Sleep Health

  • For some women, a connection may exist between poor sleep and hormones

    Original Post | Washington Post Health

    By Leigh WeingusSeptember 18, 2021 at 9:00 a.m. EDT

    I’ve struggled with sleep since I was a teenager, and have spent almost as long trying to fix it. I’ve absorbed countless books and articles on getting better sleep that instructed me to go blue-light free at least two hours before bedtime, take nightly baths to lower my body temperature, keep my phone far from my bedroom and avoid caffeine after 12 p.m.

    In between all my diligent sleep hygiene work, I couldn’t help but feel like there was a larger force at play. My sleep seemed to change throughout my menstrual cycle, for example, getting worse in the days before my period and significantly better afterward. When I was pregnant, I experienced the best sleep of my life, and when I stopped breastfeeding, I didn’t sleep for days.

    Hormones and Women Sleep

    I finally started to ask myself: When we talk about getting better sleep, why aren’t we talking more about hormones?

    According to the National Sleep Foundation, the lifetime risk of insomnia is 40 percent higher for women than it is for men. Blaming this discrepancy entirely on hormones oversimplifies it — women also tend to take on the bulk of household worrying and emotional labor, and they tend to experience higher levels of anxiety.

    But according to Mary Jane Minkin, an obstetrician-gynecologist and clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the Yale School of Medicine, anecdotal evidence and studies suggest that hormones likely play a role.

    If you look at the curve of hormonal secretion throughout the average menstrual cycle, Minkin says, you’ll see varying levels of estrogen and progesterone throughout the month, with a big drop of estrogen occurring right before menstruation.https://414a56c8c82860bb2b57ff47754d945d.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html

    “Many people will tell me that a day or two before their period, their sleep is terrible,” Minkin says.

    When a woman enters perimenopause, she starts to experience more fluctuations and produces less estrogen and progesterone throughout the month, which may wreak havoc on her sleep. The true correlation between these hormone dips and fluctuations and insomnia needs to be studied more extensively, Minkin and other experts say, and understanding this connection is confused by how a lack of estrogen is associated with hot flashes, which can disrupt sleep.

    Studies of women on hormone replacement therapy (HRT) and sleep strongly suggest a connection between female hormones and insomnia, Minkin and other experts say.

    HRT is often prescribed to women going through menopause (and the years after it) to help them deal with unpleasant side effects of that transition, which include sleep problems, Minkin says. Some types of HRT include only estrogen, while others have a combination of estrogen and progesterone. High levels of estrogen and progesterone occur naturally during pregnancy, which may explain why some pregnant women like me often experience blissful sleep, Minkin says.

    “During pregnancy, guess what? Your levels of estrogen and progesterone are very high,” Minkin says.

    Although postmenopausal women have very low levels of estrogen and progesterone, once the process of menopause is complete, they often begin to sleep better. “We think hormone fluctuations can be more bothersome to some women than their actual hormone levels,” Minkin says.

    She adds that if a postmenopausal woman does struggle with insomnia, low hormone levels could be the culprit, so it’s a good idea to talk with a medical professional about HRT options. A 2008 randomized, controlled study of some 2,000 postmenopausal women in the United Kingdom found “small but significant” improvements in sleep after a year of HRT vs. those taking a placebo.

    Hadine Joffe, a psychiatry professor who is executive director of the Mary Horrigan Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital at Harvard, says hormonal fluctuations may be a cause of insomnia for some women. But for others, she says, sleep disruptions might be anxiety-related, or caused by noisy neighbors or a snoring bed partner.

    She says that while some women experience amazing sleep during pregnancy, many others report terrible insomnia during that time of life. Her advice? If you want to figure out whether any connection exists for you, track it.

    “Try a [sleep] app or even a conventional sleep diary,” Joffe says. “If you track your sleep for several months, you may start to notice a pattern emerge, like more waking in the middle of the night right before your period.”

    If you do notice a pattern, she says, that information may be helpful going forward.

