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.
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:
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.
Continuing with our series of tips for holiday sanity, and even enjoyment, this is the most fun suggestion of all: Schedule a quick, romantic getaway for after the holidays to re-connect with your honey and get some downtime in a sweetly unfamiliar place.
You want to keep the emphasis on the fun and not get carried away with anything elaborate and expensive. A weekend away with minimal planning increases the chance that you’ll actually do it—no good excuses, and it’s easy to find someone to check in on the cat.
A quickie in midwinter can be especially economical and especially delightful. You’ll encounter a laid-back and welcoming atmosphere that’s lacking in the midst of summer tourist season. You’ll also encounter off-season rates.
I fondly recall a midwinter weekend in a tourist town near my West Michigan home. Yes, some places were closed for the season, but the rest of the town was just as scenic and beautiful in winter. We eavesdropped on local chatter in the diner and neighborhood pub that had been crawling with tourists just a few months before.
So, here’s my down-and-dirty guide to a relaxed, relationship-rejuvenating weekend in the middle of the long winter night.
You are now approaching the crescendo of holiday preparation. Give yourself a treat to look forward to. A weekend getaway won’t break the bank but will ease both of you out of the post-holiday, wintertime blues. And maybe just knowing you have this special weekend on the calendar will remind you to be more gentle with each other during the holiday frenzy.
Yeah, I know. The last thing you need right now is another list of ways to avoid stress during the holidays. The mere thought of another list is stressful all by itself.
I don’t cotton to holiday de-stress lists, either. That’s why I combed through dozens of tips from experts and ordinary folks to winnow out what I think are the best, most truly helpful holiday reminders. I’m betting that something on this list will truly make your life easier and your spirit more joyous. Most of the suggestions even have some science behind them, which always makes me happy.
Holidays are a booby trap for intimacy. So much to do; so little time: cards, cooking, cleaning, decorating, gifting, partying, shopping, visiting. Makes me exhausted just to think about it! Little wonder, then, that the first casualty of holiday celebrating is usually our closest relationship. It’s just too easy, either to vent our stress on our significant other or to ignore the daily interactions and kindnesses that lubricate the wheels of intimacy.
So, to help keep those wheels humming despite the holiday frenzy, let’s explore a few creative ways to share the love with your honey. Actually, when you think about it, Christmas is delightfully sprinkled with sexy innuendo. So let’s think about it.
I hope this list gives you some ideas to work from. If nothing else, I hope you resolve to navigate this special season with an eye to preserving your own peace of mind and nurturing your relationship.
Many of us are very goal-oriented. We like to make lists and to tick items off those lists. We like order; we don’t like chaos.
Unfortunately, life is messy and sometimes chaotic.
At no time is this truer than during the holidays. All the demands of the holidays—the shopping, cooking, partying and gathering—will simply be heaped on top of our already overflowing schedule. We know that the price we pay will inevitably be snappishness, exhaustion, maybe the scratching of old scabs and regurgitation of old hurt.
In the interest of helping all of us not only to survive, but maybe even to enjoy the holidays, I offer you a mini-tutorial on a practice that has been known to help everyone from cancer patients to Fortune 500 executives. It’s even known to improve our sex lives, which is why we highly recommend the practice of mindfulness on our website.
Mindfulness is a straightforward concept. It’s developing the ability to pay attention to the moment—not to zone out, but to develop a facility of focused attention, without judgment or emotion, on the present. Mindfulness was a Buddhist concept, but in 1979 Jon Kabat-Zinn, a psychiatrist at the University of Massachusetts Medical Center, adapted and developed it into a formal eight-week program for patients “who weren’t being helped” by traditional medicine. His program incorporates meditation, mindfulness exercises, and yoga.
The results were impressive. Patients experienced less pain, and they healed faster. The practice relieved stress and improved the immune response. The concept of mindfulness meditation quickly seeped into the broader zeitgeist.
Now, I know that it’s one thing to read about a spiritual practice, helpful as it may be, and entirely another to actually incorporate it into daily life, especially in the midst of holiday frenzy. The essence of mindfulness, however, is simple and almost intuitive. Best of all, it takes almost no time. You can practice mindfulness while you’re rolling out pie crust or brushing your teeth. It quiets our “monkey mind” and brings us back to the moment, which, after all, is the only moment we really have.
