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.
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.
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
- Keep the bedroom cool, dark and as quiet as
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
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
Valerian is often combined with other sedating herbs, such
as hops (Humulus lupulus) and lemon balm (Melissa officianalis), to treat
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!