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How can I manage insomnia that occurs during menopause?

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

If you are having trouble sleeping, your menopausal symptoms might be to blame but that’s not always the case. You could have a sleep disorder such as insomnia, sleep apnea or restless leg syndrome, conditions which sometimes surface during middle age. Or perhaps you are having trouble because some psychological factor is keeping you up at night. Sometimes it is caused by medications you are taking, both prescription and over-the-counter.

Sleep can also be sabotaged by menopausal symptoms such as hot flashes, drenching night sweats, stress from the day, depression and anxiety. If you are having trouble falling or staying asleep, or you get up a lot during the night, it's a good idea to talk to your doctor. Sleep problems are important to get under control so you don't enter a vicious cycle that will be hard to break and make menopause even worse.

You can avoid difficulty in sleeping by following this:

  • Create a healthy routine that includes melatonin-rich and sleep-promoting foods.
  • Try taking a melatonin supplement. Melatonin works like pulling the blinds in your bedroom—it signals to your body that the sun has gone away and it’s time to prepare for sleep. Note, however, that melatonin supplements are not regulated or approved by the FDA.
  • Treat yourself to a pair (or 2) of lightweight pajamas and sheets that will wick moisture away from your skin and dry quickly.
  • Eat a plant-based, high-fiber, low-fat diet, which has been shown to lower estrogen levels and control hot flashes. The sooner you start eating that way (even in your 20s), the better control you will have over hot flashes later. But it's never too late to start.
  • Try black cohosh (an herbal supplement). It has been shown to help women weather menopause better.
  • Eat well and exercise to prevent or eliminate postmenopausal weight gain.
  • Try special pillows designed to help keep your airway open during sleep and eliminate snoring.
Dr. Tara I. Allmen, MD
Gynecologist

You can manage insomnia during menopause by having a relaxing, consistent bedtime routine, eating well and exercising regularly. In this video, OBGYN specialist Tara Allmen, MD, shares some tips for getting better sleep during menopause.

Hot flashes occur throughout the night disrupting deep sleep. You may not actually wake up, but your sleep is disturbed. With severe symptoms, you may wake up sweating, followed by a clammy feeling.

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Staness Jonekos
Health Education Specialist

Making some lifestyle changes can improve your ability to go to sleep and stay asleep. Among them are:

  • Create a sleep schedule, and follow it each night.
  • Do not go to bed until you are tired.
  • Avoid caffeine, nicotine and alcohol right before bed.
  • Enjoy decaffeinated tea.
  • Do not watch the news right before going to bed.
  • Do not watch television in bed.
  • Take a soothing bath or shower before bedtime.
  • Your bedroom should be a sleeping sanctuary and a place for lovemaking.
  • Avoid daytime naps.
  • Clear your mind before you get under the covers.
  • Make sure your room is dark.
  • Keep your bedroom cool to prevent night sweats; keep a fan nearby.
  • Wear cotton pajamas, and have an extra pair handy.
  • Exercise daily. Vigorous exercise should be done during the morning or afternoon.
  • Yoga may help promote good sleep.
  • Try aromatherapy for relaxation.
  • Own a comfortable bed.
  • Wear socks to bed to help control core body temperature.
Dr. Kelly Traver
Internist

To combat insomnia and mood swings, get regular exercise, practice good stress management, get proper nutrition, and drink plenty of water. Prioritize which things really need to get done now and which are not essential. Have a bedtime ritual, and keep to a predictable schedule. Devote some time to relaxation and self-nurturing every day. For memory and brainpower, try to back down on multitasking, focus on one thing at a time, write things down, and exercise your brain daily with new, stimulating mental activities and challenges.

Patricia Geraghty, NP
Women's Health

Sleep disturbances are almost as common a symptom during this time of life as hot flashes. Trouble falling asleep and difficulty staying asleep may be associated with the hormone changes of menopause, but it also seems to be a natural change with age as we see this in both men and women. We only have to compare infants to teens to the elderly to see big differences in sleep with age! As we age, the time spent in each the stages of sleep change and when we are Stage 1, the lightest sleep, we awaken even more easily. It is important to have a comfortable room temperature and decrease bright lights so that we are not fully awakened from Stage 1. You may need to turn your digital clock away and change the type of night clothes you wear. Since these changes are normal and long term, it is not recommended that you use sleeping pills as dependency to the pills can develop very quickly. A group of interventions, called Cognitive Behavioral Therapy, is the most effective approach if your sleep disturbance is leaving you feeling fatigued the following day.

Sleep is often a casualty of menopause, whether it is interrupted by hot flashes (called night sweats when they occur at night) or difficulty falling or staying asleep. Hormonal ups and downs are partly responsible. Plus, as you age, your sleep patterns may change. Older people may sleep less, awaken earlier and go to sleep sooner or later than they did at younger ages.

Mood disorders that come along with hormonal shifts can keep your mind racing at inopportune times. And just the anxiety of knowing that you haven't slept well since who-knows-when can set you into a cascade of more anxiety and worry that you won't sleep again tonight. Also, it's inevitable that you will have other things crowding your mind with worry, among them aging parents, chronic pain, your career, your children or your relationship.

Don't discount those late-night trips to the bathroom, either. As the bladder muscle ages along with the rest of you, its capacity to store urine diminishes.

