March 08, 2018

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diet ›   exercise ›   menopause ›   sleep ›   stress ›  


Sleep! We’re in Favor.

If you’re wearing a Fitbit to bed, like a patient I saw last week, you might be seeing pretty colored charts that confirm just exactly how poorly you slept last night. And if you’re like her, it may only be increasing your stress about what you already know: You’re tired! You’d like to sleep through the night!

Yes, as you’re likely tired of hearing, it’s hormones. Estrogen and progesterone are in decline, and the mix of hormones (add cortisol, the “stress hormone” to the cocktail, too) may be less friendly to sleep than it once was. Hot flashes, which can happen day or night, come with a surge of adrenaline, from which you need to recover before you can settle back to sleep.

What you're thinking of in the middle of the night is spam. Delete it!A few of the people I’ve talked to for The Fullness of Midlife, our podcast, have had some light to shed on our sleeplessness. Joan Vernikos, a retired NASA health science researcher, says sleep is “like a cleaning service in an office. ...The cleaning service starts out by emptying the garbage cans, by tidying up, picking up—and that’s what happens with the brain during sleep in the various cycles. If you wake up and you don’t sleep well, not only are you going to make mistakes the next day, but you’re not going to detox your brain.”

Menopause can sometimes bring its own befuddlement, right? Memory lapses. Foggy thinking. Well, add in some sleep deprivation and a brain in desperate need of a “detox,” and you can imagine a day that you’d rather forget.

Another podcast guest, Dr. Pamela Peeke, gave us a pep talk about making “sleep hygiene” a priority. She points out the relationship between sleep and diet: We’re much better able to be in control of our appetite—not because we lack self-discipline but because of busy hormones at work in our bodies—when we’re well-rested.

Make “sleep hygiene” a priority? Well, it sounds good. And there’s plenty of reason to do it, from easier healthy eating to clear-headed days. Here’s what it takes:

  • Make your bedroom comfortable for sleep. Is it dark enough? Cool enough? You might want to layer your bedding like you layer your outerwear for a hike on an early spring day—so both you and your partner can be comfortable throughout the night. Consider white noise if sounds are keeping you awake. If now is not the time to invest in your good sleep, when is?
  • Exercise. To patients in my office, I recommend 45 minutes five days a week of real exercise—walking, swimming, biking. Something that gets the heart-rate up. If some part of that can be outdoors, even better, because natural light helps us with our sleep-wake cycles. Get it in early, so you can avoid exercise in the three hours just before bedtime.
  • Stay awake during the day. I know it’s tempting to nap when you’re not sleeping well at night. But napping for more than 20 to 30 minutes can make it more difficult to sleep deeply overnight, which is when that brain detoxing Joan talked about happens.
  • Ease away from stimulants and heavy foods. The effect of caffeine can change as our bodies change. And the relaxing effect of alcohol wakes us up later when we’re metabolizing it. Digesting heavy foods can do the same.
  • De-stress generally, but especially as part of a pre-bed routine. Excess stress is a health challenge for us at any age. While it’s unlikely you can eliminate stress from your life, you can at least develop some routines for putting it in its place before you turn in for the night. Set a routine—yoga for relaxation, reading a novel, writing in a gratitude journal, taking a hot bath—that signals that it’s time to settle down. Avoid screens in the hour before bed, especially contentious text or Facebook exchanges or upsetting documentaries. And remember what Joan said when you’re churning at night: “What you’re thinking of in the middle of the night is spam. Delete it! You can’t do anything about it.”

A perhaps unexpected side effect? Since stress and fatigue are two of the three most common obstacles to sex (the third is lack of privacy), you just might find yourself with a little more romance in your life.

Makes “sleep hygiene” sound a little sexy.

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.

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.

Is Sleeping Apart the End of Sex?

People often make jokes about snoring (the word itself is kind of funny), but if you’re losing sleep because your partner is a loud snorer, you know it’s anything but humorous. Not only are you fatigued the next day, but that often leads to feelings of resentment, which is hard on the relationship, especially over time.

There are lots of remedies available for snoring, but if none of them work, what do you do? Or what if you can’t agree on the temperature of the bedroom or the depth of the blankets—you’re hot and your partner is cold? You work different schedules or your internal clocks put you to sleep or wake you up at different times?

A lot of women at this stage of life choose to move into a different bedroom, especially if the kids are gone. And while that may be a good solution for a good night’s sleep, what does it do for their sex lives?

There’s nothing more intimate than sleeping together. But if you can’t just roll over and initiate sex, will it still happen?

The answer is, yes. But it might require a little more work. You may have to become more conscious about having sex, and that can be a good thing. It might mean you cuddle up while you’re watching a sexy movie on TV. Or move your partner’s hand somewhere intimate while you’re sitting together on the couch.

Indeed, not sleeping together may actually rekindle some of the passion and make sex more exciting. It might also keep you from taking it for granted. Because it’s true what they say about absence making the heart grow fonder. If your partner isn’t so readily available anymore, it might actually make you want intimacy more often.

So not sleeping together does have its benefits (including the fact that you’ll feel a lot better once you start getting a good night’s sleep!)

The important thing is to keep the fires burning one way or another. Don’t allow not sleeping together to become an issue or get in the way of having a healthy sex life. Instead, use it to your advantage. Talk about it with your partner and communicate your true feelings: It’s not about him; it’s about getting a good night’s sleep. And if your relationship is good, things might even improve in that area.

If you’ve had experience with this situation, let us know what’s worked for you so we can share it with others!