    “If you know there are two or three days in every month when you don’t sleep well, make sure that’s a time when you practice the best possible sleep hygiene, avoid alcohol, and if you have a partner you share family responsibilities with, you can ask them to get up with the baby or toddler,” Joffe says.

    Sometimes targeted treatment for those days can help, too, she adds. For example, supplementing with a few milligrams of melatonin before bedtime — the hormone our brains naturally produce in response to darkness — can help signal to the brain that it’s time to sleep. Or if you have a prescription for a sleep aid, this could be the time to use it, she says.

    While it’s not always possible due to work or family responsibilities, Kin Yuen, a sleep medicine specialist at Stanford Medicine, suggests trying your best to honor your natural daily hormone fluctuations to help keep your sleep on track. To do this, you’ll have to try to figure out when your body naturally releases cortisol (the hormone we produce in the morning that helps us wake up) and melatonin (the hormone we produce at night to help us fall asleep).

    By figuring out when you have the most energy — are you an “early bird” who wakes up full of energy, or a “night owl” who still feels sluggish at 9 a.m.? — you can better pinpoint when your body naturally releases these hormones. If you adjust your schedule to honor these rhythms, you may experience fewer sleep disruptions even in the face of constantly fluctuating female hormones, Yuen says.

    Finally, while HRT is not prescribed for women who have not yet gone through menopause, both Minkin and Joffe say that if someone is sure that their insomnia is hormone-related — preferably by having kept a diary for a while and after having tried other techniques without success — it’s worth talking to their doctor about taking a birth control pill.

    “Hormonal birth control can smooth out the ups and downs that just aren’t good for some people’s brains,” Joffe says. “It has to be the right treatment for the right person, but it can help.”

    Of course, there are side effects to birth control. Some women report nausea, headaches and lower libido. Although rare, more serious side effects have been reported, too, such as blood clots.

    But for many women suffering from what seems to be hormonally related insomnia, the benefits may outweigh the risks.

    Minkin says that even for patients going through menopause, if they are otherwise healthy, she’ll often prescribe birth control pills. Birth control pills have higher levels of hormones than traditional HRT, and if a woman has used them in the past and hasn’t experienced negative side effects, this can be a good indication that they will work well for her.

    “The only drawback is that we have no way of knowing when a woman is done with menopause, because the pill will artificially give her a period,” Minkin says. “So in order to find out if she’s done with menopause, she has to stop the pill.”

    At this point, Minkin and other experts say more research needs to be done to truly understand how the ebbs and flows of female hormones impact sleep.

    Sleep diaries, trackers and apps can be powerful tools to help a woman understand whether a connection exists for her, and they can help her act accordingly, the experts say.

    The pandemic is ruining our sleep. Experts say ‘coronasomnia’ could imperil public health.

    It’s not just the pandemic. The moon may be messing with your sleep, too.

    Poor sleeping, no energy, low libido: Is it aging?

  • Body Clock Off-Schedule? Sleepless Nights?Prebiotics May Help

    Original Article Posted by Sleep Review Staff | Sep 16, 2021 | Jet Lag Disorder

    Whether it’s from jetting across time zones, pulling all-nighters at school or working the overnight shift, chronically disrupting our circadian rhythm—or internal biological clocks—can take a measurable toll on everything from sleep, mood and metabolism to risk of certain diseases, mounting research shows.

    But a new University of Colorado Boulder study funded by the U.S. Navy suggests simple dietary compounds known as prebiotics, which serve as food for beneficial gut bacteria, could play an important role in helping us bounce back faster.

    “This work suggests that by promoting and stabilizing the good bacteria in the gut and the metabolites they release, we may be able to make our bodies more resilient to circadian disruption,” senior author Monika Fleshner, a professor of integrative physiology, said in a statement.

    Woman Suffering from A Sleepless Night

    The animal study, published in the journal Brain, Behavior and Immunity, is the latest to suggest that prebiotics—not to be confused with probiotics found in fermented foods like yogurt and sauerkraut—can influence not only the gut, but also the brain and behavior.

