Sleep…still between the mattress, the pillow and a hard place
Sleep. Oh, how you elude me.
Whether it’s hormones or stress, I’m beginning to forget what a full night’s sleep looks and feels like. In fact, if you ask me to tell you when it was that I last had a full night’s sleep, I’d probably tell you that I don’t recall. So, yes, I keep writing about it in hopes that the magic solution will one day transcend my fingertips and actually result in…8 full hours! What a concept!
Meanwhile, back the real world, I have encountered yet another study trying to explain why middle aged women don’t get the zzz’s they need. This time, hot flash bother appears to be the golden ticket. However, even more interesting is the fact that the researchers who conducted the study say that the “concept of bothersome”/bother might explain disparate findings between studies that point to hot flashes as the primary sleep deprivation factor versus those that point to overall wellbeing and life stressors.
To provide a bit of context, this particular study is part of an ongoing trial known as STRIDE (Do Stage Transitions Result in Detectable Effects), which is looking at women in various stages of menopause (45 to 65 years). And, as part of STRIDE, these women were asked to complete two, annual questionnaires, the first relating to basic questions on menopause status, medical history, tobacco/alcohol use, etc, and the second, relating to sleep and how hot flashes were or were not interrupting their lives. Sleep quality scores were based on trouble falling asleep, waking several times during the night or waking early and then not falling back asleep. Frequency and bother of hot flashes were rated on a scale of 0 to 5, including how much they interfered with work, social activities and leisure.
Importantly, women who reported having bothersome hot flashes (32%) were twice as likely as their peers reporting no hot flashes to experience some degree of sleep interruption. Additionally, when hot flashes interfered with life, they interfered with sleep.
So, what does this mean?
Perception is key. Consequently, when women perceive that their symptoms interfere with aspects of their lives outside the bedroom, especially leisure activities, they seem to interfere with lives inside it, namely, sleep.
What is lacking in this study is information on other possible factors that might influence overall sleep disturbance, such use of certain medications or depression. And, conclusions were based on self-reports, which we all know can be biased. Still, you have to wonder about the psychology, and how much, as women, our brains influence our lives and how we respond to key parts of them, like sleep.
Meanwhile, we are still between the mattress, the pillow and a hard place, at least I am. But, we are finally coming closer to discovering the why.
Read MoreWednesday Bubble: Can yoga decrease insomnia, improve sleep quality?
I love that yoga practice continues to take center stage in Western medicine. Truly, this is mind boggling because rarely, if ever, has an alternative practice been given so much credence within the confines of a medical philosophy that allows little outside the box. However, just a few weeks ago, yoga made the headlines again with data showing that it might be useful for treating lower back pain than standard therapies.
In menopause, yoga practice has been explored for stress relief, to improve wellbeing and as a tonic for vasomotor symptoms. Notably, the latter are considered to be partially responsible for significant sleep issues that occur during and after menopause. Indeed, some data show that up to 81% to 83% of women may have sleep complaints and 52%, insomnia.
Yet, like many strategies, yoga is not a one size fits all practice and there are many branches and types, some being meditative and others breathing, and some more physical than others. These distinctions can make it difficult to standardize studies and apply their results. Still, I was thrilled to stumble across a study evaluating the effects of a specifics sequence of yoga on physical and mental health, and symptoms in menopausal women experiencing insomnia. Importantly, this study used a scientific, randomized controlled design to insure that test conditions were up to par with Western methodological standards.
Basically, researchers assigned 44 menopausal women diagnosed with insomnia to one of three group:
- a control group who ingested 500 mg calcium daily
- a passive stretching group, who participated in two, one hour passive stretching classes a week (including stretching of back, stomach, ankles, knee, thigh, elbow, shoulder, wrist and neck) or,
- a yoga group consisting of two, one hour sessions weekly. These yoga sessions were based on a sequence using stretching positions (asanas) with strong and fast breathing (bhastrika) followed by directed relaxation.
Women in these groups also took 500 m g calcium daily.
The study, which lasted for four months, showed that engaging in a particular sequence of yoga significantly reduced vasomotor symptoms and improved sleep/insomnia severity and mental health compared to passive stretching or simply taking calcium. Women who took the biweekly yoga classes also had higher quality of life scores and better resistance to stress. And while the passive stretching group certainly did not do as well, they did trend towards these benefits as well, especially with regards to the degree of reported stress in their lives.
The researchers believe that regular yoga practice, at least with these particular sequences, alters the nervous system and increases brain concentrations of a potent neurotransmitter – λ-aminobutyric acid – to help improve sleep patterns and reduce vasomotor symptoms. Likewise, stretching may lead to a state of calm that results in reduced metabolism, heart rate, blood pressure, breathing and muscle tension, all of which contribute to stress (or stress reduction).
Granted, this is a small study but it was rigorously designed and suggests that yoga may help sleep issues associated with aging and menopause. I, for one, want to run into a yoga studio. I don’t recall the last time my zzzz’s were not interrupted.
