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Get Some Sleep: Hormonal havoc, or menopause and your rest
April 5th, 2011
03:32 PM ET

Get Some Sleep: Hormonal havoc, or menopause and your rest

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs on Tuesdays on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.
The change of life affects so many aspects of a woman’s life. Our female sex hormones, estrogen and progesterone, decrease. That can cause the familiar symptoms of hot flashes, mood swings and memory lapses.  And it can play havoc with women’s sleep.

Many of us begin to have sleep difficulties as we go through menopause.   In fact, most studies show that 40 to 50 percent of women start to toss and turn as they age, often associated with hormone fluctuations.

It’s true that it’s not always hormones. Women can have more than one problem with their sleep.  The first thing to keep in mind is that once women go through menopause, they are just as likely as a man to develop obstructive sleep apnea.

Therefore, if there are other symptoms, such as snoring, morning headaches or weight gain, that accompany the complaint of disturbed sleep, then women, and their doctors, should consider the diagnosis of sleep apnea.  There is a common misconception that only chubby people can have sleep apnea.  This is not true.  At least 20 percent of all apnea patients are normal weight.  In fact, often very thin, petite women have sleep apnea because they are small all over, including the back of their throats.

The decrease in estrogen also can cause night sweats, sometimes so dramatic it’s as if a bucket of water has been poured over the sufferer.  Most cannot continue to sleep in the bed because it is like trying to sleep in child’s wading pool.  So they get up and change the sheets and make another valiant attempt to sleep.

Interestingly, even women who do not have hot flashes often have troubled sleep as they go through menopause.  Taking great care with your sleep environment is essential, especially being sure that the room is cool enough and dark.  You may have to sleep separately from your partner, either because he or she can’t stand getting into the aforementioned wading pool with you every night or because it feels like a deep freeze.  Remember, well slept people make better partners-so whatever it takes to help each other get the sleep you need, that makes for a good relationship.

Some women turn to hormone replacement therapy.  If you’re thinking of this, discuss the risks and benefits carefully with either your primary care physician or your gynecologist.  Many women were scared away from using HRT because of the research that showed increased risk for heart attack and stroke, and to a less degree, increase in breast cancer.  However, even the authors of the original research have reformed their analysis and showed that these risks are mostly associated with women using HRT who were far beyond their menopause years. Therefore, many doctors and patients feel comfortable using HRT for one to three years if the woman’s menopausal symptoms dramatically improve, especially the problems with sleep.

As with any insomnia, that which is associated with menopause can benefit from cognitive behavioral therapy aimed specifically at insomnia.  Many sleep centers accredited with the American Academy of Sleep Medicine either have a psychologist on staff or have psychologists they work with.  If you can’t find a therapist in your area, there are online CBT therapy sessions for patients, but I can’t vouch for any of them.  I tried to test one out, but they wanted me to pay. Please.

I can recommend an excellent book by Peter Hauri that also comes with a workbook for the patients.   He ran the insomnia center for years at the Mayo Clinic; it is called “No More Sleepless Nights.”  Good luck and sweet dreams.

The information contained on this page does not and is not intended to convey medical advice. CNN is not responsible for any actions or inaction on your part based on the information that is presented here. Please consult a physician or medical professional for personal medical advice or treatment.


soundoff (26 Responses)
  1. billblast

    I told my wife she has obsrtuctive sleep apnea. She has to read this and seek medical help maybe she needs a Cpap machine.LOL.

    April 5, 2011 at 17:52 | Report abuse | Reply
    • KC

      ...or maybe she needs a more sympathetic husband with whom to sleep!

      April 5, 2011 at 21:53 | Report abuse |
    • GoodAdvize

      Here's a great tip to help you reach a deep sleep, fast: listen to the sounds of nature using comfortable headphones and pay attention to every detail very, very carefully. Sounds of nature are flowing, but at the same time very random, so that you can't anticipate anything. This helps you to keep focused on the sounds, rather than wonder off with some other thoughts (conscious or unconscious), which might me preventing you from relaxing and thus falling asleep. Sites such as TranscendentalTones offer such sounds, which you can easily download to your mp3 player.

      April 6, 2011 at 03:43 | Report abuse |
    • RM

      Maybe if you would be the leader of the household and take care of your health issues first she will be more willing to deal with hers. Why don’t you go get a sleep study done and see if you have any sleep disorders before pointing the finger at your poor wife’s problems.