    Naturally abundant in many fibrous foods—including leeks, artichokes and onions—and in breast milk, these indigestible carbohydrates pass through the small intestine and linger in the gut, serving as nourishment for the trillions of bacteria residing there.

    The authors’ previous studies showed that rats raised on prebiotic-infused chow slept better and were more resilient to some of the physical effects of acute stress.

    For the new study, part of a multi-university project funded by the Office of Naval Research, the researchers sought to learn if prebiotics could also promote resilience to body-clock disruptions from things like jet lag, irregular work schedules or lack of natural daytime light—a reality many military personnel live with.

    “They are traveling all over the world and frequently changing time zones. For submariners, who can be underwater for months, circadian disruption can be a real challenge,” said lead author Robert Thompson, a postdoctoral researcher in the Fleshner lab. “The goal of this project is to find ways to mitigate those effects.”

    How a healthy gut may prevent jet lag

    The researchers raised rats either on regular food or chow enriched with two prebiotics: galactooligosaccharides and polydextrose.

    They then manipulated the rats’ light-dark cycle weekly for eight weeks—the equivalent of traveling to a time zone 12 hours ahead every week for two months.

    Rats that ate prebiotics more quickly realigned their sleep-wake cycles and core body temperature (which can also be thrown off when internal clocks are off) and resisted the alterations in gut flora that often come with stress.

    “This is one of the first studies to connect consuming prebiotics to specific bacterial changes that not only affect sleep but also the body’s response to circadian rhythm disruption,” said Thompson.

    The study also takes a critical step forward in answering the question: How can simply ingesting a starch impact how we sleep and feel?

    The researchers found that those on the prebiotic diet hosted an abundance of several health-promoting microbes, including Ruminiclostridium 5 (shown in other studies to reduce fragmented sleep) and Parabacteroides distasonis.

    They also had a substantially different “metabolome,” the collection of metabolic byproducts churned out by bacteria in the gut.

    Put simply: The animals that ingested the prebiotics hosted more good bacteria, which in turn produced metabolites that protected them from something akin to jet lag.

    Are supplements worthwhile?

    Clinical trials are now underway at CU Boulder to determine if prebiotics could have similar effects on humans.

    The research could lead to customized prebiotic mixtures designed for individuals whose careers or lifestyles expose them to frequent circadian disruption.

    In the meantime, could simply loading up on legumes and other foods naturally rich in the compounds help keep your body clock running on time? It’s not impossible but unlikely, they say—noting that the rats were fed what, in human terms, would be excessive amounts of prebiotics.

    Why not just ingest the beneficial bacteria directly, via probiotic-rich foods like yogurt?

    That could also help, but prebiotics may have an advantage over probiotics in that they support the friendly bacteria one already has, rather than introducing a new species that may or may not take hold.

    What about prebiotic dietary supplements?

    “If you are happy and healthy and in balance, you do not need to go ingest a bunch of stuff with a prebiotic in it,” said Fleshner. “But if you know you are going to come into a challenge, you could take a look at some of the prebiotics that are available. Just realize that they are not customized yet, so it might work for you but it won’t work for your neighbor.”

  • How to tell if it’s time for a ‘sleep divorce’

    (CNN)He snores until the walls rattle. She gives off a massive amount of body heat. One of you is a cover hog, kicks at night or takes consistent 3 a.m. bathroom breaks. Maybe you sleepwalk or suffer from insomnia. The list of reasons why your bed partner might be keeping you up at night could be long and as dreary as your mood when you drag yourself from bed each morning.

    When it comes to your health, that’s nothing to yawn at: Being deprived of a full seven to eight hours of sleep each night has been linked to a higher risk of diabetes, stroke, cardiovascular disease and dementia, according to the US Centers for Disease Control and Prevention.

    Sleep Divorce As A Result of Sleep Deprivation

    There’s an emotional toll as well, said sleep specialist Wendy Troxel, a senior behavioral scientist at RAND Corporation who authored “Sharing the Covers: Every Couple’s Guide to Better Sleep.”

