Sexy Sleep—Getting Enough to Get It On

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.

Nonhormonal Drugs for Menopausal Symptoms Nixed by FDA

So much for WISHes.

Following the approval of Osphena, a nonhormonal drug for vaginal pain, or dyspareunia, an advisory panel for the Food and Drug Administration (FDA) just voted against approving two nonhormonal drugs for the treatment of hot flashes.

Hot flashes, night sweats, and the sleep disturbance that accompanies them affect about 75 percent of perimenopausal women. Often, they are merely inconvenient, but for some women, they are severe enough to affect sleep, sex, and overall well-being. And they may continue for years—long after menopause is over.

However, based on the results of several rounds of clinical trials for gabapentin, a drug already used to treat seizures and nerve damage from shingles, and other trials for paroxetine, an antidepressant (the active ingredient in Paxil), the FDA panel voted overwhelmingly to deny approval.

The panel’s objection to both drugs was that their effectiveness didn’t outweigh the risks and side effects associated with their use. The most common side effects of gabapentine are dizziness and drowsiness. The most common side effects of paroxetine are nausea, sweating, drowsiness, and headache.

According to a recent New York Times article, women in the gabapentine trial experienced an average of 11 hot flashes a day. At the end of 12 weeks, they were down to about 4 per day. But the women on placebos saw almost as much relief—their hot flashes had dropped to about 5 per day. Thus, “women taking placebos in the trials experienced a substantial reduction in hot flashes that the drugs could not beat in any pronounced way.”

Women in the paroxetine trial fared slightly better, but the FDA panel decided that it still hadn’t cleared the bar for approval.

Voices on both sides of the debate are intense.

“They don’t work and cause dangerous side effects,” the consumer advocacy group Public Citizen testified before the FDA panel.

On the other hand, Linda Keyes, one of the panel members who voted to approve the drugs, said that the need for nonhormonal treatment “is high enough that I feel that a very modest reduction [in hot flashes] is still acceptable, assuming the risks are known and carefully watched, which I believe they can be,” according to an article on WebMD.

Obviously, these results are disappointing for women who are looking for a safe, federally approved, nonhormonal treatment for hot flashes and sleep disturbance. Currently, the go-to treatment for these menopausal symptoms is hormone therapy, and many women either can’t take hormones or choose not to because of the risk of stroke and breast cancer.

Both gabapentine and paroxetine are available off-label, and doctors have been prescribing them for menopausal symptoms for years. They, and other off-label options, can still be considered for treatment of menopausal symptoms—yet another reason for a detailed discussion with your health care provider so you’re making the best—and best informed—choices for you.

Sleepless Isn’t Sexy

Last month we talked about some of the disincentives to sex, and fatigue was one of the top three. As you may know from your own experience, getting a good night’s sleep during or after menopause is often a challenge. Hormonal fluctuations are often the culprits; lack of progesterone and estrogen can bring on night sweats and hot flashes, and who can sleep with all that going on! (Chances are your partner can’t either–a double whammy.)

Insomnia, snoring, sleep apnea, and restless leg syndrome are also very common among menopausal women. In fact, in one study, more than 40 percent of post-menopausal women polled reported waking up frequently during the night.

Lack of sleep can really take its toll on you, physically, mentally, and emotionally. You walk around like a zombie the next day and don’t feel like doing much of anything, least of all having sex. And if it becomes chronic, happening night after night, it can create a vicious cycle of constant fatigue that can have some serious repercussions, including:

  • Inability to concentrate
  • Reduced memory function
  • Increased irritability
  • Problems in relationships
  • Becoming accident-prone
  • Tendency to overeat

Chronic sleep disorders can also lead to depression and anxiety, creating a whole new set of problems that can be difficult to treat—and that can further handicap your sex life. That’s why it’s so important to do something about it right away.

First, try some of these steps, which many sleep experts recommend:

  • Go to bed at the same time every night and get up the same time each morning.
  • Use the bedroom only for sleep—and sex (and having sex just before sleep might help, too!).
  • Get 30 minutes of exercise during the day (but not after 8 p.m.).
  • Limit fluid intake in the evening.
  • Avoid alcohol and caffeine (many sodas have caffeine).
  • Practice relaxation techniques, such as meditating or visualizing yourself in a calm, restful setting.

If none of these techniques work, talk with your doctor about the possibility of taking medication. Sometimes it’s just a matter of breaking the non-sleep cycle. There are some good over-the-counter drugs and herbal remedies available, too. If the problem persists, you might consider going to a sleep clinic.

Just don’t allow a sleep disorder to rob you of the things you love to do. Keep trying until you find a solution that works for you.