“Life is available in the here and now, and it is our true home,” writes Thich Nhat Hanh, a Buddhist monk and globally famous spokesperson for mindfulness meditation.
Mindfulness practice doesn’t take effort, and it doesn’t take time. It just requires a focusing of thought and awareness. The basic meditation is to focus on your breath: Just paying attention to breathing in and breathing out. Your breath doesn’t have to be long or short. You just have to follow your in-breath and your out-breath.
You can think, Breathing in, I’m aware of my body; breathing out, I release tension in my body. You mentally pay attention to any parts of your body that are tensed—your lips, your neck, your back—and consciously relax that part. When you wait in line or stop for a light, you have a bit of time to practice this focus and release. And then smile, says Thich Nhat Hanh.
This principle can be applied to whatever you’re doing: cooking, cleaning, taking a shower, taking a walk. You bring your attention lightly but completely to the activity you’re engaged in. You don’t think about the next thing you have to do or the fight you had with your spouse this morning. Those thoughts are like the clouds crossing a bright, blue sky. You observe them without emotion or judgment and let them go, returning to your focus on your breath or your walk or the pie crust.
As you practice mindfulness, you may become conscious of the moment before you react to something. When you are aware of that moment, the moment before you react, then you have a choice about how you will react, whether in anger or kindness, fear or trust, passion or forbearance. If you’re aware, then you have a choice.
"Between stimulus and response there's a space, in that space lies our power to choose our response, in our response lies our growth and our freedom," writes Victor Frankl, Holocaust survivor and author of Man’s Search for Meaning.
I’m thinking that if ever there was a good tool for avoiding those uncomfortable confrontations during the holidays, this might be it. If you’re aware of the moment of stimulus, when your brother makes a snarky remark about your son’s tattoos, for example, then you are given a moment of choice about how you’ll respond. And a moment to breathe in, breathe out without tension or judgment.
Even though it’s effortless, developing this practice isn’t easy. I guess that’s why it’s called a “practice.” I do know that improvement, however incremental, helps me to live with gratitude and gracefulness.
And during the holidays, I simply can’t get enough of either.
As Thich Nhat Hanh writes: “The real miracle is not to fly or walk on fire. The real miracle is to walk on the Earth, and you can perform that miracle at any time. Just bring your mind home to your body, become alive, and perform the miracle of walking on Earth.”
Amen to that!
You describe hot flashes and night sweats that began after a hysterectomy to reduce breast cancer risk. You're right that the symptoms can be prompted by your sudden entry into menopause (through surgery) as well as by the prescriptions intended to deplete estrogen in your system. You are, as you know, not alone in facing this challenge!
I always start with lifestyle factors, which can lessen symptoms for anyone. You may be able to identify triggers (like caffeine, alcohol, spicy foods, or sugar) that you can avoid in your diet. Dressing in layers is a must for many of us. Now is the time to exercise regularly; women who do so may have fewer and/or less intense hot flashes.
Reducing stress—or learning new tactics to manage it—is helpful if you can do it (I know life doesn't always cooperate). Paced respiration is a technique to ease the intensity of a hot flash when one occurs: Breathe deeply and slowly, inhaling through your nose and exhaling slowly through your nose or mouth. There's also a biofeedback technique to slow the heart rate, which may lessen the hot flash intensity and duration (because an elevation of heart rate is part of the physiology of a hot flash).
Acupuncture has been very helpful to a number of my breast cancer patients in managing hot flashes.
Beyond that, we haven't seen a lot of success with alternative medications and complementary therapies. Those that have been tried include isoflavones (found in soy but not recommended for breast cancer patients), black cohosh, chaste tree berry, ginseng, dong quay, red clover, yarrow and others. For those that have been investigated and undergone careful scrutiny, the results are disappointing; there is limited scientific evidence for most herbal options. That being said, placebo has at least a 25 to 40 percent response rate in nearly every study, so if you can determine that an herb is not harmful (check with your physician) I do not discourage women from trying herbal preparations. I wish we could make a recommendation knowing we are in fact offering beneficial outcomes, but that just hasn’t been so for these options.
