The Menopause Expert - Rebecca Hulem

Overcoming Menopausal Insomnia: Tips for Sleeping Better

By Rebecca Hulem

Difficulty falling asleep and staying asleep are two of the most important concerns I hear from women in mid-life. Not only do I hear it, I truly empathize with these concerns, because I have experienced them myself.

You may first notice difficulty falling asleep while transitioning through peri-menopause. Difficulty staying asleep is one of the hallmark complaints during and after menopause.

No one needs to tell you why a good night’s sleep is so important to your health and well-being. You know, that without a restful sleep, your energy level and your moods will suffer. You will be cranky, easily distracted and it may take every ounce of your patience not to snap someone’s head off. You don’t want to behave this way. This is not you. But after days, weeks and even months of poor quality sleep, your relationships and your health may start to suffer.

Why Can’t I Get a Good Night’s Sleep?

Three major factors contribute to mid-life sleep problems: age, changes in hormone levels and stress.

Age: We have no control over our age, and unfortunately as you approach your mid-to-late 40’s or 50’s, you may start to experience difficulty sleeping.

Change in Hormone Levels: Fluctuating hormone levels, particularly estrogen and progesterone during the mid-life transition, can disturb sleep patterns. In addition, a third hormone that is important for a restful sleep can start to decline with age. This hormone is produced by the pineal gland and is called Melatonin, also known as “the hormone of darkness”.

All three hormones are crucial for providing a good night’s sleep, but they have very different functions in a woman’s body.

For example, the hormone progesterone works by calming moods and also makes us sleepy. Estrogen balances body temperature, and when estrogen levels drop during mid-life, we start to develop hot flashes and night sweats which cause us to wake up frequently at night. Estrogen levels are at their lowest at two o’clock in the morning, hence the 2am wake up call. Melatonin produced by the pineal gland causes us to feel drowsy when darkness occurs.

Stress:  Stress also contributes to sleep problems. Prolonged stress can eventually take its toll on your adrenal glands, reducing their ability to compensate for stress. If your adrenal glands are in good working order, however, they will take over for your ovaries after menopause and continue to produce a lower amount of natural estrogen for the body to use. Stress reducing activities such as yoga, meditation, tai chi, or short walks can give your adrenal glands the boost they need to remain in good working order before, during and after menopause.

Sleepless in Seattle – Does it Ever End?

How long will these sleepless nights go on? Women all over the country are anxious for the answer to this question. Some women will have difficulty sleeping during the menopause transition but when their hormones level off they return to their normal sleep patterns. For others insomnia can last much longer. Every woman is an individual. Let’s consider some practical steps you can take to bring back long forgotten “sweet dreams.”

  • Go to bed and get up at the same time every day…even on weekends!
  • Establish a relaxing ritual to wind down before bed, such as taking a hot bath, or practicing relaxation techniques like meditation or yoga
  • Limit caffeine intake, especially after 2p.m.
  • Exercise regularly, on days that you feel like it and days that you don’t, but not within three hours of bedtime
  • Stop smoking, or at minimum, limit nicotine within two hours of bedtime
  • Don’t use alcohol as a sleep aid, and limit alcohol within two hours of bedtime
  • The time you spend in bed should be limited to sleeping and sex. Yes! There is sex after menopause
  • Forego naps if you have trouble sleeping at night
  • Keep the bedroom cool, dark and as quiet as possible

Hormones (estrogen and progesterone) are a viable option for some women. Estrogen helps to relieve hot flashes and night sweats. Night sweats can occur frequently during the menopause transition, which causes night time arousals that make getting back to sleep difficult. Progesterone provides a calming effect and promotes drowsiness. Low progesterone levels can be responsible for sleep problems for some women. Discuss your individual needs, benefits and risks with your doctor to see if taking hormones will help relieve your insomnia and are right for you.

Sleep Medications by prescription, such as Ambien and Lunesta, have been prescribed by the billions. These medications are called “hypnotics” and are intended for short term use. They are powerful (hence their popularity) and can cause a high level of dependency. They are difficult to get off of due to their level of dependency and therefore should be used as a “last resort”. The FDA has recently informed doctors prescribing these medications, particularly Ambien, to lower the dose for women to 5 milligrams because of side effects, stating that the medication “lingers in the body” and may cause car accidents due to morning drowsiness.

Over the counter sleep aides such as Tylenol PM have Benadryl, an antihistamine, as their main ingredient. Benadryl causes drowsiness for most people and can help with getting to sleep but doesn’t necessarily help with frequent arousals caused by night sweats. There are no dependency concerns regarding the use of Benadryl containing products.

Valerian: an herb which has been used for centuries is a popular alternative to prescription medications for sleep problems because it is considered to be both safe and gentle. Some studies show that it helps people fall asleep faster and feel that they have better quality sleep.

Other studies show that valerian reduced the time it takes to fall asleep and improves the quality of sleep itself. Unlike many prescription sleeping pills, valerian may have fewer side effects such as morning drowsiness.

Valerian is often combined with other sedating herbs, such as hops (Humulus lupulus) and lemon balm (Melissa officianalis), to treat insomnia.

Melatonin, a hormone produced by the pineal gland is another over the counter option that is considered safe to be used for insomnia. It’s been noted that our production of Melatonin drops by 80% by the time we are 60 years old. No wonder we have trouble sleeping during and after menopause. The dose recommendation can vary from 0.5 to 5 milligrams. It’s always best to start with the lowest dose and increase slowly for best results.

In closing, always incorporate healthy life style choices into your daily routine first, to see if your normal sleep patterns return, before trying over the counter sleep aids. If you find that good quality sleep still eludes you be sure and discuss your individual sleep issues with your doctor. Sleeping soundly at night and feeling rested in the morning is a vital component to health, quality of life and longevity. Sweet Dreams!

 
 
 
 
 
    
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