    “Sleep deprivation can affect key aspects of relationship functioning, like your mood, your level of frustration, your tolerance, your empathy, and your ability to communicate with your partner and other important people in your life,” Troxel said.Poor sleep — and that resulting crummy mood — makes people “less able to engage in ‘perspective taking,’ or putting small adverse events in context,” said sleep specialist Rebecca Robbins, an instructor in the division of sleep medicine for Harvard Medical School, who coauthored the book “Sleep for Success!”

    That strain can contribute to depression, anxiety, and other emotional and relationship dysfunction, Robbins said.

    Sleep training for adults prevents depression, study findsResearch done by Troxel and her team found that a well-rested person is “a better communicator, happier, more empathic, more attractive and funnier” — all traits that are key to developing and sustaining strong relationships, she said.Sleeping apart can help couples be happier, less resentful and more able to enjoy their time together in bed, particularly on weekends when work demands are lighter, Troxel said.”I tell couples to try to think of it not as a filing for sleep divorce, but as forging a sleep alliance,” she added. “At the end of the day, there is nothing healthier, happier and even sexier than a good night of sleep.”https://www.cnn.com/audio/player?episodeguid=85e00da6-889c-4c66-a203-adb70011ee08&parentOrigin=https%3A%2F%2Fwww.cnn.com&canonicalUrl=https%3A%2F%2Fwww.cnn.com%2F2021%2F12%2F04%2Fhealth%2Fsleep-divorce-wellness%2Findex.html

    Rule out underlying sleep issues

    Sleep partners are often the ones to flag signs of sleep disorders and encourage their loved one to visit a doctor or sleep specialist. Undiagnosed, sleep disorders may well harm you and your partner’s future health.That’s why experts say it’s best to check with a sleep specialist to rule out and treat any underlying condition before you leave your loved one’s bed — you may well be the key to identifying and treating a true health issue.

    Coping skills

    Once any serious health issue is ruled out, couples who find it emotionally bonding to sleep in the same bed may wish to try some practical coping tips before making the decision to sleep apart, Troxel said. No alcohol please. If you struggle with insomnia, cut out alcohol well before bed, experts say. It may appear to be helping you sleep, but booze actually causes middle of the night awakenings that can be hard to overcome. Snorers should eliminate alcohol as well, Troxel said, “because as everyone probably knows, if you sleep with a snorer and they have one too many drinks, the snoring will be much worse that night.” That’s because the alcohol further relaxes the throat muscles, encouraging that loud snore.

    Keep your brain sharp by finding your sleep ‘sweet spot,’ study saysThis is where partners can be powerful and beneficial sources of what experts call “social control,” Troxel said.”If you’re prone to drinking but you know that the consequences are not only going to bad for your sleep, but your partner’s sleep as well, then maybe you’ll be more motivated to cut back a bit,” she said.Raise the head. For snoring, try sleeping on additional pillows or using an adjustable bed — anything that raises the head to keep the throat open, Troxel said.”For many people snoring tends to be worse when they are flying flat on their backs, so raising the head a little bit can be useful,” she said.If the underlying issue is congestion, try adding a humidifier to the room, she added. “Some people have had success with over-the-counter nasal strips to keep the airway open.”Drown the sound. Survival 101 for dealing with a snoring partner is trying to deafen the noise, Troxel said. Try ear plugs and run a fan or white noise machine.Try sleep scheduling. A snorer who sleeps with a partner with insomnia can help that partner get more sleep by going to bed later than their partner, Troxel said.”For example, a snorer can delay their bedtime by a half an hour to an hour,” Troxel said. “That allows the partner to fall into a deeper stage of sleep and possibly stay that way once the snorer comes to bed.”Turn the snorer. Sleeping on the back is the worse position for snoring, because the soft tissues of the mouth and tongue collapse into the throat. As the sleeper unconsciously forces air past those soft tissues, snores emerge.

