During menopause, hormonal changes can be disruptive, and in particular cause problems in getting a restful night’s sleep. A recent patient of mine complained of bothersome menopausal symptoms which were making her chronically fatigued. She wanted a non-pharmaceutical solution to her insomnia, so she could have more energy during the day, which would decrease the severity of her other symptoms. These are the principles we discussed to help her get better sleep during menopause.
First, it is important to understand the time course and typical symptoms of menopause in order to know what to expect. Onset is typically between 45 and 55, and the major symptoms usually last for a couple of years although on occasion can last 5 years or more. Hot flashes, night sweats, and insomnia are common symptoms. Surgical menopause can bring on these symptoms immediately. A cousin of mine recently had a complete hysterectomy with both ovaries removed, and instantly got menopausal symptoms. She was reassured when told her menopausal caused insomnia would gradually go away, which it did over the following 18 months.
The initiation of sleep sometimes is the primary cause of insomnia from menopause. For this, it is helpful to initiate a bedtime routine, such as having a small cup of chamomile tea, then washing up, and finally going to bed with the room dark and no electronic devices such as the TV turned on. In the case of my recent patient, this was found to be the primary problem. Setting up a simple three step routine (tea, washing up, then to bed with all lights off) greatly improved her sleep and energy level during the day.
When insomnia from menopause disrupts the entire night of sleep, the focus is upon maintaining sleep. For this, once again setting up good habits is the key. First, do not have very much to drink, even water, for a few hours before going to sleep, and then go to the bathroom just before going to bed. Go to sleep at a regular hour every night, and wake up at a regular hour. My mother had this problem. She tried a pharmaceutical which allowed her to fall asleep, but she would always wake up throughout the night. Following these good sleep habits helped her, although she did still struggle with insomnia for about 2 years.
Insomnia from menopause can be challenging to overcome completely. Establishing good sleep habits, however, can have a dramatic effect. First, rest assured that in most cases the insomnia will gradually improve after about a year or two. Second, make up a restful routine just before going to bed. Having something warm, like a small cup of herbal tea, can help relax the body as can washing the face with a warm rag. Finally, minimize disruptions from having to go to the bathroom in the middle of the night. This can often be accomplished by limiting fluid intake after dinner, and using the bathroom just before going to bed. Pharmaceutical therapy can sometimes be helpful, especially in menopausal women who are or become depressed, but in many cases not necessary.
REFERENCES
Hendrix SL. Menopause. In: Porter RS, Kaplan JL (eds). The Merck Manual Online [accessed 12/12/2011]
Lande RG, Gragnani C. Nonpharmacologic approaches to the management of insomnia. J Am Osteopath Assoc. 2010 Dec;110(12):695-701.