Menopause and Insomnia

A survival guide through this difficult period

Dr. David W. Sparks

Women are almost predestined from birth to face difficulty either falling asleep easily or staying asleep as they age and enter that period in their life when they go through menopause. Not only do the hormonal changes experienced during menopause cause grave discomfort to many women, but the overall fatigue associated with menopause and accompanying insomnia can make the quality of their lives far less than optimal. Menopause symptoms may include insomnia, hot flashes, moodiness, aching joints, headaches, and a significant drop in libido. Thus, it is important that a woman going through these “life trials” consult her doctor concerning potential treatments she should take to reduce the symptoms and possible after-effects.

Menopausal symptoms obviously can make life extremely uncomfortable and women often complain most bitterly about the inability to sleep. Tossing and turning when one is exhausted is close to torturous when it is considered that there is immense stress and anxiety that is precipitated by the inability to sleep. A large portion of this stress, ironically and sadly, is produced by hormones that are released into the body as a function of the stress that results from insomnia.

Research indicates, in fact, that one in three menopausal women undergo considerable misery during the change in their lives to the extent that major medical investigations are ongoing in an effort to ameliorate the discomforts associated with insomnia and menopause. The results of these ongoing research efforts in conjunction with providing information to women appear to be helping with this very challenging frontier.

During menopause it is common for women to experience interruptions in sleep cycling because of a variety of factors that include night sweats, due to a drop in estrogen levels in the body. These episodes in which a woman can awake in the middle of the night drenched in sweat are obviously a major disruption to sleep. Further, because of the associated stress with these episodes, it can be difficult getting back to sleep once they have aroused.

Normal sleep has a very specific architecture. Four or five times a night we cycle through an ordered series of sleep stages that begin with light sleep and progress into deeper and deeper sleep. These stages of sleep are known as non-REM (NREM). Deep sleep is characterized by an EEG record showing slow brainwave activity called delta-wave sleep. After making the journey through progressively slower wave sleep, we shift into rapid eye movement sleep a dream sleep characterized by faster brain wave activity and rapid eye movement (REM) sleep. Suffice it to say, that arousals due to menopausal symptoms have a hugely deleterious effect on normal sleep architecture.

What Do I Do?

Many treatments include hormone therapy, homeotherapy, herbal treatments, Chinese medicine, eating soy products and exercising. Perhaps the best way to treat this problem, however, is keeping a healthy lifestyle even before the onset of this period of life. Eating right, maintaining the right weight and exercising can go a long way in helping the body to adjust to this when it comes.

Another important step that women can take during menopause and insomnia is to follow the rules of sleep hygiene. These are listed below:

•         Fix a bedtime and an awakening time. Do not allow bedtime and awakening time to drift. The body "gets used" to falling asleep at a certain time, but only if this is relatively constant. So go to bed and wake up at the same time every night and day.
•         Avoid excessive napping during the day. If you nap throughout the day, it is no wonder that you will not be able to sleep at night. The late afternoon for most people is a "sleepy time." Many people will take a nap at that time. This is generally not a bad thing to do, provided you limit the nap to 30-45 minutes and can sleep well at night.
•         Don’t stay in bed tossing and turning. If you find that you cannot get to sleep within 15-20 minutes, then do not remain in the bed "trying hard" to sleep. Get out of bed. Leave the bedroom. Read, have a light snack, do some quiet activity, or take a bath. You will generally find that you can get back to sleep 20 minutes or so later. Do not perform challenging or engaging activity such as office work, housework, etc. Do not watch television.
•         No Television. Many people fall asleep with the television on in their bedroom. Watching television in bed is a bad idea. Television is a very engaging medium that tends to keep people up. It is recommended that the television not be in the bedroom. At the appropriate bedtime, the TV should be turned off and you should go to bed.
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  Avoid alcohol 4-6 hours before bedtime. Many people believe that alcohol helps them sleep. While alcohol has an immediate sleep-inducing effect, a few hours later as the alcohol levels (blood-sugar) in your blood start to fall, there is a stimulant or wake-up effect.

•         Avoid caffeine 4-6 hours before bedtime. This includes caffeinated beverages such as coffee, tea and many sodas, as well as chocolate.
•         Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime. These can affect your ability to stay asleep.
•         Exercise regularly, but not right before bed. Regular exercise, particularly in the afternoon, can help deepen sleep. Strenuous exercise within the 2 hours before bedtime, however, can decrease your ability to fall asleep.

Your Sleeping Environment

•         Use comfortable bedding. Uncomfortable bedding can prevent good sleep. Evaluate whether or not this is a source of your problem, and make appropriate changes.
•         Find a comfortable temperature setting for sleeping and keep the room well ventilated. If your bedroom is too cold or too hot, it can keep you awake. A cool (not cold) bedroom is often the most conducive to sleep.
•         Block out all distracting noise, and eliminate as much light as possible.
•         Reserve the bed for sleep and sex. Don't use the bed as an office, workroom or recreation room. Let your body "know" that the bed is associated with sleeping.

    Getting Ready For Bed

•         Try a light snack before bed. Warm milk and foods high in the amino acid tryptophan, such as bananas, may help you to sleep.
•         Practice relaxation techniques before bed. Relaxation techniques such as yoga, deep breathing and others may help relieve anxiety and reduce muscle tension.
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  Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a few minutes of reading, can help you sleep.

The rules of sleep hygiene are the first step in finding a cure for insomnia. The next step is to try some behavioral modification techniques that are considered to be a sure fire method for the treatment of insomnia. Behavioral scientists have shown that chronic insomniacs can institute a series of behavioral modification steps into their lives. These steps require very little effort and really only demand incorporating “mini regimens” into their nightly sleep routines. Steps including breathing exercises, progressive muscle relaxation, image replacement, training the conscious mind, mindfulness, meditation and music all have been shown to yield huge benefits to those who suffer chronic sleeplessness. These behavioral modification steps are available through this web site.

Make sure you sign up in the Action Steps section and I will send you a sample of both the first day of Actions Steps for Better Sleep and A Healthier Life and Day 1 of The Better Sleep in 7 Days audiobook. We value your privacy and will not pass along your email address to anyone.

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