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Got Sleep? You may want to consider valerian
I was out the other day with a few friends and one of them mentioned to me that she was not sleeping well, mainly due to the start of night sweats. She asked me what my secret was. To be entirely honest, I laughed; while I’ve managed to shut down just about every other symptom associated with perimenopause, a full night’s sleep continues to elude me. Still, ever the optimist when it comes to alternative strategies, I pointed her to a few potential interventions that had some strong evidence backing their use for night sweats and symptoms in general, which by default, may help sleep issues.
Ironically, a newly published study in the journal Menopause focuses on valerian and its potential use for insomnia during menopause. A bit more about valerian:
- Valerian is a perennial that is native to Europe and Asia but is grown in North America. It is well known for its sedative properties and was used by the Greeks and Romans as early as the second century AD.
- In modern times, valerian has been used for insomnia and other sleep disorders. It has a GRAS (generally recognized as safe) designation by the FDA and is prescribed as a sedative in Germany under Commission E approval.
- Valerian, which comes most commonly in tablet, extract (tincture) and tea forms, is reportedly among the eight most widely used herbal supplements in America, and data from 2002 suggest that approximately 2 million adults in the US report using it on a weekly basis.
Okay, so we know it’s safe. But, does it work?
To date, reports about valerian effectiveness have been mixed, with some showing benefits with regards to sleep and others, no benefits. In this latest study, researchers evaluated 100 menopausal women between the ages of 50 and 60 who were not using hormones and did not have any medical or psychiatric conditions that would interrupt sleep. The women, all of whom had been in menopause for at least a year, used a supplement containing 530 mg valerian daily or placebo tablet. Over the course of the study, they were asked to report sleep information using a scientific questionnaire measuring:
- quality of sleep
- length of time required to fall asleep
- length of time asleep
- ratio of time asleep versus total time in bed
- anything that disturbed their sleep
- use of sleeping medication
- any interruption in daytime activities due to lack of sleep
The result? Valerian was shown to significantly improve sleep quality in as many as 30% of participants compared to placebo, which the researchers say, support its use in the management of insomnia. Moreover, valerian reportedly does so without any significant side effects that are generally associated with sleep agents. Nevertheless, individuals using valerian have reported feeling hungover or drowsy the next day.
Inarguably, many factors affect sleep quality beyond hormones including stress, partner issues, use of alcohol or other drugs or caffeine, light conditions and psychiatric issues like depression and anxiety. In an accompanying editorial, the author claims that in addition to the loss of progesterone, societal pressures are at play, namely the loss of “youthful appearance in a culture drenched with youth-oriented values” and “post-bedtime ruminations” resulting from change in social roles and associated mood disorders. Granted, while cultural issues may be a factor in some women, I hardly believe that aging’s toll interferes with sleep or that a woman’s sense of worth is an overriding cause of insomnia. Indeed, many optimistic, happy women start losing their sleep numbers as they age.
Regardless of the overriding cause, insomnia affects roughly half of all menopausal women and the problem pervades just about every aspect of a life as a result. If valerian offers relief, I say go for it. If anything, it’s a safe tool that may improve sleep quality.
Got sleep? Maybe valerian holds your key to getting enough zzzs.
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Insomnia and menopause. Awake again…naturally
Sleep and menopause. One’s elusive and one simply won’t go away. Yes, I know, I keep writing about this topic. But when you can’t recall the last time you slept through the night without awakening at least once, well, it becomes a bit of an obsession. So bear with me as I provide a bit more information on sleep and why (or why not) it may be eluding you as well.
Research suggests that menopausal women have significantly more sleep disturbance compared to their younger peers and on average, achieve less than six hours of sleep per night. This results in fatigue-related accidents in the short term and more serious problems in the long term, including an increased risk for diabetes and heart disease. And those wonderful mood swings that many of us experience? Well, it’s no surprise but they are made worse by insomnia. And yet, the reasons for the high prevalence (up to 60%) of sleep disturbances in menopausal women continue to be explored because definitive answers aren’t being discovered. Hence, is it menopause or aging or something else?
In a new report which appears online in Maturitas, researchers say age is not the key culprit and rather, that the factors causing a high percentage of women to lose sleep are actually multifaceted and believed to be controllable. The findings?
340 women (ages 40 to 59) underwent analysis to assess hot flush presence and severity, and then used an insomnia severity index to rate the perceived severity of their insomnia based on sleep satisfaction, the degree to which daytime functioning was impaired, overall perception of impairment and distress, and how concerned they were about about their sleep. Roughly 65% of women in the study were sedentary (i.e. participated in less than 15 minutes of physical activity twice weekly):
- Roughly 61% had hot flashes, of which approximately 17% were severe to very severe
- While about 41% of women reported some degree of insomnia, the majority said it was mild and only 9.5%, moderate to severe
- Many women said that they had challenges with their partners that range from erectile dysfunction (~24%) and alcohol abuse (35%) to being unfaithful (42%)
When the researchers ran additional analyses, they discovered certain factors were definite contributors to insomnia, including being sedentary, having hot flashes, and having partner issues, namely men who had erection issues.
