, struggle more with socialization.

Women are often overwhelmed with the demands of relationships and tend to have fewer meaningful relationships as a result. They rarely initiate friendships, and have trouble maintaining them. Isolation protects from discomfort and confusion.

and tend to have fewer meaningful relationships as a result. They rarely initiate friendships, and have trouble maintaining them. Isolation protects from discomfort and confusion. They often struggle with rejection sensitivity , an intense emotional response to real or perceived rejection, which can make social interaction a potential source of pain.

, an intense emotional response to real or perceived rejection, which can make social interaction a potential source of pain. They are more likely to engage in risky sexual behaviors compared to women without ADHD. One theory for this is early recognition of sexuality as a shortcut to social acceptance. It’s common to find a history of early initiation of sexual activity, early intercourse, more sexual partners, more casual sex, less protected sex, more sexually transmitted infections, and more unplanned pregnancies in women with ADHD. While common, these experiences are aspects of ADHD that elicit shame.

[Click to Read: How to Make Friends as a Woman with ADHD]

ADHD in Women: Hypersensitivities

Women with ADHD tend to experience more central nervous system hypersensitivities compared to men with ADHD. They often report more of the following:

tactile defensiveness and sensory overload (to being touched, and to common items like clothing material, tags, loud music, light, smells, etc.)

somatic complaints, including headaches, migraines, stomach aches, and nausea

sleep difficulties

ADHD in Women: Comorbidities

By adulthood, most women with ADHD have at least one comorbid disorder that can complicate the ADHD symptom picture, including:

anxiety (25-40% of people with ADHD have an anxiety disorder)

mood disorders

dysregulated eating (bulimia is most common)

externalizing disorders, like oppositional defiant disorder (ODD) or conduct disorder (mostly found in women with impulsive-type ADHD)

personality disorders, like borderline personality disorder (BPD)

ADHD in Women: Impulsivity

Symptoms of impulsivity further influence how ADHD presents in women. Impulsivity is associated with

gender atypical behaviors, including behaviors perceived as controlling, demanding, easily irritated, etc.

high-risk behaviors, like speeding and extreme sports

addictive behaviors, including substance use and gambling

a significantly increased likelihood of acting on negative feelings, including self-harm (picking skin, cutting, etc.)

ADHD Symptoms in Women: Diagnostic Considerations and Challenges

Clinicians use DSM-5 guidelines to diagnose ADHD, as well as rating scales, interviews, and other practices. Research indicates that girls and women, compared to boys and men, are consistently under-identified and underdiagnosed for ADHD using these diagnostic criteria2. Reasons for this disparity include the following.

1. ADHD in Women: Inattentive Symptom Presentation

A subtle symptom presentation with a greater likelihood of inattentiveness marks the ADHD experience for many women and girls, who are not outwardly disruptive to others. Many clinicians, however, are most familiar with the hyperactive, disruptive presentations of ADHD that are more common in men and boys. Studies indicate that hyperactivity and impulsivity, along with other externalizing symptoms (like conduct problems) are strong predictors of diagnosis compared to other ADHD presentations. 3

with a greater likelihood of inattentiveness marks the ADHD experience for many women and girls, who are not outwardly disruptive to others. Many clinicians, however, are most familiar with the hyperactive, disruptive presentations of ADHD that are more common in men and boys. Studies indicate that hyperactivity and impulsivity, along with other externalizing symptoms (like conduct problems) are strong predictors of diagnosis compared to other ADHD presentations. Camouflaging symptoms: Research shows that women are highly motivated to hide their ADHD symptoms and compensate for them. The symptoms that are observable are often anxiety or mood-related, which can lead to misdiagnosis.

2. ADHD in Women: Gender Bias

Gender bias is rarely intentional, but it is insidious and pervasive. It influences how clinicians see and label women.

Referrals: Inattentive, non-disruptive symptoms rarely arouse concern, which is why few girls and teens with these symptoms are referred for diagnosis or consultation.

