Restful Sleep Often Elusive for Menopausal Women

By Jill Daly / Pittsburgh Post-Gazette

The recommended seven to nine hours of sleep can be elusive to so many people in modern society — from teenagers who stay up late and rise early for school to new parents, night-shift workers and people working two shifts. But even after getting through those experiences, many women in midlife report that their sleep problems are worse than ever.

“Menopause is not a pathological state, though it feels like it sometimes,” said Pittsburgh neurologist and sleep medicine specialist Maria Sunseri. “This is a big problem for women in the perimenopausal time period.”

Menopause, when a woman naturally and permanently stops her period, is preceded by hormonal and other physiological changes including irregular periods, vaginal dryness, hot flashes and sleep problems.

“In a survey of our patients, sleep was in the top five complaints of reasons women come to see us,” said Mary Beth Peterson, director of the Mid-life Center at Magee-Womens Hospital of UPMC. Typically women enter menopause between the ages of 45 and 55.

“A lot of women want to blame everything on their hormones,” Dr. Peterson said, cautioning that other common conditions that come with aging can be involved, such as arthritis, depression, anxiety and restless legs syndrome. “Sometimes it’s a little bit of everything. It adds up.”

When a woman does have problems sleeping, Dr. Sunseri said, she may find herself seeing multiple doctors for help. Dr. Sunseri practices with Midlife Women’s Associates, a group of Allegheny Health Network gynecologists who focus on helping women through the transition into menopause. “A lot of people get passed along from doctor to doctor… By the time people got to me they were so exasperated.”

There are prescription medications that can help women deal with problems sleeping during midlife, but both doctors say they prefer to avoid them. Dr. Sunseri works with a sleep-log system that uses natural and behavior modification techniques to get her patients back on track.

“It’s interesting and fun when you understand,” she said. “My heart goes out when women who become so frightened, it can be so very scary. I think that is why it’s important for women to have some direction, to know when symptoms are more serious and know how to describe them to their doctors.”

Hot times

Hot flashes and night sweats, known as vasomotor symptoms, affect up to 80 percent of all women during this transition.

Symptoms can last for seven or more years, as reported February 2015 in the journal JAMA Internal Medicine. The report analyzed data from a large, long-term study of U.S. women conducted from February 1996 through April 2013. Called the Study of Women’s Health Across the Nation, it has a study site in Pittsburgh.

The JAMA analysis included 1,449 women with frequent hot flash and night sweat symptoms (at least six days out of the previous 14 days).

More than half of the women had at least 7.4 years of the symptoms. The longest duration — 11.8 years or more — was experienced by women who were premenopausal or just beginning the time of change when they first had the frequent symptoms. They were also the group of women who kept having the symptoms long after their last period, many of them 9.4 years or longer.

Women who were past menopause when they first got symptoms had them last for the shortest time; the median was 3.4 years.

Dr. Peterson said symptoms at night are not entirely to blame for sleep interruptions: “Studies have found during the first half of the night, night sweats can disrupt your sleep. But it’s less likely in the second part of the night.”

Trio of tips

Both Dr. Sunseri and Dr. Peterson advise women to practice healthy sleep habits. Going to bed and getting up at the same time each day; a calm, quiet, dark bedroom and a pen and notepad at the bedside for bothersome worries and concerns are among the most popular.

Three important things to remember, according to Dr. Sunseri, are timing, temperature and what she calls the track.

“You have to know your circadian rhythm,” she said. “The timing of sleep affects sleep. Are you a night owl or a morning person?” She said if your daily schedule conflicts with that — say you’re a night owl with an early morning job — you have to learn to change your internal rhythm.

Temperature for sleeping comfort is important for everyone, but, at menopause, she said it’s crucial.

“Hot flashes, even a fraction of a degree in your body temperature, will wake you,” she said. Sometimes a woman feels warm; other times the sheets are wet with sweat. A room kept at 60-67 degrees is recommended by the National Sleep Foundation.

“We fall asleep as our temperature drops,” Dr. Sunseri explained. For help falling asleep, she recommends a fan, and suggests women layer a sheet, a light blanket and then a cover on top, to use as needed.

The track stands for exercise.

“You need to get your exercise … anytime during the day, but not within three hours of going to bed. That’s crucial because of temperature. You don’t want to increase your core body temperature before bedtime, because you have to allow time for your body to cool off.”

The amount of exercise isn’t important, she said. “You can’t go wrong with walking. Start with 5 minutes a day or 10 minutes a day — start wherever you are and go from there.” She recommends some exercise most days of the week.