Sleep disturbances are far more common in midlife women than in younger women, though it’s unclear if these disturbances are caused by the hormonal changes of perimenopause and menopause or if they simply occur around the same time.
Most commonly, a woman will fall asleep without a problem, then wake up in the early-morning hours and have difficulty getting back to sleep. Women who experience hot flashes or night sweats tend to have insomnia more often than those who don’t.
Sleeplessness can cause fatigue, irritability and a feeling of being unable to cope. Chronic sleep loss can put people at increased risk for such diseases as heart disease, high blood pressure and diabetes.
If you are having trouble falling or staying asleep, you may want to try the following:
- Cut out caffeinated beverages (coffee, tea, colas, and chocolate), especially after 3 p.m., as caffeine stays in the bloodstream at least six hours.
- Avoid smoking — tobacco is a stimulant.
- Avoid or limit alcohol consumption. Although alcohol is initially a sedative and makes one sleepy, it becomes a stimulant as it is metabolized, resulting in fragmented sleep and the need to urinate during the night.
- Go to sleep around the same time every night.
- Exercise regularly. Exercising during the day or early evening can relieve tension and help promote sleep. Avoid doing anything strenuous just before bed.
- Try to relax before bed: take a hot bath, listen to music, or read.
- Filter out noise and light. Close doors and windows, use earplugs, or try a soothing sound machine. Use room-darkening shades or an eye mask to block light.
Valerian has long been used as an herbal sleep remedy and has shown benefit in some, but not all, clinical trials. Evidence is strong that melatonin works for jet lag and sleep problems due to changing work schedules such as shift work, but the data is not clear on regular insomnia.
Some women find antihistamines such as dimenhydrinate (for example, Dramamine), diphenhydramine (Benadryl), and chlorpheniramine maleate (Chlor-Trimeton) helpful for occasional insomnia.
If sleep disturbances persist, you may want to discuss medical relief with your health care provider. Sleeping pills are best used only occasionally, as they can be habit-forming and stop working after prolonged use.
In some women, oral micronized progesterone helps to decrease the time it takes to fall asleep, increase early night rapid eye movement sleep, and increase total sleep time without causing morning changes in alertness or brain function. Both estrogen and low-dose antidepressants in the tricyclic family can relieve insomnia for some women. Be sure to learn about the effects and long-term impact of these medications.
If these treatments don’t help, it may be worth consulting a sleep specialist. Sleep conditions unrelated to menopause, such as apnea and restless leg syndrome, can contribute to sleep difficulties, and a sleep study may be necessary to diagnose them.