Cannot Sleep with Menopause

Last October an issue in Sleep reported that the increase in the hormone FSH (follicle stimulating hormone) is associated with the poor sleep quality. FSH regulates the development, growth, pubertal maturation, and reproductive processes of the body. FSH is produced by the pituitary gland. These findings from a study of 365 participants indicated that postmenopausal women slept deeper and longer than premenopausal women. The faster a woman transitioned from premenopausal to postmenopausal they slept longer earlier, but during the “change” reported the inability to sleep easy. If you cannot sleep with menopause it may not be due to the level of FSH, but how quickly your menopause transition occurs.

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Women who are near the end of their menopause cycle, indicated by the decreasing percentage of estradiol to testosterone, sleep better without interruption than those in their early stages. Estradiol is the sex hormone that effects reproduction and sexual function. Unlike FSH, estradiol does not affect sleep by its level or rate of change. Estradoil levels do not decline gradually but drop within a year or two of the final menstruation period. Menopause can last between four to ten years with many symptoms that can trigger or worsen sleep problems. The higher a women’s testosterone level or those close to completion of the transition period will sleep better and fall back asleep faster if awoken during the night.

The study concluded to state that 59% of women between the ages of 35 and 55 won’t get much sleep in the four to eight year period prior to menopause (perimenopause) as this group will experience insomnia more than any other. When their menstruating cycle actually stops, usually between the ages of 45 and 51, 61% reported they had trouble falling and staying asleep several nights every week. Symptoms of menopause are; hot flashes, anxiety, depression that disrupt sleep. Hot flashes/night sweats alone cause women who are perimenopausal to wake 100 times a night which is three times more likely than women you do not have these symptoms. Other sleep-related problems caused by menopause are obstructive breathing, narcolepsy and/or restless legs syndrome (RLS).

New research shows that these symptoms are a result of imbalances in various hormones that regulate the body’s biological clock in the brain’s hypothalamus, the SNC. The SNC is the alliance between the sleep/wake cycle and the endocrine glands affect on the monthly reproductive cycle. We know the insomnia symptoms; waking up during the night or waking up too early can be associated with external and internal factors.  External factors can simply be that you just have to go to the bathroom or you are too hot or too cold. During a hot flash you may throw off the blanket, sleep, wake because you are cold and pull the covers back up…if you are perimenopausal, you know what I am talking about.

Internal factors are less direct, as it may be due to something conjured up in the subconscious. Your mind is very active during REM sleep, but when it wakes you up it involves processing two kinds of events; the ones that happen recently and the ones from your past that are the most powerful. Example: a report that is due for your boss tomorrow or something that happened during the war. These internal factors can be controlled or not, but when you are thinking about what is bothering this will cause stress and anxiety which will keep you from getting a good night’s sleep.  Sometimes it is best to get up and write down what is bothering you.  Getting the issues out of your head and onto paper may help you to fall asleep easier.

External or internal factors that trigger sleep problems due to menopause have been treated with hormone replacement therapy for years. The fact is that perimenopausal women sleep well who use HRT because it reduces hot flashes even though long term studies indicate HRT can increase chances of blood clots, breast cancer and gallbladder disease. If cancer runs in your family but you suffer from hot flashes/night sweats nightly, a super-low dose might be helpful if taken only in the short-term and only once a week just enough to keep symptoms in check. Most women do not need HRT to get through the hormonal transition of menopause. But for the 1 in 5 that can’t sleep HRT still plays an important role for these women. Another medication that decreases hot flashes and is prescribed by doctors for their breast cancer patients is the antidepressant Effexor. Effexor is twofold as it may not be as good as HRT but can reduce hot flashes up to 60% and will make you drowsy.

Lifestyle changes that can help you sleep include reinforcing your sleep schedule. Going to bed and waking up at the same time everyday can make it easier for your body to override some of the conflicting messages it may be receiving from unruly hormones set off by perimenopause. If you want to be able to count on a good night’s sleep in this uneasy stage of life establishing good sleeping habits can serve you for the rest of your life. If you don’t get enough sleep at night taking a short 20 minute nap during the early afternoon can take the edge off your daytime drowsiness. Unruly hormones will bring about an out of balance sleep/wake cycle and some physicians recommend tai chi, meditation, prayer, biofeedback, yoga or any activity that allows you to cultivate a peaceful center and a sense of control in your life.

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There are a few products out there that can curtail or reduce hot flashes. Clothes made by fabrics that wick away moisture won’t stop hot flashes but can keep you from waking up during the night and changing clothes from night sweats. The Chillow Pillow has a cooling water insert that lowers the body temperature that can reduce the intensity of hot flashes. Lowering your body temperature is an internal signal that it is time to go to sleep. Reducing the bedrooms temperature to 65 degrees or taking a hot bath right before retiring will help. In a hot bath your body’s temperature will rise, but your body will respond to the heat and drop your internal temperature.

Your doctor may also recommend a sleep specialist especially if you have a sleep disorder involving obstructive sleep apnea, restless legs syndrome (RLS) or narcolepsy. A sleep clinic can perform many tests to determine your diagnosis and propose which treatment method is best for you. See: Overnight Sleep Study at a Sleep Clinic Center for more information. The content provided in Cannot Sleep with Menopause is for information purposes only, intended to raise the awareness of different solutions for you or your families sleep problems and should not be considered medical advice. For medical diagnosis and treatment, please see your qualified health-care professional.