Lifestyle changes for coping with insomnia include:

  • Sleep in a cool room to help relieve hot flashes that may be disturbing your sleep. In hot weather, you may want to lower your bedroom thermostat at night and use a small fan to keep air circulating.
  • Exercise regularly.
  • Set and keep a regular routine and hour for going to sleep.
  • Drink a glass of warm milk right before bedtime but avoid other foods.
  • Avoid alcoholic beverages or smoking before sleep.
  • Avoid watching TV in bed (some programs are anything but relaxing!).
  • Practice relaxation techniques like deep breathing.
  • Review any medications you are taking to see if they may cause sleeplessness.

Menopause can cause sleep disruptions. Many women have insomnia (difficulty falling asleep) or find they wake up early. Night sweats, which are hot flashes at night, might wake you up or make it difficult to sleep.

Experts say that trouble sleeping is part of the aging process, and may (or may not) be related to hormonal changes. Some women in menopause become depressed, which can make sleeping difficult. Sleep disorders such as apnea (when you temporarily stop breathing) and restless leg syndrome are common in this age group.

There are some home remedies you can try to help yourself fall (and stay) asleep at night. Exercising, eating a healthy diet, and avoiding alcohol and caffeine (especially in the hours before bedtime), might help.

Try using cotton sheets and wearing cotton pajamas instead of silk or a synthetic material. Take a cool shower before you head off to bed. Also try staying on a regular sleep schedule, going to bed at the same time each night and waking at the same time in the morning.

Eat your meals on a regular schedule as well, avoiding late-night snacking or late-night dinners.

Hormone replacement therapy (HRT) may also help with sleep problems, but you should talk with your doctor about whether you’re a candidate for HRT and about the risks and benefits of these drugs.

Dr. Masoud Sadighpour
Internist

This is a complex issue.

  • Hormonal changes which causes some level of mood disorder.
  • Menopause for some might bring the idea of losing womanhood which might be a source of anxiety or depression.
  • As recent research showed, human being sleeping pattern was different in old ages. It consisted of 2 blocks of 3-4 hours of sleep. New social structure which made us to go to work early morning and electricity pushed these 2 blocks of sleep in one block of 7-8 hours of sleep. Now think about Menopause for mothers with grown up children means some "retirement from family obligations". Then there is no obligation to wake up at 6-7 am and help the kids to get ready. Does it mean that now our gene kicks in again and women wake up earlier in the morning?
  • The more we grow older, there is more chance we snore and develop "sleep apnea" which also can make our sleep fragmented.

Hope I gathered enough information here. For further reading please feel free to cruise: http://lasleepdr.com/10/common-sleep-disorders/insomnia.

If you have insomnia, the alternatives to estrogen are soy, the herbal extracts red clover and black cohosh, or small doses of drugs called "selective serotonin-reuptake inhibitors" ("SSRI's"), such as Celexa (citalopram), Paxil (paroxitine), Prozac (fluoxetine) and Zoloft (sertraline).

Soy, red clover, and black cohosh all contain estrogen-like substances that affect some estrogen receptors. However, test-tube experiments report a wide variation from batch to batch in the ways and extent these substances affect estrogen receptors. The variation is to be expected, as, for example, the average soy preparation tested in one study consisted of one hundred twenty-four different isoflavones, substances in soy that affect estrogen receptors. (I am careful to state "affect" as some isoflavones "turn on" specific receptors and some block the very same receptor from being "turned on"). The randomized controlled studies that have tested soy in women with menopausal symptoms have shown no consistent effect of soy on night sweats and insomnia. Similarly, when the placebo effect was taken into account, the studies on red clover and its isoflavones also show no effect on hot flashes or night sweats. It is interesting to note that the placebo produced a benefit of approximately 35 percent in the studies with both soy and red clover. Similarly, black cohosh produces approximately the same data. Thus, any one of these supplements may work (each works in about 35 percent of all tested women), but I can't say definitively what will work for you.

For the patient who doesn't get relief from any of these supplements and is really suffering from hot flashes and night sweats, I recommend trying the selective serotonin-reuptake inhibitors or returning to estrogen replacement therapy. (She should work with her physician to make a rational choice for her.)

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Here’s some potentially good news for the millions of women who are coping with insomnia as a consequence of menopause: a recent study indicates that the herbal supplement valerian is an effective treatment for women with postmenopausal insomnia.

Researchers at the University of Tehran examined the effects of valerian on postmenopausal women suffering from insomnia. One hundred women between the ages of 50 and 60 participated in the study. All the women had reported problems with insomnia. The women were divided into two groups: the first group was given a twice-daily dose of valerian for two weeks and the second group received a placebo. The women who received valerian experienced a significant improvement in the quality of their sleep, compared to those in the placebo group. Researchers reported that 30% of women who took valerian for the two-week study period saw a positive change in their sleep quality, compared with 4% of women in the placebo group.

Insomnia has been well correlated with poor sleep quality in women who are transitioning through menopause. Several factors are thought to influence sleep during menopause including hot flashes, polypharmacy, and sedentary lifestyle. Depressed mood can also be a factor in patients with insomnia. Because of the broad variety of reasons why a menopausal female might have trouble sleeping, I would recommend having a discussion with your family physician. A little bit of sleep hygiene can go a long way and if hot flashes are a factor, they can sometimes be medically controlled.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.