There are some non-hormone prescription options that have favorable effects. Just in the past year the FDA approved Brisdelle specifically for the treatment of hot flashes. It cannot be used with Tamoxifen, but as a very, very low dose of paroxitene (generic for Paxil), Brisdelle is well tolerated with minimal side effects. The anti-hypertensive medication clonidine has been shown to reduce hot flashes for some women, as well as gabapentin (generic for Neurontin). Other antidepressants can reduce hot flashes as well: venlafaxine (generic for Effexor), paroxetine, and fluoxitene (generic for Prozac), and escitalopram (generic for Lexapro). All of these have a modest benefit to hot flashes. They each have the potential of side effects, so a discussion with your provider is helpful in determining an option best suited for you.
Good luck, and the good news is that time will work to your advantage for the hot flashes. This too shall pass—really!
I was sitting in a tiny hut in Mexico talking with a dignified older gentleman. Outside the ramshackle house, the sun shone on the empty desert. The ocean lapped the nearby shore. There was no traffic, no noise, no shops, no phones.
“The Americans, the Germans, and the Japanese are the hardest-working people in the world,” the man said.
First, I was startled that someone in this very remote place would be so astute. Then I wondered: Is this a good thing?
With all our mobile toys, we don’t ever have to stop working in America. We can be connected 24/7. Maybe we can squeeze in a few extra obligations after-hours. Or, we might be caring for parents and children, and sometimes spouses and grandchildren. Even if we’re retired, we’re programmed to run hard and fast.
But look what it’s doing to us. We’re stressed; we’re overweight; and we’re dog-tired.
Sex life? What sex life?
Ian Kerner, a well-known sex therapist, cites a recent study by the National Sleep Foundation in which one-quarter of American couples say they’re often too tired for sex.
Mary Jo Rapini, one of our medical advisors, recalls encouraging a couple to take time for a romantic getaway. “Oh no, who’ll plan that for us?” they asked. Well, “usually the couple enjoys planning these things together,” she said.
“We don’t have the energy,” they responded.
Think of sex as the canary in the coal mine. It’s one of the first things to go when life gets out of whack. But if you ignore that quiet little loss, pretty soon the bigger stuff suffers, like good health and relationships.
If sex is just another obligation, or you’re too tired to even think about it, you need a life/work balance adjustment. If you don’t have some other physical or psychological problem, such as a thyroid condition, chronic fatigue syndrome, serious relationship issues, or hormonal imbalance, you shouldn’t be too tired for sex.
So, if stress, overwork, overcommitment, and the general pace of life, has killed your libido, consider this:
Allow time for sleep. Right now. Nothing else matters if you’re chronically sleep-deprived. Re-assess your involvements. Try to delegate tasks. Cut back on work. (Doctor’s orders.)
“A good night's sleep every night—more so than exercise and a healthy diet—keeps our sexual engines humming,” says Barry McCarthy, PhD, a Washington, D.C., sex therapist.
Give yourself an hour to unwind before going to bed in the evening. Turn off the TV and all the other screens. “It’s terrible to have a television in your bedroom, which should just be for intimacy and sleep,” says sex therapist Sherri Winston.
Spend that time relaxing with a book. Share a cup of herbal tea. Cuddle with your honey. Take a bath.
Exercise. Regular, moderate exercise is part of the work/life balance thing. Can you walk 30 minutes a day? Maybe with your partner? Can you find a gentle workout video? (My favorite now is hot yoga, but I have friends who spend 20 minutes a day with our old pal Jane Fonda.)
Exercise makes you feel better. It helps you lose weight.
And guess what? It helps you sleep better.
De-stress. Yeah, I know this sounds impossible. But you have a choice: You can continue to worship at the altar of overcommitment, at which you will offer up your health, your intimate relationships, and your quality of life.
Or you can bring your life into a healthy balance, and probably live longer—and have a lot more satisfying sex.
Need more persuading? Stress releases cortisol, a hormone that decreases testosterone, of which we women have precious little in the first place. Thus, stress directly hammers our sex drive even before the sleep-deprivation sets in.
