Menopause and Sleep Problems

The closer women get to menopause itself, the less they sleep. Here are some solutions to help you sleep like a baby!

When Frisca Yan-Go wakes up beside her husband at 3:00 A.M. in their Los Angeles bedroom, her efficient mind is likely to begin popping with creative approaches that will meet the challenges she left sitting on her desk back at the UCLA Medical Center. But unlike the rest of us, she won’t waste her energy by tossing, turning, and worrying about whether or not she’ll remember all those brilliant thoughts the next morning. Instead, she’ll calmly reach over to her nightstand, pick up a voice recorder, dictate a few words, then slide gently back into sleep.

As a neurologist and psychiatrist, as well as the medical director of the UCLA Sleep Disorders Center, Frisca L. Yan-Go, M.D., has a distinct advantage over the rest of us. For one thing, she knows what’s going on in her mind and why it woke her up. For another, she has a whole bag of little tricks to shut it down and send it back to sleep.

Those tricks are particularly important during perimenopause. Some 59 percent of women between the ages of 35 and 55 won’t get much sleep in the 4- to 8-year period prior to menopause that’s generally referred to as perimenopause. In fact, researchers say that this group of women is more likely to experience insomnia than any other.

Unfortunately, the closer women get to menopause itself, the less they sleep. According to a 2007 National Sleep Foundation poll, by the time women actually stop menstruating, somewhere between the ages of 45 and 51, a full 61 percent will report that they can’t get to sleep or stay asleep several nights each and every week.

What’s Going On

A lot of tossing and turning. Some 59 percent of women between the ages of 35 and 55 won’t get much sleep in the 4- to 8-year period prior to menopause that’s generally referred to as perimenopause. In fact, researchers say that this group of women is more likely to experience insomnia than any other.

Unfortunately, the closer women get to menopause itself, the less they sleep. According to a 2007 National Sleep Foundation poll, by the time women actually stop menstruating, somewhere between the ages of 45 and 51, a full 61 percent will report that they can’t get to sleep or stay asleep several nights each and every week.

Surveys indicate that roughly 57 percent of us can’t sleep because of hot flushes, anxiety, depression, and chronic insomnia, while another 43 percent have a sleep disorder such as obstructed breathing, narcolepsy, or restless legs syndrome. Hot flushes alone cause women approaching menopause to briefly rouse 100 times a night—around three times more than a woman who is not.

Yet as seemingly unrelated as these challenges are, new research shows that they appear to share one thing in common: They are all initiated or otherwise affected by imbalances in various hormones that are regulated by the body’s biological clock in the brain’s hypothalamus—the SNC.

“The SNC is where you have the axis for the sleep/wake cycle and the axis for all the endocrine glands that affect monthly reproductive rhythms,” says Dr. Yan-Go. “They’re all linked together like an orchestra,” so when one cycle is out of whack, it tends to sideswipe the others as well. When perimenopause arrives with its roller-coaster ride of hormonal ups and downs, the entire orchestra gets out of sync, says Dr. Yan-Go, and disrupted sleep is frequently the result.

“The best sleep we ever get is between age nine and menarchy,” she adds ruefully. “After that, it’s all ups and downs.”

The 3:00 A.M. Wake-Up Call

Although more than half of us aren’t sleeping, studies have shown that most perimenopausal women can get to sleep, they just can’t stay that way. Instead, they wake intermittently throughout the night or in the wee hours of the morning.

And sometimes women aren’t even aware of how often they wake, says neurologist Hrayr P. Attarian, M.D., director of the University of Vermont sleep center. “But if you’re falling asleep during the day when you don’t want to, or if you wake up after a good night’s sleep and feel as though you haven’t slept at all, then you should be talking to your physician.”

The type of insomnia that causes you to wake through the night or in the early morning hours can be caused by both external and internal factors, explains Dr. Yan-Go. Externally, you may have to go to the bathroom or you may simply be too hot or too cold. Or you may experience a hot flash or perhaps its chilly aftermath. Throw the covers off, doze, realize you’re freezing, and pull the covers back up. If you’re perimenopausal, you know the routine.

But insomnia caused by internal factors is less straightforward. Generally, says Dr. Yan-Go, when you wake in the middle of the night, it’s because something has bubbled up from your subconscious.

The mind is very active during REM sleep, she explains, but when it actually wakes you up, it’s usually involved in processing one or the other of two kinds of events: the ones that happened most recently and the ones from your past that are the most intense.

“Generally, you wake up and you just don’t know why,” says Dr. Yan-Go. “It may be that 5 o’clock meeting you had with your boss, or like my husband, it may be the memory of something that happened during wartime.”

For recent events Dr. Yan-Go is pragmatic. If she wakes up and recalls an unfinished report left on her desk at work, rather than worrying about it and letting it disrupt her sleep, she’ll pick up the voice recorder on her night table, dictate as much of the report as she can, shut off the recorder, then go back to sleep.

For intense events from the past, things are more complicated. In some cases, if the experience isn’t buried too deep, you can dictate the memory into a voice recorder, erase it, dictate it again, erase it, and do the whole thing all over again. “Verbalizing gets the memory out of storage, where you can deal with it so it won’t come out and bother you during the night,” says Dr. Yan-Go.

If that doesn’t work, then you need to go into talk therapy and face the event before it will stop waking you up. “Denial is good when you’re in Iraq and you have shrapnel in your shoulder,” says the psychiatrist. “When you’re drinking and thinking and not sleeping, it’s bad.

“The bottom line is that we all have challenges in our lives. Some we can control; others we can’t. What we can always change, however, is how we respond.”

Several nights a week more than half of us between the ages of 35 and 55 can’t sleep. Here’s how to turn that around.