Inattentive, non-disruptive symptoms rarely arouse concern, which is why few girls and teens with these symptoms are referred for diagnosis or consultation. Rating scales for ADHD are still skewed toward male behavior symptoms. Internalized symptoms and impairments are often unaddressed, and many instruments are not normed for women’s values.

3. ADHD in Women: Hormonal Impact

Ovarian hormones interact with almost every system in the body, and are essential components in physical, social, and emotional health for all women. The brain is a target organ for estrogen, as it protects the brain by enhancing neurotransmitter activity, which then impacts executive functioning, attention, motivation, verbal memory, sleep, and concentration.

Estrogen levels, which fluctuate throughout the month as well as across the lifespan, impact the expression of ADHD symptoms in women. ADHD is largely thought of as a condition with stable symptoms across time, but this is not the case for women and their bodies. The truth is:

ADHD symptoms vary with hormone fluctuations. ADHD symptoms increase as estrogen decreases. Estrogen decreases after ovulation, in the middle of the cycle, and even further near the start of menstruation. This combination of low estrogen and high progesterone exacerbates symptoms tremendously. It also means symptoms can vary day-to-day. Some women may be even more sensitive to these micro-fluctuations.

ADHD symptoms increase as estrogen decreases. Estrogen decreases after ovulation, in the middle of the cycle, and even further near the start of menstruation. This combination of low estrogen and high progesterone exacerbates symptoms tremendously. It also means symptoms can vary day-to-day. Some women may be even more sensitive to these micro-fluctuations. Estrogen kicks in during puberty, around the time when ADHD symptoms become more prominent in girls. These hormonal changes are often expressed as anxiety and emotional volatility, however, may also be high in this time, which could lead to being misdiagnosed with anxiety or a mood disorder, and treated improperly or insufficiently.

ADHD in Women: Treatment Considerations

ADHD can be treated with therapy, medication, lifestyle changes, and accommodations. Women with ADHD should consider the following treatment options:

A clinician and/or therapist experienced with ADHD in women and girls. Finding this professional is perhaps the most important and most difficult thing to do. Be sure to ask about their experience treating ADHD in women.

Finding this professional is perhaps the most important and most difficult thing to do. Be sure to ask about their experience treating ADHD in women. Family psychoeducation: It’s important for your support network to understand ADHD as well.

It’s important for your support network to understand ADHD as well. Reframing: Therapists can help you validate your experience, question the impact of societal expectations on your outlook and teach you to practice self-advocacy.

Therapists can help you validate your experience, question the impact of societal expectations on your outlook and teach you to practice self-advocacy. Medication: It’s important to find a doctor who understands the impact of hormones on ADHD, and the interplay with medication. Stimulants, for example, may be less effective in the second half of the menstrual cycle. Hormone replacement therapy greatly improves ADHD symptoms in postmenopausal women, as it increases available estrogen and progesterone. SSRIs are commonly prescribed for anxiety and mood disorders, so it’s crucial for clinicians to understand how stimulants interact with SSRIs and impact symptoms all around.

It’s important to find a doctor who understands the impact of hormones on ADHD, and the interplay with medication. Stimulants, for example, may be less effective in the second half of the menstrual cycle. Hormone replacement therapy greatly improves ADHD symptoms in postmenopausal women, as it increases available estrogen and progesterone. SSRIs are commonly prescribed for anxiety and mood disorders, so it’s crucial for clinicians to understand how stimulants interact with SSRIs and impact symptoms all around. Environment restructuring: Therapists and other professionals can help you learn to restructure your surroundings to better suit your needs.and thoughts to suit your life.

Therapists and other professionals can help you learn to restructure your surroundings to better suit your needs.and thoughts to suit your life. Coaching and support groups: ADHD coaches can help you meet goals, and support groups do wonders in normalizing the ADHD experience and reducing isolation, anxiety, and distress.

The content for this article was derived from the ADDitude Expert Webinar “Why ADHD is Different for Women: Gender Specific Symptoms & Treatments” (ADDitude ADHD Experts Podcast episode #337) by Ellen Littman, Ph.D., which was broadcast live on December 15, 2020.

ADHD Symptoms in Women: Next Steps

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