Is There Is No Rest For The Weary?

Is there anything worse than a bad night’s sleep? When we experience poor sleep, which refers to both the amount and quality of sleep, we will be tired and cranky the next day. Our ability to focus, concentrate, think clearly, do our work, and take good care of ourselves and our families suffers. Poor sleep leads to fatigue and irritability, increases the risk for heart disease and depression.

Poor Sleep, Perimenopause and Menopause

Sleep issues increase dramatically during perimenopause and menopause and are one of the most common complaints I hear in my practice. In fact, almost fifty percent of women in their late 40’s and 50’s will experience some degree of sleep disturbance. And despite the fact that sleep issues are twice as common in women, most of the sleep research has been done on men!

Of the non-medical reasons why midlife women experience problems with sleep, perhaps they all funnel down to one word…stress. Difficulties with work, finances, relationships, snoring spouses, children having bad dreams, aging parents who are not listening to your advice, divorce and death are enough reasons to keep women worrying about stuff and not getting enough sleep. I would also like to add pets to the list. My dog, Sadie, woke me up several times last night.

Of course, there are some specific medical reasons why midlife women experience sleep disturbances. These include hot flashes, night sweats, depression, anxiety, sleep apnea, restless leg syndrome, chronic pain, nighttime urinary frequency and certain drugs that treat thyroid disease, depression and anxiety. You can bet that anyone with major chronic health issues like heart and lung disease as well as cancer are also suffering from fragmented sleep.

Now here comes a midlife medical research mystery. Despite the fact that you and I are convinced that our hot flashes and night sweats are waking us up, many clinical studies that have sought to prove this cause and effect have not clearly made the connection. It seems so obvious. However, it turns out that not every women wakes up after a nighttime flash or sweat. There is also evidence that perhaps it is the awakening that happens first which then triggers the flashing and sweating.  But when we wake up drenched or just very hot, that is the end of our chance at getting a good night’s sleep.

How Can I Beat Fatigue and Get Better Sleep?

So what solutions are available for midlife women’s sleep issues? The non-prescription strategies start with the usual healthy lifestyle recommendations which include a healthy diet, daily exercise, weight maintenance, and quitting cigarette smoking. It turns out that nicotine makes it both harder to fall asleep as well as to stay asleep. Additionally, while alcohol makes many of us sleepy initially, it ultimately disrupts our sleep hours later. Caffeine from coffee, tea, soda, chocolate, non- prescription pain relievers, allergy and cold medications, and weight loss drugs will also keep you from getting the sleep you need. Eating a large and heavy meal near bedtime will make it harder to sleep. I no longer make fun of older people eating at the “early bird special”. I have joined them!

Additional non-prescription strategies include maintaining good sleep hygiene. Establish a sleep routine that you stick to every night of the week. Go to bed and wake up around the same time whenever possible. Your bed and bedding must be comfortable. Your bedroom should be cool, dark and quiet. Reading in bed is okay unless you have chosen a Stephen King novel. Watching TV in bed is not okay. Nor is working on your computer or smartphone. Do those activities in the living room until you feel sleepy. Then go to bed. I should also add that I personally sleep with soft foam ear plugs and have been doing so for years. I can still hear when my kids call out for me, but the extra protection muffles out most of the sounds of my city.

You can also try yoga, acupuncture, and meditation, although there is not enough research on whether these make any difference. The same is true for botanical supplements and melatonin. My feeling about these strategies is that if you want to try something that your best friend swears by, go ahead. However, if it does not help you after 3 months, it is time to move along to a new strategy.

Finally, I will address prescription solutions for midlife women who are experiencing sleep disturbances. Your healthcare professional can offer sleeping pills that work well, but there is always a concern that you may also experience sleepiness the next day as well as a tolerance to their initial effects and, worst of all, a dependence upon them. I think short-acting sleeping pills are helpful for women when the cause of the sleep disturbance is stress related, like dealing with an illness, divorce, job loss or death. I also think that taking a sleeping pill helps when taking a long, overnight flight to a faraway place.

Hormone Therapy and Sleep

Here is how hormone therapy shakes out with regard to improving sleep. If you are having hot flashes and night sweats, then hormone therapy will definitely help you sleep better. That is especially true when using an oral estrogen and a natural progesterone tablet. The progesterone tablet is taken at bedtime, because it can help women feel drowsy. If you are not flashing and sweating at night, hormone therapy still appears to benefit sleep especially by reducing the number of times you wake up at night. The bottom line is that midlife women report that they generally feel more rested after they start hormone therapy.

Most of us would like to make the necessary lifestyle changes on our journey to midlife health and wellness. But the reality is that eating healthier and exercising more is hard to do when you feel so tired and miserable. My advice to my own patients is to start with one change for the better. We can all do that.

What change will you make today?

Tara Allmen, MD Credentials:
– Board Certified Gynecologist and Nationally Certified Menopause Practitioner
– New York City’s Leading Expert In Menopause
– President, North American Menopause Society Foundation
– Fellow of the American College of Obstetrics and Gynecology
– New York City’s Top Gynecologist, 2015
– Five Star Rating From Doctor’s Choice Awards
– Five Star Rating From HealthGrades