Follow your rhythms. If you’re exhausted at night, why not have a little afternoon delight? Or maybe sex in the morning? Testosterone levels naturally rise a little then, so that might be the opportune moment to turn up the heat. Caress and cuddle at night and save the sizzle for the morning.
Just do it. You know how you may not be in the mood, but a little nibble on the ear, a little stroke on the thigh… and, well,… maybe…
Libido is like a puppy. Give it some loving, and it will follow you home. And sex begets more sex. You have to do it to want it.
When I recall the tranquility I felt in that simple hut in Mexico, I wonder if we somehow took a detour on the road to the good life. Maybe we can learn something about simplifying, cutting back, enjoying the little things, and loving each other from people who don’t have many possessions, but who probably sleep very well at night.
The American Association of Retired Persons (AARP), the venerable group that’s always looking out for our best interests, has completed three major surveys of the sexual behavior of midlife (and older) adults.
This third such survey was released in 2009 (following earlier surveys in 1999 and 2004), and while nothing was truly shocking, some information was interesting, and some might be helpful. And, with three such studies conducted over a period of years, the organization is able to identify some trends and changes.
The 2009 study surveyed 1670 adults (the “panel”) over the age of 45. According to the firm commissioned to conduct the study, it’s “the first online research panel that is representative of the entire U.S. population.”
So, what’s happening behind our bedroom doors?
It’s no news flash that men and women are different in the way they view sex. For one thing, Mars thinks about sex more than Venus. (Men are five times more likely than women to think about sex once a day). They masturbate more (34 percent to 12 percent) and admit to having oral sex more. (Presumably with women? So… are the women just too timid to admit it?) They are also twice as likely to have sex outside their long-term relationship (21 percent of men admit to infidelity as opposed to 11 percent of women).
Bottom line: “Sex is far more important to the overall quality of life of men than women and also more critical to a good relationship.”
This doesn’t mean women don’t like sex—or think about it, or fantasize, or masturbate. It just means sex is front and center in the male brain, while it nestles cozily into a less prominent lobe in women.
Married vs. dating
While simply having a partner increases the odds of sexual satisfaction (now there’s a news flash), being married doesn’t—necessarily. Respondents who were “partnered but unmarried”—single and dating or engaged—have sex more often and like it more than their married counterparts.
Gives those of us who are married something to work on, hey?
But having a partner, whether married or not, also seems to make a difference in the broader scheme of things. Partnered respondents reported significantly higher overall quality of life and greater sexual satisfaction than those without a partner. And, obviously, they have sex more often, too.
So here’s the news flash. According to the study, “the number one factor predicting satisfaction with one’s sex life is the frequency of sexual intercourse.” See? Use it or lose it. The more you have it, the more you like it.
You heard it here first. What are you waiting for?
Among those who have sex once a week, 84 percent are satisfied with their sex life, compared to 59 percent of those who have sex once a month and 16 percent of those who haven’t had sex in the past six months.
And how often are those Eveready bunnies doing it? Of those who have partners, 41 percent are doing the once-a-week thing and 60 percent have sex at least once a month. Partnered folks are pretty touchy-feely, too: 78 percent hug and kiss at least once a week and 64 percent caress or otherwise give a little booty squeeze (sexual touching).
For women, that whole partner business is a bit of a conundrum. As we know, demographics is not on our side, since we live about five years longer on average than men, plus men tend to partner with younger women. As we age, we are more likely to be unpartnered, with the predictable impact on our sex life.
In addition to being affected when we're partnerless, sex is, of course, exquisitely sensitive to other events in our lives. The major life events that impact sexual frequency and satisfaction are health, stress, and financial worries (a different kind of stress, no?).
Good health is a top predictor of sexual frequency and satisfaction in many surveys. In this one, of those who rated themselves in “excellent” health, 42 percent have sex at least once a week and 54 percent are satisfied. Of those in fair health, 19 percent have sex once a week, and 23 percent are satisfied.
And while good health is partly the result of good genes and good luck, it’s also strongly related to good habits. The most active respondents—those who report exercising at least 3 to 5 times weekly—also rate themselves in excellent to good health.
