Menopause and Insomnia

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Sleep onset insomnia (trouble getting to sleep) and sleep maintenance insomnia (trouble staying asleep) get worse during perimenopause and menopause. Menopause brings longer sleep latency and decreased length of time spent in slow-wave sleep. Scientists still don’t totally understand the effect of estrogen on the circadian rhythm and somatic thermoregulation (how the body controls its own temperature), although estrogen supplements tend to prevent these unwelcome sleep changes. It used to be common for doctors to prescribe estrogen supplements for older women, but the general use of estrogen replacement has largely been eliminated.

One idea is that insomnia in menopausal women has two causes: the vasomotor symptoms and depressive symptomas.

Surveys indicate that women consider insomnia among the most irritating of menopausal symptoms. “Hot flashes” (due to fluctuation in estrogen and progesterone levels) are another common symptom, and many times, the reason for insomnia is due to the body’s inability to maintain a consistent temperature. A hot flash includes a surge of adrenaline, which tends to awaken sleepers. Many women experience night sweats. Both these sweats and the tiredness resulting from insomnia can have a large negative effect on subjective “quality of life”. The International Classification of Sleep Disorders (ICSD) includes premenstrual insomnia and premenstrual hypersomnia within the category of menstrual-associated sleep disorder.

Both longer sleep latency and less slow-wave sleep are characteristics of menopausal sleep. Hormone replacement therapy seems to alleviate these problems, but HRT is used less today than in the past because of problems with it.

Like insomnia from other causes, this insomnia can be a challenge to live with and to treat. The first line of action for the insomniac is making sure good sleep hygiene is practiced, including a comfortable dark room and a regular sleep schedule.

In bad cases some doctors prescribe medicines, including nonbenzodiazapines. Researchers are looking into phytoestrogens and other estrogenic substances for control of many symptoms related to menopause and this may eventually result in some treatment in the future. The use of hormone supplements to address menopause has a long and contentious history which we won’t go into, but doctors do still have this tool in their arsenal if they feel if is appropriate for women with vasomotor symptoms in sleep.
A recent study showed that Zolpidem was effective in treating insomnia in menopausal women, and of course there are many over-the-counter and prescription sleep aids.

Postmenopausal women (but not premenopausal women) with sleep apnea have been found to have changes in heart EKG patterns. The changes may indicate a higher chance of heart problems.

Obstructive sleep apnea can occur in menopausal women because of diminishing levels of progesterone in the bloodstream. This hormone is a respiratory stimulant and upper airway dilator and the body needs time to adjust to the decline. Increased body weight with older age also increases the risk of apnea.

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