By Dr. Kiran Varma

Insomnia is a prevalent condition that women deal with during menopause, and it can have many negative effects on their lives. Some studies suggest that perhaps up to 60% of older women experience some form of sleep disturbance at some point in time. Other reports quote figures as high as 80%. 

Reports also show an increased propensity towards other health icebergs like depression and cardiovascular disease that often accompany insomnia – these are preventable if diagnosed early enough.

Sleep is a necessary part of life. We all know we should be getting 7-8 hours of sleep per night. We also know that the quality of sleep is as important as the quantity. 

It’s important to get enough rest so that we can function normally during waking hours, but when menopause symptoms are significant and hot flushes keep you awake at night, sleep quality can be severely affected. 

Furthermore, hormonal changes and weight gain can increase a woman’s risk of sleep disorders like Obstructive Sleep Apnoea (OSA) and restless legs.

We hear of the stress hormone cortisol playing a role in our lives, and this is true in menopause as well. 

An underlying change in cortisol response alongside a reduction in reproductive hormones is thought to be a contributing factor in the degradation of sleep quality, leaving many women feeling “wired yet tired”.

Well, how can someone know if they have a sleep disorder? 

Sometimes the obvious, asking yourself if you feel tired, isn’t enough. 

Screening tools such as STOP BANG, Epworth Sleepiness Scale and OSA50 questionnaire may be able to help to clarify the extent of symptoms.

Simultaneously, it is important to visit your GP to further get referred for a sleep study.

 

How Sleep Disorders Around Menopause Are Treated

There is often a large behavioural component to sleep issues which must be addressed alongside medical approaches.

No matter what your reasons for insomnia are, poor sleep habits can prolong them if it’s not dealt with properly; so we need a comprehensive approach that will help manage these problems successfully.

We recommend a systematic approach to improving sleep:

*Identify and treat the contributing factors with your doctor: Treat hot flushes, work on losing weight, and get a sleep specialist review if required. Sometimes, a mandibular advancement splint (MAS) or CPAP device if recommended. Managing concurrent anxiety symptoms or chronic pain can also assist people with getting better sleep.

*Sleep hygiene – behavioural changes to improve sleep problems: Sticking with regular bedtimes helps restore normal sleep/wake cycles which promote better quality sleep.Cognitive Behavioural

*Therapy (and similar therapies) have shown good benefits in studies.

*All exercise can be beneficial. At the time of writing this article, high-intensity exercises and yoga seem to yield the best benefit for insomnia.

*Acupuncture may also be an option for you if other therapies have failed.

*Medication options used depend on the exact pattern of the insomnia and also the cause:

-Hormonal or non-hormonal treatment to reduce the frequency and severity – for those on HRT, micronised progesterone taken orally at night can provide a sedating effect which is usually well perceived by patients.

-Melatonin can help in treating circadian sleep disorders as well as Valerian which shows some promise when it comes to improving your night time hours.

-Antidepressants like gabapentin and agomelatine (structurally similar to melatonin) can also be beneficial for insomnia.

-Sedating antihistamines can help and while they can be bought over the counter, we would recommend that they are taken after consultation with your GP.

-Benzodiazepines like diazepam and oxazepam are poor choices for chronic insomnia due to side effects and dependence concerns.

It is really important, especially for women going through menopause, to consider their sleep quality and how they feel in the morning. Some of the steps mentioned above hopefully point you in the right direction. If you need further assistance, it is important to follow up with your regular GP for further advice.

TXT us on 0488 882 069 to find out how we can help.

References:

1.Sleep problems during the menopausal transition: prevalence, impact, and management challenges”: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810528/

2.AMS Information sheet: “Sleep disturbance and the Menopause” https://www.menopause.org.au/hp/information-sheets/949-sleep-disturbance-and-the-menopause2