Its like clockwork.  You wake at 2am, for no particular reason and your brain is wide awake.  Without the forecast of more sleep on the horizon, you lay there in the misery of your sleeplessness knowing your exhaustion will only be compounded with the demands of the ensuing day. Night after night, like the movie Ground Hog Day, the same events play themselves out over and over.  Ugggg.

Its estimated that menopausal insomnia affects forty to fifty percent of women going through the transition compared to non-menopausal women.  There appears to be a direct relationship to hormonal change and is common across different cultures and ethnicities.  More severe symptoms are reserved for women who are launched into menopause after a complete hysterectomy, in which the ovaries are removed.  Also, menopausal symptoms of hot flashes and night sweats can be predictive of poor sleep quality. The deck is stacked.

The impacts of menopausal insomnia extend beyond a day of exhaustion.   There is an increased risk of depression, high blood pressure and heart disease as observed in the Study of Women’s Health Across the Nation (SWAN) which evaluated over three thousand menopausal women for eight years.  Of these, mood change and depression seems to be most prevalent outcome of poor sleep.  However, this works in two directions; women who suffer from depression often report poor sleep quality and duration.  Its a real dilemma.  

If you are like my patients and women I know and love who are suffering, I’m probably preaching to the choir.  So, lets get to the “to do” about it and get you back on the path to more rest with all its benefits of better energy, emotional stability, brain health, etc.

The path forward seems to have several branches but when combined together can yield the best results. Here are my suggestions:

  1. Get hot flashes under control:  Eighty percent of women in menopause report hot flashes.  Hormone replacement therapy can be a lifesaver for many women. Non-hormonal therapies including natural and prescriptive solutions and can be equally effective.  Talk to your medical provider about what is right for you.
  2. Create a positive state of mind and bedtime environment: The science around Cognitive Behavioral Therapy is very strong and includes sleep hygiene methods like creating a dark, quiet space for sleep and changing your state-of-mind.  Many patients dread going to bed, which further exacerbates anxiety.  If you feel this way, get up and go to another room and save your bed for a time when you can finally relax. Consider seeking professional counseling in this field.
  3. Kick the stress:  I attended a lecture on sleep once where the presenter said something important, “Insomnia is not a nighttime problem, it’s a daytime problem.”.  So, the stressors of the day, can wind up influencing our rest at night. Formulate a plan for stress reduction: consider meditation, yoga, a hot bath, a walk with a friend, anything. Consistency is the key.
  4. Get active:  Participate in higher intensity exercise at least 3-4 days per week for 30 minutes or greater. The evidence on exercise and sleep is indisputable.  So, get moving today and tomorrow, and the next day, etc, etc.
  5. Consider sleep aids: There are so many options here and while they are often the first things considered, I encourage you to make them your last.  However, it if it comes down to it, natural formulations, over-the-counter medicines and finally prescriptions are all available and can be a useful tool. In an upcoming blog, I’ll address my five most used sleep aids for women. 

The benefits of restful sleep are numerous, while the opposite is equally true.  Our cognitive, emotional, heart, and metabolic (and more) health can be disrupted without it.  If you are counting sheep, night after night, take some actions today to get you back on track.  If one method doesn’t work, don’t give up.  A full night sleep is closer than you think.