    How to fall asleep more quickly — the healthy way“If you can keep someone on their side, that can attenuate the snoring,” Robbins said. “I’ve heard of all kinds of creative techniques, such as putting a bra on the snorer in reverse and then putting tennis balls in the cups.”Full support body pillows may be an option, if they stay in place, said sleep specialist Dr. Raj Dasgupta, an associate professor of clinical medicine at the Keck School of Medicine at the University of Southern California.”I’m a fan of the simple things, but if you want to purchase something we’ve come a long way from sewing tennis balls into the back of our pajamas,” Dasgupta said. “You can buy a strap-on to your back that has little protruding foam-like things which are supposed to make you sleep on your side.”And there are some FDA-approved devices that strap to the throat or chest and provide vibrations designed to go off when you are on your back, prompting a move to side-sleeping.”

    Time for separate rooms?

    You’ve tried it all, and good sleep is still a distant dream. At this point, there’s no reason not to do what is best for each of you to get the quality sleep you need — especially since there are other ways to nurture a relationship besides sharing a bed.

    The best alarm clocks of 2021 (CNN Underscored)“Couples can still make the bedroom a sacred space, even if they choose not to actually sleep together,” Troxel said. “You can develop pre-bedtime rituals and use that time to actually connect with your partner instead of being independently on a phone or laptop or whatnot. “She encourages couples to spend quality time together before bed, sharing details of the day and sending positive messages to each other. “We know self-disclosure is good for relationships, it’s good for sleep,” Troxel said. “If you tell your partner you’re grateful for them, that’s a deep form of connection. Gratitude is good for relationships, it’s good for sleep.”

    Nor does a “sleep divorce” have to mean separate beds every night, Troxel said. It could be just the workweek, with weekends spent in the same bed. It could be every other night — the options are as unique as each couple. “There truly is not a ‘one-size-fits-all’ sleeping strategy for every couple,” Troxel said. “It’s really about finding the strategy that’s going to work best for the two of you.”

  • Marijuana may make sleep worse, especially for regular users, study finds

    By Sandee LaMotte, CNN | Original Article

    (CNN)It’s a common assumption among marijuana users: Using weed will help you fall asleep and stay asleep. Scientists, however, aren’t so sure that’s true.

    This is an understudied but important area, as many people are increasingly turning to cannabis products as sleep aids,” said sleep specialist Wendy Troxel, a senior behavioral scientist at RAND Corporation, who was not involved in the study.

    “But we really lack solid evidence demonstrating whether cannabis helps or hurts sleep,” Troxel added.

    Use of weed may actually harm sleep, a new study has found. The research, published Monday in a BMJ journal, revealed adults who use weed 20 or more days during the last month were 64% more likely to sleep less than six hours a night and 76% more likely to sleep longer than nine hours a night.

    Optimal sleep for adults is defined by the US Centers for Disease Control and Prevention as seven to eight hours a night.Moderate consumption — using weed less than 20 days during the past month — didn’t create short sleep problems, but people were 47% more likely to snooze nine or more hours a night, the study also found.

    No clear evidence either way

    The study analyzed use of marijuana for sleep among 21,729 adults between the ages of 20 and 59. The data was gathered by the National Health and Nutrition Examination Survey, and is considered representative of over 146 million Americans.

