Menopause and Sleep Problems

When Frisca Yan-Go wakes up beside her husband at 3:00 A.M. in their Los Angeles bedroom, her efficient mind is likely to begin popping with creative approaches that will meet the challenges she left sitting on her desk back at the UCLA Medical Center. But unlike the rest of us, she won’t waste her energy by tossing, turning, and worrying about whether or not she’ll remember all those brilliant thoughts the next morning. Instead, she’ll calmly reach over to her nightstand, pick up a voice recorder, dictate a few words, then slide gently back into sleep.

As a neurologist and psychiatrist, as well as the medical director of the UCLA Sleep Disorders Center, Frisca L. Yan-Go, M.D., has a distinct advantage over the rest of us. For one thing, she knows what’s going on in her mind and why it woke her up. For another, she has a whole bag of little tricks to shut it down and send it back to sleep.

Those tricks are particularly important during perimenopause. Some 59 percent of women between the ages of 35 and 55 won’t get much sleep in the 4- to 8-year period prior to menopause that’s generally referred to as perimenopause. In fact, researchers say that this group of women is more likely to experience insomnia than any other.

Unfortunately, the closer women get to menopause itself, the less they sleep. According to a 2007 National Sleep Foundation poll, by the time women actually stop menstruating, somewhere between the ages of 45 and 51, a full 61 percent will report that they can’t get to sleep or stay asleep several nights each and every week.

What’s Going On

A lot of tossing and turning. Some 59 percent of women between the ages of 35 and 55 won’t get much sleep in the 4- to 8-year period prior to menopause that’s generally referred to as perimenopause. In fact, researchers say that this group of women is more likely to experience insomnia than any other.

Unfortunately, the closer women get to menopause itself, the less they sleep. According to a 2007 National Sleep Foundation poll, by the time women actually stop menstruating, somewhere between the ages of 45 and 51, a full 61 percent will report that they can’t get to sleep or stay asleep several nights each and every week.

Surveys indicate that roughly 57 percent of us can’t sleep because of hot flushes, anxiety, depression, and chronic insomnia, while another 43 percent have a sleep disorder such as obstructed breathing, narcolepsy, or restless legs syndrome. Hot flushes alone cause women approaching menopause to briefly rouse 100 times a night—around three times more than a woman who is not.

Yet as seemingly unrelated as these challenges are, new research shows that they appear to share one thing in common: They are all initiated or otherwise affected by imbalances in various hormones that are regulated by the body’s biological clock in the brain’s hypothalamus—the SNC.

“The SNC is where you have the axis for the sleep/wake cycle and the axis for all the endocrine glands that affect monthly reproductive rhythms,” says Dr. Yan-Go. “They’re all linked together like an orchestra,” so when one cycle is out of whack, it tends to sideswipe the others as well. When perimenopause arrives with its roller-coaster ride of hormonal ups and downs, the entire orchestra gets out of sync, says Dr. Yan-Go, and disrupted sleep is frequently the result.

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“The best sleep we ever get is between age nine and menarchy,” she adds ruefully. “After that, it’s all ups and downs.”

The 3:00 A.M. Wake-Up Call

Although more than half of us aren’t sleeping, studies have shown that most perimenopausal women can get to sleep, they just can’t stay that way. Instead, they wake intermittently throughout the night or in the wee hours of the morning.

And sometimes women aren’t even aware of how often they wake, says neurologist Hrayr P. Attarian, M.D., director of the University of Vermont sleep center. “But if you’re falling asleep during the day when you don’t want to, or if you wake up after a good night’s sleep and feel as though you haven’t slept at all, then you should be talking to your physician.”

The type of insomnia that causes you to wake through the night or in the early morning hours can be caused by both external and internal factors, explains Dr. Yan-Go. Externally, you may have to go to the bathroom or you may simply be too hot or too cold. Or you may experience a hot flash or perhaps its chilly aftermath. Throw the covers off, doze, realize you’re freezing, and pull the covers back up. If you’re perimenopausal, you know the routine.

But insomnia caused by internal factors is less straightforward. Generally, says Dr. Yan-Go, when you wake in the middle of the night, it’s because something has bubbled up from your subconscious.

The mind is very active during REM sleep, she explains, but when it actually wakes you up, it’s usually involved in processing one or the other of two kinds of events: the ones that happened most recently and the ones from your past that are the most intense.

“Generally, you wake up and you just don’t know why,” says Dr. Yan-Go. “It may be that 5 o’clock meeting you had with your boss, or like my husband, it may be the memory of something that happened during wartime.”

For recent events Dr. Yan-Go is pragmatic. If she wakes up and recalls an unfinished report left on her desk at work, rather than worrying about it and letting it disrupt her sleep, she’ll pick up the voice recorder on her night table, dictate as much of the report as she can, shut off the recorder, then go back to sleep.

For intense events from the past, things are more complicated. In some cases, if the experience isn’t buried too deep, you can dictate the memory into a voice recorder, erase it, dictate it again, erase it, and do the whole thing all over again. “Verbalizing gets the memory out of storage, where you can deal with it so it won’t come out and bother you during the night,” says Dr. Yan-Go.

If that doesn’t work, then you need to go into talk therapy and face the event before it will stop waking you up. “Denial is good when you’re in Iraq and you have shrapnel in your shoulder,” says the psychiatrist. “When you’re drinking and thinking and not sleeping, it’s bad.

“The bottom line is that we all have challenges in our lives. Some we can control; others we can’t. What we can always change, however, is how we respond.”

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