You know the feeling … you’ve been awake for, oh, five minutes, maybe 15, or wait, it could been an hour now. What time is it? Oh, no! It’s 3 a.m.!
It’s not much fun when sleeplessness becomes a regularity, but sleep disturbances and insomnia are common among perimenopausal and postmenopausal women. While it’s not true that menopause itself makes a woman irritable, inadequate sleep definitely causes crabbiness, and worrying about not getting enough sleep soon becomes part of the vicious cycle of insomnia, defined as the failure to fall asleep or stay asleep.
Night SweatsHot flashes can occur at night or during the day. At night, if sweating accompanies the flashes, they are known as night sweats. As with hot flashes, the cause is uncertain, but it’s thought to be the result of changes in the hypothalamus—the part of the brain that regulates body temperature. The hypothalamus mistakenly senses that the woman is too warm and begins a chain of physiological events to cool her down. Blood vessels close to the skin dilate to increase blood flow to the surface and give off heat. This produces a red flushed face and neck, as well as an increased pulse rate and a sensation of rapid heart beating. A chill often follows.
The first time this happens can be very upsetting—no matter how prepared you might be. Jan Makovick, a hairdresser from Baltimore, Md., couldn’t believe the intensity of her night sweats. “The first time it happened I was shaken by the experience. The sheets were drenched, and I had to strip the bedclothes and replace them, and then an hour or so later it happened again. I sat on the floor and cried. My husband couldn’t believe it. He just said, ‘OK, well, here we are with this. Let’s work it out.’”
The next day, Makovick made an appointment to see her doctor, who understood just how disturbing and inconvenient it was but explained that it was really quite normal. The doctor suggested she consider hormone therapy. Makovick gave it a try, and very quickly the night sweats reduced, dwindling to no flashes over time. She hasn’t looked back.
Night Sweat TreatmentThe treatment options for night sweats are the same as for hot flashes. Prescription estrogen therapy remains the most effective treatment, particularly for moderate to severe symptoms, and it is the only FDA-approved treatment available. A systemic level of estrogen, delivered by a tablet through the skin or by one type of vaginal ring, is required. Most local vaginal estrogen therapy is not enough for relief of hot flashes or night sweats. Lower doses than were used in the past have been show to be effective in helping with hot flashes, and experts and the FDA recommend using the lowest possible dose for the shortest possible time.
Is It Anxiety?Although night sweats account for a dramatic form of sleep disruption, it’s not uncommon to experience insomnia caused by anxiety. If a perimenopausal woman is not experiencing hot flashes or night sweats, then hormone therapy may not be of any use, and lifestyle changes should be tried instead.
Ally Parker, 52, a fashion buyer from Michigan City, Ind., remembers her sleeplessness taking its toll on her family. “I was uncharacteristically irritable, particularly in the mornings and evenings, and so short-tempered and stressed.”
Although Parker had not discussed the possibility of her being perimenopausal with her family, the tag was soon attached. “I became aware of my lack of patience when I was 48, and my daughters identified me as ‘menopausal.’”
Parker thought it was normal to be miserable around menopause. “After all, we all know your hormones dictate your mood, right?”
The red light came on when her eldest daughter threatened to move out. Parker sought help from her doctor, who asked a whole range of questions, many about her sleep patterns. Through the completion of a sleep diary, Parker realized that she was only getting six hours of sleep or less per night and even that wasn’t very restful. Her physician recommended a sleep specialist who found that the probable cause of her sleeplessness was anxiety. “It was anxiety about getting older, but mainly anxiety about my two teenage daughters growing up and leaving home,” she admitted.
Midlife can bring with it associated anxieties such as older children leaving the nest (or, as is more and more the case for older mothers, bringing up young children), floundering relationships, divorce or widowhood, career issues and anxiety about aging in a society that values youth.
Or Is It Depression? Lying awake or waking very early in the morning and not being able to go back to sleep may be a sign of depression. Depressed women feel blue or discouraged most of the time. Sometimes they sleep all the time or lose or gain weight. A lack of motivation and sadness, coupled with fatigue caused by prolonged sleep deprivation, is not pleasant and sometimes can be paralyzing: It can disrupt relationships and interferewith work or home life.
Treatment for Anxiety
and DepressionWhile stressful times happen, and we may cope with them adequately most of the time, there may be times when professional assistance is needed. Talk therapy (psychotherapy) with a trained psychotherapist can often be helpful. Cognitive behavioral therapy (CBT) is a way of changing your thought patterns and behavior in small ways, which can then help you see and deal with problems differently.
Drugs such as oral contraceptives may help with mild perimenopausal mood swings, particularly if you’ve suffered from difficulty with hormone fluctuations (such as PMS or postpartum depression) in the past. However, no hormone drug is FDA approved for the relief of anxiety or depression.
For mild to moderate depression, herbal remedies such as St. John’s wort may be helpful. If other options don’t provide the needed relief, prescription antidepressants may be the best choice. Prescription antianxiety drugs are also available. Studies show drug therapies work best when accompanied by
talk therapy.
Everyday StressorsAnd if you’re not suffering from anxiety or depression? Well, the regular everyday stresses of life can take their toll without your even realizing it. Make sure you’re allowing yourself to get into the “zone” before going to bed. Breathing exercises or practices such as Hatha yoga, which focus on concentrating on and slowing the breath, are great for relaxing the mind in preparation for sleep. Simply setting aside 15 minutes to read a book or magazine before you turn the lights out also can help you empty your head of the day’s worries.
Certainly you should make sure you’re tired both physically and mentally before you hit the sack. Ensure you’ve had some exercise during the day, but don’t exercise within two hours before bedtime, as it can overstimulate your body and brain.
Hunger can also keep you awake or cause you to wake in the early hours when your blood sugar levels drop, so eating a snack before getting some shut-eye can aid a restful night’s sleep. And before you get any ideas, we’re not talking milk and cookies!
Getting a Restful NightTreatment of sleep disturbances should first focus on improving sleep routines and maintaining an environment conducive to sleep. Try the following:
Maintain a regular schedule of going to bed at the same time each night and getting up at the same time each morning, even on the weekend.
The bedroom environment should
be quiet, cool and dark. Research has found that without full darkness, the
body cannot produce the hormone melatonin effectively. Melatonin is vital
in inducing sleepiness within the body, and during menopause it is in short supply as the decline in estrogen reduces melatonin levels. Make sure that your blinds or curtains keep light out sufficiently until morning, when light levels should gradually increase, helping you to wake naturally.
Your bedroom should be cool—this is especially important for women with night sweats.
Make sure you only use your bedroom for sleeping and sexual activity, otherwise it could become associated with things like work or study.
If you don’t fall to sleep within about 15 minutes, get up, leave the bedroom and do something relaxing, such as reading, until you become drowsy. If this doesn’t help, you may have to try it again.
The following can all trigger poorsleep, so try to avoid:
- Heavy meals in the evening
- Exercising close to bedtime
- Alcohol
- Nicotine
- Caffeine after noon
Prescription therapies are also available, but these should be used only for a short time. If you and your primary care clinician cannot solve the problem of sleep disturbances, think about consulting a sleep specialist. Adequate sleep is an important component of good heath and a healthy life.
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