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Sleep And Menopause


Sleep_And_MenopauseMenopause, the transition into midlife, is normal event in every womanís life and most women live long enough to experience it. Generally, menopause is said to be present once there has been an absence of any menstruation for 12 months.


The average age at which menopause occurs in Western societies is 51.4 years but it can occur between 40 to 58 years and is also influenced by lifestyle and genetic factors such as smoking, obesity, ethnicity, oral contraceptive use, age at menarche, and duration of breastfeeding. Some women can experience a very early menopause in their thirties and if the ovaries are removed at any age after puberty, menopause will result.


The time before and after menopause is called the perimenopausal period. It is a period a period of transition where changes take place in the hormonal system and brain (with the decreasing production). Sleep disturbances and daytime fatigue are the most commonly reported symptoms during menopause. Other symptoms that occur include hot flushes, mood disorders, and night sweats.


Does Sleep Quality Change With Menopause?

During menopause, many women are less satisfies with their sleep than previously. The most common complaint is difficulty in falling asleep. Other problems include an increase in the number of night time awakenings and daytime drowsiness. However, actual sleep time and sleep stages are not different from those on permenopausal women, so differences in perception of poor quality sleep probably have more subtle background.


Are All Sleep And Health Problems In Menopause Related To Changes In Hormone Levels?

No. Many women assume that symptoms such as weight gain, sleep disturbances, and fatigue are related to hormonal changes alone. Such misconceptions can lead to women missing potentially reversible and treatable causes of poor health. Post menopausal women are at increased risk of snoring and sleep disordered breathing, which can be there cause of daytime sleepiness and fatigue. These conditions should not be ignored as they can be treated to improve the quality of life remarkably.


Why Do I Get Hot Flushes?

No one knows the precise mechanism of hot flushes (hot flashes or night sweats). Hot flushes can also occur in women receiving certain treatments for breast cancer. Hot flushes are worsened by smoking and physical inactivity. They last about 3-5 minutes, but sometimes can go on for 20 minutes. Some women have up to 20 hot flushes a day, others 1-2 times a week. Women who experience hot flushes at night report reduced sleep quality. Hot flushes cause awakenings at night, but there is little evidence to show any major disruption to the various sleep stages.


What Can I Do About Hot Flushes Affecting My Sleep?

If the hot flushes are extremely disruptive, short term hormone replacement therapy (HRT) is still the treatment of choice. However, many women are reluctant to try this due to health risks. HRT should not be used by anyone who has had breast cancer or a stroke. Antidepressants, such as serotonin reuptake inhibitors may be useful. Another useful medication that can be tried is gabapentin.


Can Alternative Therapies Help With Hot Flushes?

The evidence for complementary and alternative therapies is not strong and their effectiveness is questionable. It might be worth trying acupuncture, yoga, or herbal treatments containing phytoestrogens such as red clover, soy, dong quai, or black cohosh. Obviously a cooler bedroom environment is better than a warm or hot one. The strategies outlined in pp28-34 may also help to stem development of insomnia and ingrained bad habits.


How Does Stress During Menopause Affect Sleep?

As oestrogen levels decline, the heart and blood vessels as well as other hormones become more sensitive to stress. Increasingly, there is evidence that even day to day hassles can impact sleep more significantly during menopause and result in frequent awakening, less sleep time and slow wave sleep, and poorer quality sleep overall. It is therefore important to try and minimize stress in your life.


Are There Any Particular Sleep Disorders Associated with The Menopause?

Obesity, raised blood pressure (hypertension), and sleep apnea are more common after menopause. Increase in weight canít be blamed just on menopause, they are more likely to be the result of normal ageing and reduction in physical activity. Obesity is a risk factor for sleep apnea.


Are There Any other Medical Illnesses That Are More Common After Menopause And That Can Disrupt Sleep?

Depression and mood disorders become more common after menopause and can result in disruption. Undergoing a hysterectomy after menopause can worsen symptoms of menopause and lead to mood problems. Cancer becomes more common after this stage in life as well and has its own problems associated with diagnosis and management. The incidence of thyroid problems increase and is more common in women, hypothyroidism is associated with tiredness and fatigue.


Menopause Rating Scale

Sleep_And_MenopauseThe menopause assessment scale is designed to indicate the severity of the symptoms you may be experiencing. You will see that these can be physical, psychological or sexual, or a mixture of all three. By completing it you may become aware of changes in yourself that you had not originally considered to be menopausal.

Click Here to begin your test.



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Department of Neurology. Helsinki, Finland