      I was recently diagnosed with sleep apnea and I now use a CPAP machine. At first I thought OMG there is no way I'm going to spend the rest of my life sleeping that awful looking mask on my face every night. But now that I have been with a CPAP for nearly six weeks, it’s been such a wonderful change in the way I feel during the day. I wish I would have done this sooner, I've been struggling with daytime drowsiness for many years and now it's all gone thanks to the CPAP treatment.

      April 6, 2011 at 10:06 | Report abuse |
  2. MARTHA

    SO HOW DO YOU EXPLAIN INSOMNIA AT AGE 92 PLUS?

    April 5, 2011 at 19:17 | Report abuse | Reply
  3. Virginia Hopkins

    Many menopausal women can't sleep due to estrogen dominance, where the progesterone to estrogen ratio is low. Estrogen is a stimulating hormone, progesterone is a calming hormone. Using a little bit of progesterone cream before bed often works wonders. Here's an article with more details, including a link to a great sleep article by Dr. John Lee:
    http://www.virginiahopkinstestkits.com/hormonesinsomnia.html
    Virginia Hopkins

    April 6, 2011 at 01:31 | Report abuse | Reply
  4. Garrick

    Melatonin works wonders for me- Age 58

    April 6, 2011 at 01:51 | Report abuse | Reply
  5. Tasha

    Turn off the lights. Light pollution causes or exacerbates many problems (NIH agrees). Of course or local mor-men are goingt o build an overlit temple in the middle of our neighbrohood – wreck eco-destruciton on the conservation park agross the street along with all the human ills they'll cause. Really xristian – NOT.

    April 6, 2011 at 10:44 | Report abuse | Reply
  6. Kay

    I would give anything for a full nights sleep. This article answered my question as to why. I'm 43 and I am going through menopause. I've had hormone problems for many years (undiagnosed) as it is but now I know why I can't sleep straight through more than my first 4 hours of rest a night.
    I was blaming my sleep apnea (diagnosed as too mild for a CPAP machine but the paint peeling off my walls nightly would beg to differ as would my husband). Then I blamed my 5 year old son who crawls into bed next to me in the middle of every night. Finally, I tried going to another room/bed to see if I could sleep through the rest of the night at my first wake up and lo and behold, I can't sleep more than 30 mins at a time for the rest of the night.
    I'm exhausted! I hope it gets better soon.
    Kay

    April 6, 2011 at 11:55 | Report abuse | Reply
  7. Larry J. Frieders

    Dr. Shives is on target. I'd like to add a little information about the hormone issue. Yes, levels decline at menopause. Progesterone falls more than estrogen – because the process of ovulation – which stimulated progesterone production – has stopped. Before looking to HRT (OR – Bioidentical HRT) replacement that includes estrogen, take a close look at using only a progesterone supplement. If hormone balance is important, women would probably want to look at replacing the hormone that has declined the most – thus bringing the hormone system back to balance. I should also note here that a topical (transdermal) form of progesterone is an excellent delivery mechanism – far more reliable than hormones taken by mouth.

    April 6, 2011 at 12:04 | Report abuse | Reply
  8. Jacqueline

    It might be the lack of sleep from hormonal changes during menopause that is triggering the rise in type 2 diabetes among women in perimenopause/menopause (http://www.womentowomen.com/fatigueandstress/insomnia.aspx); lack of sleep/insomnia really does a number of insulin resistance. Add weight and changing hormones just ups the risk.

    April 6, 2011 at 21:19 | Report abuse | Reply
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    Diet solutions with an healthy approach. Knowing what to eat according to your health conditions: http://www.alphadiet.org

    April 22, 2011 at 10:42 | Report abuse | Reply
  10. John

    As you go through Menopause, the first thing that happens is progesterone falls. second thing is estrogens start to vary widely. You are just as likely to get hot flashes from high estrogens and low progesterone as you are from low estrogen. Estrogens are made by the body in adipose tissue so you still make estrogens after menopause. If you are using hormones use hormones identical to the hormones the body produces.

    July 10, 2011 at 16:01 | Report abuse | Reply
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    September 10, 2017 at 20:39 | Report abuse | Reply
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    Though you may be able to purchase some CPAP machines from a supplier or retailer at a cheaper price than buying directly from the manufacturer, keep in mind that you still need a prescription from your doctor.

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