    Young adult cannabis consumers nearly twice as likely to suffer from a heart attack, research showsIn addition to issues with short and long sleep, people in the study who used weed within the last 30 days were also more likely to say they have trouble falling asleep or staying asleep, and were more likely to say they have discussed sleep problems with a health care provider, Diep said.”The problem with our study is that we can’t really say that it’s causal, meaning we can’t know for sure whether this was simply individuals who were having difficulty sleeping, and that’s why they use the cannabis or the cannabis caused it,” he added.Prior studies have also found a connection between the two components of marijuana, CBD and THC, and poor sleep. CBD, or cannabidiol, is a key component of medical marijuana, while THC, or tetrahydrocannabinol, is the main psychoactive compound in cannabis that produces the high sensation.A 2018 randomized, double-blind, placebo-controlled study — the gold standard — found no benefit from CBD on sleep in healthy volunteers. Other studies have also found high rates of insomnia when withdrawing from nightly use of marijuana.”At this time there still isn’t any clear evidence that cannabis is helping sleep,” said Dr. Bhanu Prakash Kolla, a sleep medicine specialist in the Center for Sleep Medicine at the Mayo Clinic in Rochester, Minnesota, who was not involved in any of the studies.”We know that when people initiate use there is some benefit in the immediate short term but there is quick tolerance to this effect,” Kolla said. There currently is no good quality evidence to suggest that cannabis will help improve sleep quality or duration.”

    Confounding factors

    Still, people continue to believe that weed is helping their sleep. Surveys of marijuana users show they do indeed rely on the drug for better sleep.”The issue is that there’s a disconnect between these anecdotal reports of people reporting therapeutic benefits and the evidence behind it in terms of the data,” Diep said.

    Sleep training for adults prevents depression, study finds One possible reason, Kolla said, is that when people stop using cannabis after a period of regular use, the withdrawal effects from weed can cause sleep disruptions. That leads people to believe “the cannabis was in fact helping (sleep), while what they are actually experiencing are withdrawal symptoms.” Another factor to consider is the increased potency of weed today as compared to when many of the studies on cannabis and sleep were conducted, said Dr. Karim Ladha, staff anesthesiologist and clinician-scientist in the department of anesthesiology and pain medicine at the University of Toronto.” A lot of the older data related to cannabis is based on lower doses of THC than what patients are using now, and there’s very little research related to CBD,” Ladha said.” Studies tell us about what happens at a population level, but on an individual level that discussion is much more personal,” he said. “The studies just give us the possibilities that (marijuana) could hurt your sleep, but it may help and so we just don’t know until you try it.”

    That’s why additional studies need to be done, he added.”Patients are spending money and time and resources to obtain cannabis right now to help with sleep,” Ladha said. “I think as the medical community, we need to do everything we can to make sure that we enable our patients to make the best possible decisions for their health.”

  • Sleep-disordered breathing tied to greater preeclampsia risk

    Women with high-risk pregnancies who experience sleep-disordered breathing have an increased risk for preeclampsia, according to a study published in the American Journal of Obstetrics & Gynecology.

    The prospective observational cohort study involved women with high-risk singleton pregnancies, author Stella S. Daskalopoulou, MD, MSc, PhD, of the department of medicine’s division of internal medicine at McGill University Health Centre in Montreal, and colleagues reported in the study.

    Women with mid-gestation sleep disordered breathing have a 3.4 odds ratio for preeclampsia, and women with late-gestation sleep-disordered breathing have an 8.2 odds ratio for preeclampsia.
    Phan K, et al. Am J Obstet Gynecol. | Original Post

    High-risk factors included age of at least 35 years, BMI of at least 25 kg/m2chronic hypertension, pre-existing diabetes or renal disease, conception via in vitro fertilization and personal or first-degree relative family history of preeclampsia.

    Of the 235 women recruited between 10 and 13 weeks of gestation at two tertiary obstetric clinics in Montreal, 181 women completed questionnaires about their sleep based on the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index and restless legs syndrome during each trimester.

    Women identified with sleep disordered breathing (SDB), defined as three or more incidences of loud snoring or witnessed apneas each week, in the first or second trimester were diagnosed with mid-gestation SDB. Women identified with SDB in the third trimester were diagnosed with late-gestation SDB.

    The researchers also conducted arterial stiffness, wave reflection and hemodynamic assessments between 10 and 13 weeks and again six more times at approximately 4-week intervals through the rest of the pregnancy.

    Carotid-femoral pulse wave velocity (cfPWV), which is considered the gold standard for predicting arterial stiffness and is predictive of preeclampsia, and carotid-radial PWV were calculated to determine aortic and peripheral arterial stiffness, respectively.

