In Search of Sleep

Perimenopause is the beginning of a brand new stage of life for most women. It's a time when hormonal changes leading to menopause take place, and also a time that brings new perspectives and opportunities.

The only problem is, many of us are more interested in taking a nap than we are opportunities! ''Some perimenopausal changes can result in sleep disruption,'' says Martha J. Lentz, Ph.D., a sleep researcher and research associate professor in nursing science at the University of Washington in Seattle.

The Importance of Sleep

For something that humans spend so much time doing, researchers know precious little about why we sleep. But scientists do know that sleep deprivation can cause serious problems: irritability, anxiety, depression, increased risk for cardiovascular and gastrointestinal disease, increased stress on the immune system, and infertility problems in women.

Women and Sleep

Most sleep research is done on men, but one German study indicated that women may need as much as an hour and a half more sleep than men each night--for a total of eight to nine or more hours of sleep a day. Most of us get less than seven. Women are particularly vulnerable to insomnia, which affects up to 40 percent of American adults.

Insomnia is classified by how long it occurs and when it occurs--difficulty getting to sleep; difficulty staying asleep; or a problem with early-morning awakening. Transitional insomnia only lasts a day or two--jet lag is a classic example. Short-term insomnia lasts up to three weeks; anything beyond that is considered chronic insomnia. Treating insomnia usually means treating the underlying cause, Lentz explains. ''The primary care provider really needs to do a thorough assessment, and that includes both physical and emotional health.''

Hormones and Sleep

During perimenopause, hot flashes and night sweats caused by declining estrogen levels can severely interfere with sleep. This form of insomnia is classified as chronic, because it lasts for more than three weeks, Lentz says.

The exact cause of hot flashes is unknown, but low-dose hormone therapy usually resolves both the flashes and the sleep problems. For women who can't or won't take estrogen, natural progesterone or sometimes vitamin E (usually 400 IU per day) will often lessen menopausal symptoms. Usually, the body eventually adjusts to the lower estrogen levels and the symptoms stop.

Insomnia could also be the sign of a serious thyroid disorder. Women develop thyroid problems four times more often than men, but many doctors overlook thyroid problems. Underactive thyroid function (hypothyroidism) can cause fitful sleep and extreme daytime fatigue. Overactive thyroid function (hyperthyroidism) can cause anxiety and a racing heart-- women can wake up in the middle of the night with palpitations and sweating. A simple blood test, the sensitive TSH (thyroid stimulating hormone) test, is the best and most accurate way to measure thyroid function.

Sometimes a woman's TSH test will come back normal even when she is exhibiting what appear to be symptoms of low thyroid. In this instance, a progesterone imbalance may be causing her symptoms, and supplementation with low-dose natural progesterone may alleviate the sleeplessness and fatigue.

Lentz also notes that some medications can cause insomnia. Be sure to inform your doctor about all the medications you take, including birth control pills.

Mind-Body Connections

Depression, anxiety, and stress are major triggers of insomnia. In fact, sleep problems may be one thing that motivates depressed people to see a doctor. ''We need to focus in and deal with the depression,'' Lentz notes.

Stress and anxiety, if not dealt with promptly, can turn transitional insomnia into a ''learned insomnia'' or sleep anxiety--a woman can start worrying that she won't be able to sleep. If you sleep better somewhere else than at home, you may have sleep anxiety. You can correct this by improving your sleep habits, which sleep researchers call ''sleep hygiene.'' Many women charge through the day at maximum speed, then drop into bed and expect the day's pressures to shut off automatically.

Lentz suggests creating bedtime rituals--cues that tell the body to get ready for sleep. Taking some personal time, reading, taking a relaxing bath and brushing your teeth can help you wind down and go to sleep.

Exercise can also relax you and prime your body for better sleep. But exercising within three hours of bedtime could prevent you from falling asleep--instead, Lentz advises, exercise in the late afternoon or early evening.

Maintaining a regular schedule is crucial. Sleeping in and staying up late on the weekends actually gives you a kind of chronic jet lag. Your circadian (daily) body clock thinks it's in another time zone, and your performance in your real time zone suffers as a result.

''If you're having trouble sleeping, then every day of the week, seven days a week, get up at the same time within a half hour of the same time,'' Lentz states.

Medicating Sleep

Prescription sleep medications should be used only to break the cycle of poor sleep, Lentz states. They provide symptomatic relief, not a cure. Such medications, usually sedative hypnotics called benzodiazepines, should not be used for more than three weeks. The reason: your body builds up a tolerance and they stop working. Over-the-counter sleep aids only work for a few days.

One over-the-counter product, melatonin, has become increasingly popular as a sleep aid (click here to order online). Melatonin is a hormone, and the amount found in the over-the-counter preparations is significantly higher than the amount normally produced by our bodies. As an occasional sleep remedy, melatonin may be useful. However, routine use may cause the body to adjust to much higher levels of the hormone, making it difficult to sleep without taking melatonin.

Hormone therapy can enhance the absorption of some sleep medications, so your doctor should monitor your medication dosage, to ensure that you're not getting too much.

Alcohol is not advised for insomnia. Alcohol taken at bedtime may make you fall asleep, Lentz says, but it causes a rebound effect and can trigger insomnia. You could find yourself wide awake at 3 a.m. ''I think sleep right now has sort of a bad rap--people are trying to get by on less and less,'' which is not a good health practice, Lentz says.