The Menopause Exchange Blog

INSOMNIA AT THE MENOPAUSE

Insomnia – difficulty getting to sleep, or in staying asleep long enough to feel refreshed the next morning – can significantly impact on your quality of life. It can cause tiredness and limit your daytime activity and concentration.

This article was included in issue 70  (autumn 2016) of The Menopause Exchange newsletter.

On average, adults sleep for about six to nine hours every night, but this reduces as we age. What’s important is whether you feel you’re getting enough good-quality sleep, enabling you to wake up refreshed in the morning.

Common triggers

General factors that can affect your sleep include:

  • Poor environment, such as an uncomfortable bed or a bedroom that’s too light, noisy, hot or cold
  • Lifestyle factors, such as shift work or jet lag
  • Using alcohol, caffeine, tobacco and recreational drugs before going to bed
  • Stress, anxiety, depression and other mental health problems
  • Physical disorders, such as heart, respiratory or neurological conditions, chronic pain or hormonal problems
  • Medicines, such as some anti-depressants or treatments for high blood pressure, epilepsy or asthma.

Sleep and the menopause

Hot flushes and sweats can interrupt your sleep, affecting its quality, causing drowsiness or irritability the following day. Anxiety and depression may make it hard to fall asleep and cause early morning waking. Snoring is more common and more severe in post-menopausal women, which, along with pauses or gasps in breathing, may be signs of a more serious sleep disorder such as sleep apnoea, which is also more common at this age. Muscle and bone pain can also interrupt and affect general quality of sleep.

Dealing with sleepless nights

Try to achieve good ‘sleep hygiene’:

  • Take daily exercise, e.g. 30 minutes of walking, but not just before bed.
  • Try to establish fixed times for going to bed, then set an alarm for waking up, even if you feel you haven’t had enough sleep. But only go to bed when you’re tired.
  • Avoid heavy meals, caffeine, nicotine and alcohol two hours before bedtime.
  • Create a relaxing bedtime routine, e.g. take a bath, listen to soft music, have a warm, milky drink, to associate these activities with drowsiness and sleep.
  • Maintain a comfortable sleeping environment that’s not too hot, cold, noisy or bright – consider thick curtains/blinds, an eye mask or earplugs to stop you being woken by light and noise. Ensure your mattress and pillows are comfortable and appropriate for the weather, but try to have some fresh air flow in your room.
  • Light is a stimulus so don’t use bright or back-lit devices such as televisions, phones, tablets and computers shortly before going to bed.
  • Keep the bedroom for sleep or sex, not activities such as watching TV, making phone calls, eating or working in bed.
  • Write a list of your worries, and consider how to solve them, before going to bed to help you forget about them until the morning.
  • Don’t nap during the day.
  • Don’t lie in bed feeling anxious about your lack of sleep. Instead, go to another room for half an hour to do something quiet, such as reading, before trying again.
  • Complementary therapies, such as acupuncture, hypnotherapy, relaxation therapies and reflexology, may help by addressing background anxiety and tension. They may also play a role in managing chronic pain.

Seeking medical advice

See your GP if insomnia has been a problem for several weeks and self-help hasn’t worked. Your GP may suggest you keep a sleep diary – a daily record of the time you went to bed and woke up, how long it took you to fall asleep, how often you woke up during the night etc.

Your GP will review the diary, your general health and medication you take, then discuss and treat any underlying health condition, such as anxiety or pain, that may be affecting your sleep.

They may then refer you for Cognitive Behavioural Therapy for insomnia (CBT-I), a talking therapy aimed at helping you avoid thoughts and behaviours affecting sleep. Aspects include:

  • Stimulus-control therapy – associates the bedroom with sleep, establishing a consistent sleep/wake pattern.
  • Sleep restriction therapy – limits the amount of time spent in bed, creating mild sleep deprivation; sleep time is then increased as your sleeping improves.
  • Relaxation training – reduces tension or minimises intrusive thoughts.
  • Paradoxical intention – used if you have problems falling asleep, you try to stay awake and avoid any intention of falling asleep.
  • Biofeedback – sensors placed on your body measure your body’s functions, such as muscle tension and heart rate. These are linked to a machine producing pictures or sounds to help you recognise when you’re not relaxed.

Medication choices

You can buy over-the-counter (OTC) sleep aids, usually a type of anti-histamine, from pharmacies. These aren’t suitable for long term use and can cause side-effects, including making you drowsy the next morning, making driving and operating machinery dangerous.

Prescription sleeping tablets are usually a last resort, used for only a few days at a time, as they don’t treat the cause, can cause side effects and become less effective over time. Doctors now prescribe the ‘ Z–drugs’ e.g. zolpidem and zopiclone, but long-term treatment isn’t normally recommended because they become less effective over time and some people become dependent.

Circadin, for adults aged 55 or over, is sometimes useful. Containing the naturally occurring hormone melatonin, it helps to regulate the sleep cycle.

If menopausal symptoms are affecting your sleep, HRT may help to improve your sleep quality.

About the author
Gill Jenkins is a GP in Bristol with particular interest in lifestyle health, women’s health and travel.

Created autumn 2016

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