    According to the study, the 41 women (23%) who had SDB also had increased cfPWV across gestation independent of blood pressure and BMI (P = .042). Also, only women with SDB saw an association between excessive daytime sleepiness and increased cfPWV.

    After 20 weeks’ gestation, women who had BP of at least 140 mm Hg/90 mm Hg were diagnosed with preeclampsia.

    Women with mid-gestation SDB had an OR of 3.4 (95% CI, 0.9-12.9; P = .063) for preeclampsia, which increased to an OR of 5.7 (95% CI, 1.1-26; P = .028) for women who also experienced hypersomnolence. Women with late-gestation SDB had an OR of 8.2 (95% CI, 1.5-39.5; P = .009) for preeclampsia.

    Additionally, the researchers reported a positive association between excessive daytime sleepiness and central arterial stiffness in women with SDB but not in women who did not have SDB. Women who reported SDB and excessive daytime sleepiness appeared to have a greater risk for preeclampsia than women with SDB alone as well.

    However, women who had positive restless legs syndrome scores did not see increased odds for developing preeclampsia either in mid-gestation (OR = 1.23; 95% CI, 0.25-4.68) or late gestation (OR = 1.01; 95% CI, 0.21-3.75). The same held true for women who had positive Pittsburgh Sleep Quality Index scores in mid-gestation (OR = 2.11; 95% CI, 0.58-8.66) or late gestation (OR = 2.83; 95% CI, 0.65-19.81).

    Overall, the researchers said, there was an association between SDB in the first or second trimester and greater central arterial stiffness starting at 10 to 13 weeks’ gestation for women with high-risk pregnancies.

    Further, the researchers said, their results provide supporting evidence for arterial stiffness as an important mediator and promising surrogate endpoint for vascular dysfunction in preeclampsia, as well as for the need to screen for SDB throughout pregnancy.

  • Menopause and insomnia: What is the link?

    Original Post | Medical News Today

    After menopause, a person’s ovaries produce much lower amounts of certain hormones, including estrogen and progesterone. For some, this transition comes with sleep disturbances.

    Insomnia refers to the difficulty falling or staying asleep. It is a commonTrusted Source experience in menopause and may occur as a result of hormonal changes.

    It may also be a secondary result of the other symptoms of menopause, such as hot flashes.

    Read on for more information on menopause and insomnia, including why it happens, how long it may last, and what medical treatments and complementary therapies are available.

    Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

    Can menopause cause insomnia?

    The exterior of a large apartment building at night. Bright light illuminates one of the windows.
    Colin Anderson/Stocksy

    Yes – insomnia is a frequent occurrence during perimenopause and menopause. Some people only experience mild or occasional sleep disturbances, but for others, the insomnia can be severe.

    According to a 2018 article, 26%Trusted Source of people going through perimenopause and menopause experience insomnia that affects their daily activities.

    In females, the rate of insomnia increases with age. According to the Study of Women’s Health Across the Nation (SWAN)Trusted Source, the prevalence of sleep disorders is as follows:

    • 16–42% in premenopause
    • 39–47% in perimenopause
    • 35–60% in postmenopause

    Why does menopause cause insomnia?

    Research on the exact cause of insomnia during menopause does not point to one clear cause. Several things may contribute to it, including:

    Hormonal changes

    Some evidence suggests that low hormone levels can increase the likelihood of insomnia during menopause.

    According to the SWANTrusted Source, previous longitudinal studies have found a correlation between lower levels of estradiol and poorer sleep. This is especially true if the decline in hormones happens quickly, as it does after a person undergoes surgery to remove the ovaries.

    Hot flashes

    Sometimes, insomnia happens during menopause because of hot flashes or night sweats. These symptoms can disrupt sleep, causing frequent waking.

    Hot flashes, which are one of the so-called vasomotor symptoms, are common in menopause, affecting 75–85%Trusted Source of people going through menopause.

