Few things affect quality of life like lack of sleep. Nothing kills the jazz or even dulls the everyday ho-hum routine like that head-in-a-fog, feet-in-the-mud feeling of too little sleep.
And sex? Romance? That delicate dance we do to stay connected with our life partner? Fuggedaboudit. We’re having enough trouble keeping our heads up and off the desk at work. All we want is a good night’s sleep, and that’s the very thing that’s as elusive as a four-leaf clover in an alfalfa field.
If you haven’t discovered already, insomnia is the dark shadow of the menopausal years. (And insomnia can begin years before other menopausal symptoms and can last long after other symptoms subside.) In fact, almost half of women age 40-64 report having sleep problems, according to a 2007 National Sleep Foundation survey. Compared to premenopausal women, those in peri-and post-menopause report sleeping less, sleeping badly, and are twice as likely to use prescription sleep aids.
Yuck. That’s a lot of cranky, sleep-deprived women.
As you might expect, menopausal insomnia can be caused by a lot of things—hormonal changes, for one. "With impending menopause, most women experience a reduction in progesterone and estrogen," says David Slamowitz, MD, medical director of the SleepWell Center in Denver, in an for More magazine. "These hormones help regulate sleep, so declining levels can cause sleeping difficulties."
Better sleep may be another reason to consider hormone therapy.
But these years are often associated with change in our careers, health, children, parents, and partners. Change is stressful, and stress is the archenemy of sleep. If you’re anxious about your health (or your parents’ or your partner’s), if your children are adjusting to adult life, if you’re having difficulty covering the demands of your job, it’s hard (or impossible) to drop these worries at the bedroom door.
Other causes of sleeplessness can be the physical insults of getting older—arthritis, frequent nighttime urination, sleep apnea, restless leg syndrome. Not to mention the misery of hot flashes and night sweats, which can awaken us several times a night. The only mercy here is that if we can make it to blessedly sound REM sleep, hot flashes tend to lose their power to wake us up.
So, what is a foggy-brained, sleep-deprived, menopausal woman to do?
Well, first, if you snore, feel depressed, or find insomnia to be seriously affecting your ability to function, talk to your doctor. You may need to tease out how other factors may be influencing your sleep. Review the medications you’re taking, which can also interfere with sleep (and sex). Ask him or her to check your thyroid for an endocrine disorder that can disturb sleep.
But you have some control over your sleep (or lack thereof) as well. You can be proactive about getting a good night’s sleep. Plus, good sleep hygiene often ends up being good for your overall health as well. (You knew we were going there.)
Here’s a regimen that may have you sleeping, if not like a baby, perhaps almost like a normal human being.
- Exercise. Vigorously in the morning with maybe a bit of gentle yoga in the evening.
- Get outside when you exercise. Natural light helps establish a good sleep-wake cycle, and we tend to become more housebound as we age.
- Don’t nap. Yeah, this can be tough when you haven’t slept at night, but we’re moving toward establishing a rhythm here.
- No stimulants. Obviously, a double latte at 8 p.m. will keep you jittery into the wee hours, but avoid caffeine in any form, including chocolate. Ditto for nicotine and alcohol. Contrary to common (mis)perception, alcohol will relax you at first and wake you up later when your body begins to metabolize it.
- Don’t eat heavily before bedtime.
- Establish a soothing bedtime routine that sends “now we’re getting ready to sleep” signals to your brain. And do it at the same time every evening. (That rhythm thing again.) Drink an herbal tea. Read a book. Do your yoga. Don’t watch TV or do computer work if it winds you up. Don’t engage in stressful conversation in the evening.
- Make the bedroom pleasant and sleep-inducing. It should be dark and cool but not cold. The bed should be comfortable and you should use it only for sleep—and sex. Oh yeah, remember that?
With any luck, you’ll gradually move beyond this tough transition and slowly reestablish more normal sleep patterns as your hormones settle down. But as with many issues during menopause, we may need to adjust to a new normal as well. Some women say they’ve been able to make their peace with and adapt to different sleep patterns.
And whether we’re talking about sex or sleep, adaptation is what it’s all about right now.
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.