Stress “is a major factor in sexual satisfaction,” especially among the youngest respondents. After age 60, respondents tend to experience lower stress levels. So, while younger people tend to be more sexually active, the study’s authors hypothesize that they might be even more so if they were less stressed.
The economic crisis and its attendant financial uncertainties may account for lower levels of sexual frequency and satisfaction, which were a full ten points lower than the 2004 survey.
From the mass of data they collected, the study’s authors compiled a short list of qualities that are good predictors of a happy sex life. They are:
Whether you’re a tortoise or a hare on the sex scale, remember that studies like these are only for information; they aren’t meant to pigeonhole or categorize. Your sex life and habits are unique to you and your partner. If sex is pleasurable and satisfying for both of you, who cares how often you “do it”? And if you find yourself dissatisfied and frustrated, well, this is one area in which improvement is always possible.
If you want to read the full report, you can find it here.
(But you probably knew that, right?)
I wanted to elaborate a bit more on the Wall Street Journal article I mentioned in a recent post. “The Joy of Researching the Health Benefits of Sex,” (a play on the famous book, The Joy of Sex) talks about what researchers are finding about the physiology of sex and the health benefits that may come along with it—a topic I’m always interested in exploring.
Dr. Irwin Goldstein, a urologist and director of sexual medicine at Alvarado Hospital in San Diego, says some benefits are obvious even without scientific evidence. “When you have good sex, there’s a relaxation response and a satiation response… you lie there and life is great.”
That’s the result of hormones and neurotransmitters that rise and fall during sexual activity, especially dopamine and oxytocin, which we’ve discussed before. That nice relaxed feeling is what sometimes causes people to fall asleep right afterwards. In fact, in a 2006 survey of 10,000 British men, 48 percent admitted to having fallen asleep during sex!
Not that we want to encourage that, but it’s comforting to know there’s a physiological reason for it.
Another researcher, Stuart Brody, a psychologist at the University of the West of Scotland, says all this relaxation can be very helpful in reducing stress in both men and women. In one study, he had people keep diaries of their sexual activities for two weeks, then took their blood pressure while performing a stress-inducing activity such as adding numbers rapidly in their heads. Those who had had intercourse during the fortnight had smaller blood pressure spikes more quickly than those who had no sex at all.
While you’ve probably experienced a peaceful feeling immediately following sex, you may not have been aware that its benefits were so long lasting.
Researchers have also studied sex and its relationship to cancer: Can frequent sex lower the risks of some types of cancer? Although there is evidence that does point to that, most researchers say there are too many other variables in the studies to draw any certain scientific conclusions about it.
The real lesson, says Dr. Erick Janssen, a senior scientist at the Kinsey Institute at Indiana University, is how sex can contribute to our overall well-being. “If you’re having sex in a frequency and in a way that is compatible with who you are, then that’s healthy.”
I couldn’t agree more. How about you?
This is the first of three blog posts on the three main reasons women might decide not to have sex, a series introduced last week.
Maybe the kids have flown the coop—or maybe not. Maybe your parents need more attention. Maybe you’re still involved with your career; in fact, maybe you have a big presentation in the morning, and you need to be refreshed and on-point. Is it any wonder that sex is the last thing on your mind?
Life’s demands ebb and flow, but they never go away. And your sexual self is closely connected to all the other flotsam and jetsam of your life. However, if your stress level and the demands on your time are chronic and overwhelming, other important parts of life, such as exercise, time to yourself, and intimacy with your partner are all too likely to fall quietly by the wayside.
Chronic stress, in addition to putting a terrible strain on your overall health, also interferes with the production of hormones that fuel libido. So, even though you may love and be attracted to your partner, lack of time and energy for sexual intimacy will cause that relationship to suffer over time. And, eventually, your desire for sex will diminish, too.
If the demands on your time and energy are draining away life’s pleasures, it’s time for some tough re-evaluation. The stresses may be unavoidable, like caring for elderly parents, but there’s probably something you can do to ease the burden.
To really deal with the “too tired” state of affairs, you need to view your life holistically. Lack of time and energy for sex is only part of the picture.