What happened to my sleep?
Difficulty sleeping is one of the most common problems brought up by women who come to see me. It can be one of the earliest symptoms women notice in the perimenopause, affecting roughly half of us. Women are more likely to experience insomnia than men. Why this should be is not well understood. The times in a woman’s life when she is most likely to experience insomnia are premenstrually, in the third trimester of pregnancy and in menopause. Mood disorders can contribute to insomnia, and persistent insomnia increases the occurrence of depression. Chronic insomnia is also common in women with breast cancer.
What to do about sleep problems? The first recommendation in any discussion of the topic is to apply the principles of sleep hygiene. These include going to bed and getting up at the same time every day (including weekends), avoiding caffeine and alcohol in the evening, avoid exercising close to bedtime, keeping the bedroom quiet and cool, and using the bedroom only for sleeping and sex. Vasomotor symptoms (VMS), hot flashes and night sweats, are notorious for disrupting sleep. Hormone therapy in low doses has been shown to be effective for many women with VMS, and any related sleep problem. Cognitive behavioral therapy has been shown to be helpful in cases of chronic insomnia and is preferable to medications as a first-line treatment. If the access to a therapist is limited, there are books and DVDs available that teach relaxation techniques and meditation that may be helpful to sleep. For insomnia related to depression and/or anxiety, an anti-depressant medication may help sleep and the mood symptoms. Sleeping pills may be helpful in the short term, but their use should be limited due to the risks of developing a tolerance to them or a dependence on them.
Our approach to sleep problems should be built around sleep hygiene and relaxation techniques first, hormones and medications if needed later.