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What to Do When Menopause Won’t Let You Sleep

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I have a confession: Sleeping is not my greatest skill. That is why I am writing this at 2 am. Because I can’t sleep. So if you are having trouble sleeping too, I get it. Intimately. It would be one thing if a lack of sleep were due to a creative maelstrom forcing you into wakefulness in order to write something, paint something, or be brilliant in some way. But when it comes to menopause, inability to sleep seems to be based on, well…nothing. Not brilliance. Not even anxiety. You just can’t sleep! It’s more than frustrating. It seems like a huge waste of time.

I get a lot of complaints from my patients about the inability to get to sleep, but it’s more than that. I also hear complaints about waking up drenched in sweat in the middle of the night, waking up at 3 am and not being able to get back to sleep, even chronic bad dreams. All these sleep issues would be bad enough, but the fact is that sleep issues do not exist in a vacuum. They are often connected to—or lead to—overeating and weight gain, fatigue, moodiness, anger, snapping at loved ones, and being too tired to exercise, which can lead to more weight gain, fatigue, moodiness, anger, snapping at loved ones…you get the picture.

When it comes to the insomnia associated with menopause, I am afraid the scientific answers are not very clear. It likely has something to do with declining estrogen. But we do know that sleep is a critical and important part of life. Sleeping is important for rejuvenation, recuperation, healing, and good health. A lack of sleep can lead to moodiness, tension, irritability and, of course, fatigue…as well as problems with memory and concentration. It can lead to high blood pressure and obesity, which can lead to diabetes. It is also associated with heart disease. Insomnia isn’t something to take lightly. Yet almost half of US women aged 40-64 years old report sleep problems (National Sleep Foundation Survey, 2007).

But before I address menopause-induced insomnia, let’s make sure nothing else is going on with you.

Sometimes sleep issues are due to depression, anxiety, or stress. If these issues are causing your insomnia, maybe it’s time to consider talking to your doctor, a psychologist, or another health care professional about it—now that you know all the health issues it can cause. There are good solutions to these problems. Or maybe chronic pain is the issue. Conditions such as arthritis, fibromyalgia, pain syndromes, or even thyroid disease can interfere with sleep. A simple blood test, history, physical exam, and evaluation may be the only things standing between you and a good night’s sleep.

Sleep issues could even be due to one of the medications or supplements you are taking. Sometimes antidepressants can have this effect. So can thyroid medication, over-the-counter decongestants, and other medications. It could be gastric reflex, or having to use the bathroom multiple times per night, or sleep apnea, or that urge to jump out of your skin called restless legs syndrome. Have your doctor help you investigate all the possibilities. Solving your sleep problem might be easier than you think.

But what if there is no other explanation? What if menopause is the only thing left on the table? While a few studies suggest that menopause doesn’t cause insomnia, I’ve heard enough women tell me about how they turn the lights out and sleep just won’t come to make me want to say “Are you kidding me?” From my perspective as a physician, as well as a woman, the connection is pretty obvious.

One of the reasons that menopause could cause sleep disturbance is that changing hormone levels can lead to a nervous system miscommunication. The mind is saying “sleep” and the body is saying “let’s dance.” An overactive sympathetic nervous system (otherwise known as the fight-or-flight system), and a decrease in vagal tone (the resting system) contributes to hot flashes, restlessness, and the feeling that you have been doing the cha-cha all night long, with the pool of sweat to go with it.

So, what do you do about it? First, as I have already suggested, make an appointment with your doctor to determine whether something else is causing your insomnia. Review your medication and supplements. Assuming your doctor doesn’t find a cause, here’s what else you can try…

  • Cut out the caffeine in your world. Don’t forget that you can find that in some teas, coffee, chocolate or medication. Understand that caffeine can stay in your system from 7 to 20 hours, keeping you awake.
  • Stop the alcohol. It may make you sleep for a bit, but then it can wake you up prematurely, and your sleep can be restless.
  • Get back to the basics—daily exercise, small snacks with lean protein and carbs before bed, and practicing a daily sleep-inducing ritual to help put yourself to bed. I think about the steps I took to put my son to bed when he was a baby and just force myself to go through similar ones. TV off. Hot bath. A book. Darkness.
  • Turn your bedroom into a den of peace and calm. This step is most important. Leave the craziness outside your door, and make it a dark cave that allows you to escape. No work, no computers, no files to be organized, or clothes to be folded from the laundry. No extra stuff to cloud your thoughts or interrupt your sleepiness. Make your bedroom a place that allows you to relax, to dream, and to rejuvenate. Put a drop of lavender oil on your pillow or find some lavender potpourri to put next to your bed, play some classical background music, snuggle in a fluffy blanket, put on silky pajamas, and get under the covers. Now remind yourself that tomorrow is another day to live the best life that you can, and your sleep will help you do that. Close your eyes and say, “I can. I will.”

It’s working. I am going back to bed. Goodnight!!!

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