    Hot flashes cause a sudden sense of heat around the face and neck and often occur with sweating and a fast heartbeat.

    Reduction in melatonin

    Melatonin is a hormone that plays a key role in the sleep-wake cycle, helping keep people asleep. It is especially important at the start of sleep.

    However, melatonin levels appear to decrease with age, which may cause sleep disturbances.

    It is not clear whether there is a link between menopause and a decline in melatonin. Some evidenceTrusted Source suggests that there is and that individuals during postmenopause have less melatonin than those during premenopause.

    Mental health

    For many people, menopause signals a major change. It is also a sign that a person is getting older. This, along with the symptoms of menopause, can have an impact on an individual’s mental health.

    Many mental health conditions, including anxiety and depression, affect sleep. However, insomnia can also make depression more likelyTrusted Source. The relationship between sleep and mood is bidirectional, and changing hormone levels can also play a role.https://a76fa006e565d376844b91a5d5a8864a.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html

    How long will insomnia last?

    How long insomnia lasts during and after menopause depends on many factors. Every person who goes through menopause has a different experience. Some will find that the symptoms last longer than they do for others.

    A person’s hormone levels can start to change 7–10 yearsTrusted Source before a person’s last period. After this point, people can continue to have symptoms such as hot flashes for several years.

    Estradiol levels continue to decline for the first 1–6 years in early postmenopause, which may result in continued symptoms.

    It is of note, however, that there are treatments and therapies available that can reduce sleep difficulties. It is also important to address any other factors that may be contributing to poor sleep quality.powered by Rubicon Project

    Medical treatments for insomnia during menopause

    The main treatment for menopause-related insomnia is hormone therapy. This works by replacing the lost hormones, which can improve many menopause symptoms. People may find that they sleep better and experience fewer hot flashes while using this treatment.

    Hormone therapy is available in topical gels, creams, and patches. People can also take it internally via tablets or an implant.

    Another potential treatment is a low-dose selective serotonin reuptake inhibitor (SSRI).

    Doctors typically prescribe SSRIs for mental health conditions, but these medications can also reduce the frequency of hot flashes, which may help with sleep. However, it is of note that insomnia can also occur as a side effect of SSRIs.

    For those who are experiencing mood changes, anxiety, or depression, talk therapy may help them understand and cope with these feelings. Lessening the impact of mental health conditions may also benefit sleep.

    Doctors rarely prescribe sleeping pills to treat insomnia, as these can have serious side effects. Many are also addictive and are not suitable for managing a long-term sleep problem.

    Natural and complementary therapies

    According to a 2019 review, no study has found that herbal or dietary supplements consistently help with menopause symptoms. However, there are many other ways people can try to make sleep easier during menopause.

    Below are some evidence-based approaches:

    Avoiding caffeine, nicotine, and alcohol

    Smoking, consuming caffeine, and drinking alcohol can all make it more difficult to sleep. While it may seem that alcohol makes people drowsy, even a small amount reduces overall sleep quality.

    A person can try to reduce or avoid any of these, especially in the afternoon and evening.

    Aromatherapy

    Aromatherapy may be helpful in inducing relaxation and reducing hot flashes.

    In a clinical trial involving 100 women, researchers found that after 12 weeks of lavender essential oil inhalation, the participants had 50% fewer hot flashes.

    Other studies have also found that aromatherapy together with massage was more effective than massage or aromatherapy by themselves.

    Hypnosis

    A 2019 review notes that there is evidence that hypnosis may reduce the frequency and severity of hot flashes by up to 50%.

    Moreover, for people whose insomnia results from hot flashes, hypnosis may be a helpful complementary treatment.

    Yoga

    Some studies have found that yoga has a beneficial impact on the psychological symptoms of menopause. If a person is having difficulty sleeping due to stress or anxiety, yoga practice may help reduce these symptoms.

    However, the results of other studies on yoga have been mixed. This is partly because there are many styles of yoga and numerous ways of practicing, which may lead to inconsistent results.