1. THINK ABOUT SHORT-TERM HRT. Surprised? Hormone replacement therapy (HRT) has largely fallen out of favor among women and their doctors, and for good reason. Long-term research studies have found it can increase your risk of blood clots, breast cancer, and gallbladder disease.

Still, the fact is that perimenopausal women who use HRT sleep better. Whether it’s because it reduces hot flushes or has some other effect isn’t known.

How do you weigh the risks and benefits? “The risks and benefits of any treatment need to be individualized to your particular body—not just what the research says or professional scientific associations prescribe,” says Becky Wang-Cheng, M.D., a medical director at Kettering Medical Center and author of Menopause.

If breast cancer runs in your family but hot flashes are preventing you from getting enough sleep to do your job, a super-low dose of hormones might be helpful despite the research. And we’re not talking about long-term or daily use. “Sometimes just one pill a week is enough to keep symptoms in check,” says Dr. Wang-Cheng. JoAnn Manson, M.D., the Harvard researcher who pioneered much of the research that uncovered the dangers of HRT and author of Hot Flashes, Hormones and Your Health, agrees that HRT should still be an option for some women.

Most women do not need hormone therapy to get through the hormonal transition into menopause, says Dr. Manson. Menopause is natural, and we need to guard against the over-medicalization of our lives. “However, for about one in every five women, menopausal symptoms are severe enough to disrupt sleep and quality of life,” she adds. “Hormone therapy still has an important role to play for such women.”

2. REINFORCE YOUR SLEEP SCHEDULE. Like other kinds of insomnia, the sleeplessness of perimenopause can be overcome by sticking to the cycles of sleeping and waking that you have previously established with your biological clock. This helps your body override some of the conflicting messages it may be getting from wayward hormones activated by perimenopause.

It’s important that you keep your sleeping and waking schedules pretty steady—no Sunday sleep-ins, for example—if you want to be able to count on good, restorative sleep during this uneasy stage of life. And good, restorative sleep is the best gift you can give yourself at this time.

If you don’t already have a firm sleeping schedule, now is certainly the time to develop one. It isn’t hard to do, and the benefits will serve you for the rest of your life.

3. CONSIDER AN ALTERNATIVE. Women who are reluctant to use estrogen may want to talk with their doctors about the antidepressant Effexor, says Dr. Wang-Cheng. It decreases the hot flushes that can disrupt sleep and is even prescribed by doctors for breast cancer patients who are undergoing active therapy.

“It’s not as good as estrogen,” adds the physician, “but it reduces hot flushes by 40 to 60 percent and will make you drowsy.”

4. WORK WITH A THERAPIST. Eight or 10 weeks with a certified cognitive behavioral therapist will frequently give you a handful of sleep strategies custom-tailored to your particular issues during this life stage. If you’re regularly waking up in the middle of the night and can’t get back to sleep, however, you might find it more helpful to contact a psychiatrist to talk over old struggles that may be troubling you.

5. TAKE A SLEEP BREAK. After those nights when your reproductive hormones and the hormones that control your sleep/wake cycle really can’t work together, try to get back some of the sleep you’ve lost by 4:00 P.M., says Dr. Yan-Go. Not all of it—that’s not practical for most of us. Just take the edge off your drowsiness and you’ll be surprised at how effectively your brain cells will start firing again. If you drive to work, go out to the car at lunch, put down the backseat, and snooze for 10 minutes. Or just put your head down on your desk for 5.“I do that all the time,” adds the psychiatrist. “People with sleep deprivation can go crazy!”

6. WICK AWAY THE PROBLEM. If hot flushes are your particular sleep disrupter, buy long johns, or gym shorts and T-shirts made from fabrics that athletes use to wick away moisture such as PowerDry and CoolMax. Then wear them as pj’s. They won’t stop a hot flush, but they’ll keep it from turning into a majorly disruptive night sweat in which you have to get up and change clothes.

7. CHILL IN BED. Chillow is a pillow with a cooling water insert that lowers your body temperature. It won’t stop hot flushes, but it can reduce their intensity and their ability to disrupt your sleep.

8. DROP YOUR TEMP. Lower the temperature of your bedroom before you climb into bed, says Dr. Wang-Cheng. Lower temperatures signal your body that it’s time to sleep, and they make hot flushes less disruptive. If your bed partner objects, just tell him to bundle up.

A hot bath also helps you lower your body’s temperature. Yeah, your temperature goes up while you’re in the bath, but your body’s response to the heat will be to drop your temperature.

As long as perimenopausal dryness hasn’t resulted in painful intercourse, enjoy a quickie, suggests Dr. Wang-Cheng. Some 44 percent of perimenopausal women say they don’t have time for sex. But the Big O is still one of the most sleep-inducing agents around. Just don’t forget to protect yourself against an unanticipated side effect that could appear nine months later. Now that would really trash your sleep!

9. TONE IT DOWN. Toning down a jumpy sympathetic nervous system will encourage a balanced sleep/wake cycle in perimenopausal women, says Dr. Yan-Go. Think about tai chi, meditation, prayer, biofeedback, yoga—any activity that allows you to cultivate a peaceful center and a sense of balance.

If you enroll in a class for one of these, just keep one thing in mind. “Don’t try to be perfect at it,” says Dr. Yan-Go. “I tried tai chi, but kept wobbling when I had to stand on one foot.” She kept trying to master the movements but ended up tying herself in knots—which is about as far from cultivating a peaceful center as she could get.

“Now I do yoga, where I can sit on my butt and not worry,” chuckles the psychiatrist.

10. TALK TO A SLEEP DOC. If you suspect you have a sleep disorder involving breathing difficulties, restless legs, or narcolepsy, ask your primary-care physician for a referral to a sleep center for testing, diagnosis, and treatment. If your doctor doesn’t know of one in the vicinity, flip to page 214. Chances are, we do.

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