Midnight Madness: From Sweet Dreams to Nightmares

Sleep is good medicine
Sleep is one of the body's basic needs. It restores and preserves our health. Too little sleep puts us at risk for health problems such as high blood pressure and heart disease. Immunity to sickness declines, and tolerance for stress plummets.

When we don't have a well-rested body and mind, every aspect of our waking day is affected. Yet statistics show that as many as 70 percent of Americans are sleep-deprived.

Of course, some of those exhausted Americans are women in midlife. In fact, according to the National Sleep Foundation, women who report the most sleep problems are those dealing with perimenopause through postmenopause. Their symptoms include hot flashes, mood disorders, insomnia, and sleep-disordered breathing. Such sleep problems are often accompanied by depression and anxiety.

Many women don't realize just how important sleep is, so they put it at the very bottom of the "to do" list. We tend to squeeze every hour out of every day. We cram our schedules with professional, social, and family activities, rarely leaving time to relax and get to bed on time. But sleep is when the body renews and recharges itself with energy and strength for the next day.

When your head finally hits the pillow at the end of the day, your mind is probably still racing, and your inner dialogue may sound something like this:

I'm so tired. How come I can't relax? I've go to get to sleep – I have a million things to do tomorrow. I've got to finish that report and get Mom to her doctor's appointment. And I can't remember, does Jessie need a ride home after soccer practice? I can't keep up. I'm just not feeling right these days. Oh, I hope I don't have hot flashes tonight.

If you have trouble falling or staying asleep, you may have a problem that needs medical attention. During midlife, it's important to sort out whether a sleep problem is related to menopause symptoms or is that's called a "primary" sleep disorder, a condition that creates sleep problems but has nothing to do with menopause.

Is nighttime a bad dream?
Menopause itself doesn't cause difficulty sleeping, but its symptoms certainly can. As we've discussed, hot flashes occur more frequently at night, causing interrupted sleep and tiredness the next day. In addition, our daily stresses and concerns with physical changes during menopause tend to "turn on" when the lights go off. Our minds go into overdrive and we ruminate.

In addition, menopause-related anxiety depression, and mood swings can keep thoughts churning long past bedtime. For some women, the physical and psychological changes they experience during the menopause years can feel like a bad dream that won't go away.

Here's a hopeful note. Although we can't treat sleep problems with hormone therapy, we can use it to treat menopause symptoms that deprive you of the rest you need. Often, restoring hormone balance with low-dose, short-term hormone therapy will help you get a good night's sleep. Women who prefer not to take hormone therapy can discuss alternative options with a women's health doctor. And if you have a primary sleep problem, there are many excellent treatments available today.

But before you can rest easy, you and your doctor will need to figure out whether your symptoms are related to menopause or a sleep disorder.

Watch for these signs
Whether related to menopause or not, sleep problems show up in a number of different ways that may include:

• Trouble falling asleep
• Difficulty staying asleep
• Waking too early and being unable to get back to sleep
• Finding it hard to wake up on time
• Being tired during the day
• Sleeping too much

These could indicate one or more of the following problems:

Problem: Hot flashes and night sweats that frequently disrupt sleep.
Solution: Depending on how severe your hot flashes are, you may benefit from alternative remedies (discussed in Chapter 7) or hormone therapy. Otherwise, try these tips to keep cool at night:

• Wear loose clothing to bed
• Keep your bedroom cool and well ventilated
• Avoid taking hot showers or baths before bed
• Sleep with your socks on to help regulate body temperature

Problem: Physical discomfort. Menopause symptoms that can set you up for a poor night's sleep include hot flashes, itchy skin, a dry vagina – any physical irritation that is bothering you.
Solution: If you had a pounding headache, you’d probably take a pain reliever to alleviate it. Why wouldn't you treat menopause symptoms so that you can rest at night? Use various treatments discussed throughout this book to care for your symptoms and sleep is likely to come much more easily.

Problem: Mood swings, depression, or anxiety.
Solution: Natural ways to improve your mood include eating right, exercising regularly, and practicing relaxation techniques to restore balance. You can also try taking vitamin B, which is believed to boost mood because it restores elements involved in different aspects of brain chemistry. (See Chapter 4 for more details.)

But if you remain depressed or anxious for more than two weeks, it's important to see a doctor. Only a physician can properly determine whether your case calls for a prescription to treat depression or anxiety.

Problem: Stress. Most of us don’t have an "off button" that allows us to erase the day's stressors when we retire at night. Instead, thoughts of family, work, and personal affairs churn in our heads as soon as we turn off the lights. We lie in bed and worry and think.
Solution: Relaxation techniques are an important part of slowing down at the end of the day. Establish a bedtime ritual like taking a warm bath, reading a favorite book, or writing in a journal to set the mood for sleep. Consider the hour before your bedtime as "you time."