When high-octane coffee can't wake you up, and your day is one long round of irritation and bone-tiredness, it's time to get some help. This ongoing column will explore the in's and out's of getting a truly deep, restorative sleep.
If you're tired all the time, you're not alone. Seventy-four percent of women don't get the recommended eight hours sleep every night, and 41 percent are having trouble sleeping at all. Around menopause particularly, many American women face a constant battle with fatigue.
Why is fatigue more a problem for women than men? It's part of their biology to be on "alert" even when we're resting. Women have "mother's ears" that are ever-sensitive to nighttime cries. But that means they also have more trouble screening out the snores, snorts and sighs that come from the male side of the bed.
Also, women are more susceptible than men to daytime stress and worry and anxiety more easily disturb their night's sleep. This means that an argument with a colleague can keep you awake, and so can unfinished business at the office. While an inability to relax and "come down" from a stressful day is linked to insomnia, biology also plays its part. Menstruation, menopause and pregnancy are the Big Three when it comes to altering sleep patterns.
Not getting enough sleep can have serious consequences. Your work can suffer; other people can get under your skin unduly; your concentration can fray; and even your memory can stumble. If your sleep problems persist, you'll have a hard time juggling the rest of your life: your partner, your family, your work and your friends.
We believe sleep is such an important issue for women that we plan to devote a regular column to it. In this issue of the newsletter, we will explore night sweats, one of the most common menopausal sleep disturbances.
In future newsletters, we will describe ways to alleviate teeth grinding, jaw pain, leg twitches, snoring and breathing problems that happen during sleep. We'll also address such root problems as depression, anxiety, bladder trouble and medications that affect your sleep. Finally, we'll consider how drugs and alcohol alter your sleep patterns and what to do about life- long sleep disorders.
Hot flashes: an unwanted wake-up call
Night sweats and hot flashes are common menopausal symptoms that can last for years. You may wake up so drenched you have to change your nightgown. Your body temperature's set point may shift, causing you to sweat. This can disturb your sleep or make you restless for the entire night.The more often you wake up, the more drained you will be the following day. You may not be able to concentrate well, and you might even feel sad or get easily upset. Not every menopausal woman has sleep disturbances but those who do have widely varying symptoms.
Women with menopausal sleep disorders are often encouraged to "tough it out." Some doctors quote the classic definition of menopause as "having one year without a period" and tell their patients that they are not at this stage yet or that the discomfort is only temporary. In fact, researchers have found that symptoms of the "change" can start up to 10 years prior to the final menstrual period. This is a long time to go with no relief.
If you're perimenopausal, you may still have periods, and there may be no difference in your blood tests such as the FSH that measures follicle-stimulating hormones. Doctors often refer to this transition as a time of "sputtering for the ovaries." This refers to the inconsistent hormone production during the time the ovaries slowly shut down their egg production and consequent estrogen and progesterone production.
If you start your change very early – in your 30s or 40s–and find yourself waking up with night sweats, you need to find out why.
Some women in early menopause have a tough time convincing their doctors that they are having any serious discomfort. But they should insist on discussing the problems. If you have night sweats and sleep problems tell your doctor you need help and ask how to alleviate these symptoms.
You may have to explain that night sweats are significantly affecting both your sleep and your quality of life. Remember, too, that both hot flashes and night sweats are often made worse by anxiety, depression or stress. If that's the case, it is often better to treat the underlying emotional problem and then wait to see if the symptoms lessen or disappear.
Treatment Options
Among the array of remedies your doctor may suggest are birth control pills, hormone replacement therapy, nutritional supplements such as soy (isoflavones), black cohosh or Remifemin ®. The natural treatments are less proven but very popular. Studies show that antidepressants can also help.
This is where frank talk with your doctor is invaluable. Detail how severe your symptoms are, and, together, settle on the right treatment for you. If you do not want to use hormones, and the nutritional approach has not worked for you, ask your doctor or nurse practitioner about low-dose antidepressants, specifically Effexor, generically referred to as Venlafaxine.
Dr. Charles Loprinzi of the Mayo Clinic in Rochester, Minn. has been studying treatments for hot flashes in women with breast cancer, specifically those who cannot take hormone treatments and do not get relief with nutritional supplements like soy and herbs. Dr. Loprinzi found that certain antidepressants given at lower-than-normal doses can significantly reduce hot flashes. Effexor, Paxil and Prozac all were effective, but the best results were with Effexor, which reduced hot flash episodes by up to 61 percent. Dr. Loprinzi is also investigating a well-known antipain and antiseizure drug called Neurontin (Gabapentin) for this purpose. At the North American Menopause Society meeting in Miami, September 2003, researchers noted that Zyrtec, a popular antihistamine, shows promise for reducing hot flashes as well.
For further information, try these tips from the National Sleep Foundation http://www.sleepfoundation.org/sleeptips.cfm
References
Armitage, R., M. Trivedi, et al. (1997). "Relationship between objective and subjective sleep measures in depressed patients and healthy controls." Depress Anxiety 5(2): 97- 102. Abstract
Baker, A., S. Simpson, et al. (1997). "Sleep disruption and mood changes associated with menopause." J Psychosom Res 43(4): 359-69. Abstract
Loprinzi, C. L., J. W. Kugler, et al. (2000). "Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial." Lancet 356(9247): 2059-63. Abstract
Loprinzi L, Barton DL, Sloan JA, Zahasky KM, Smith de AR, Pruthi S, Novotny PJ, Perez EA, Christensen BJ. Pilot evaluation of gabapentin for treating hot flashes. Mayo Clin Proc. 2002; 77(11):1159-63. Abstract
National Sleep Foundation. Women and Sleep Poll, 1998. Full Text
Ramos, C. C. et al. Cetirizine (Zyrtec) in the management of menopausal hot flashes: a randomized controlled trial. Presented at the North American Menopause Society Meeting, Miami, FL 2003.
Tataryn, I. V., P. Lomax, et al. (1980). "Postmenopausal hot flushes: a disorder of thermoregulation." Maturitas 2(2): 101-7. Abstract
This article is for educational purposes only and is not intended as a substitute for medical advice. Please consult with a clinician to review any current symptoms and address your medical concerns.