This is not the first study to link hot flashes to insomnia. Likewise, male sexual dysfunction has been associated with depression in the female, which impairs life quality and interrupts sleep. What’s more, in this particular study, women whose partners were faithful appeared to have less severe insomnia (perhaps, as a result of not worrying so much). However, the researchers also concede that the precise cause of insomnia has yet to be clearly defined. And, they did not evaluate whether or not study participants had depression or anxiety or stress, all of which might contribute to insomnia.
In other words, they aren’t quite sure what the exact issues are.
So, does this bit of news tell us anything we’ve not heard before?
Where does this leave us? Between the pillow and the mattress and unfortunately, a hard place. There are no clearcut answers. Flashes and sweats and partners and life and estrogen, oh my.
Maybe it’s just going to be what’s it’s going to be. Sleep or no sleep? Blame it on…
Read MoreAre you getting the sleep you need?
Sleep.
Sometimes I don’t even know what that means any longer. I long for the day (night) that I sleep a solid eight hours without awakening. However, that may the thing that my dreams are made of.
As I’ve written previously on Flashfree, sleep becomes more of an issue as we grow older. Factors like less efficient sleep and a greater difficulty staying asleep can lead to depression and affect overall wellbeing. More frustrating than the lack of sleep however, is the fact that experts can’t quite agree on the key factor underlying sleep disruptions: is it aging? Hormone fluctuations? Apnea? Moreover, do you treat the cause or the factor?
Besides my own personal interest in the topic, I do believe that the more that individuals understand the factors affecting their sleep quality, the greater their ability to proactively do something about it. That’s why I am always intrigued when I run across new research, like this study on isoflavones and sleep in the February edition of Menopause.
In it, 38 menopausal women who qualified as insomniacs (i.e. having difficulty falling or staying asleep or whose sleep is disrupted or insufficient enough to affect alertness and physical/mental wellbeing) participated. Over a course of four months, the women were asked to take a daily 80 mg isoflavone pill (primarily made up of genistein) or a sugar pill. During the study, all women had blood work done, were visited monthly by a researcher to discuss their menopausal symptoms/complaints, and underwent sleep assessments.
The researchers say that they found that use of daily isoflavones actually decreased the frequency of insomnia by as much as 30%, and increased sleep efficiency — the ratio of time asleep to time spent in bed — by as much as 6%. Apparently, women using isoflavones also had fewer and less intense hot flashes.
Importantly, the researchers say that there is a paucity of published sleep studies in menopausal women and even fewer that look at alternative or complementary therapies. Nevertheless they point out that by using a standard of sleep analysis — polysomnography – they were able to demonstrate significant objective improvements in insomnia among women taking isoflavones. In contrast, studies reporting improvements in sleep after hormone therapy have been based on subjective reports.
Another critical point that they make is that although this was a small study, almost 70% of women had objectively defined insomnia, demonstrating the breadth of the problem in menopause. Moreover, sleep disturbances that drove these women to seek help tended to be individualized, indicating that there is a depth of insomnia-related complaints that affect aging women in this stage of their lives that warrant a closer look. Still, despite these differences, soy appeared to work well across the range of complaints.
Are closer to unlocking the chicken versus egg, ie aging versus factors mystery surrounding sleep? Perhaps not. And it’s unlikely that soy will work exactly the same for each person. No medicine does. However, soy appears to be a safe and potentially effective treatment for sleep disturbances during menopause.
How’s your sleep? And what steps are you taking to improve it? `
Read MoreSleep and energy: what’s in a good night’s sleep?
Did you know that a lack of sleep adds up to a whole lotta energy? For the first time ever, scientists have quantified how much energy we lose when we lose a full night’s sleep…and how much we save when we get the required 8 hours.
I’ve written about sleep, aging and menopause often on Flashfree, and the outlook isn’t great. In fact:
- Difficulty falling asleep appears to be associated with menopausal symptoms in general, stress, and lower stress hormone levels.
- Awakening during the night appears to be associated with age, being late in the menopausal transition (before moving into full-blown menopause), having had early menopause, hot flashes, depressed mood, joint pain and stress.
- Early morning awakening appears to be associated with age, hot flashes, depressed mood, anxiety, joint pain, stress, and lower estrogen/higher fallopian stimulating hormone (FSH) levels.
Now, researchers are saying that a night’s sleep actually depletes the body of energy while getting 8 hours of sleep conserves it.
In a very small study, 7 young adults were asked to stay in bed and consume a carefully regulated diet comprising of 30% fat, 50% carbohydrates and 20% protein During the study period, they had 8 hours of sleep, followed by two days of sleep deprivation (40 hours total) followed by another 8 hours of sleep.
Compared to a typical 8 hours sleep, losing a night’s sleep actually increased the amount of energy expended by as much as 7%. This is equivalent to about 135 calories (i.e. two slice of bread) or walking about two miles. In contrast, getting a normal nights sleep actually saved almost as much energy.
Hence, it appears that sleep deprivation is a waste of energy, literally! And while it may generate some returns in terms of immediate weight loss, other researchers have shown that over time, sleep deprivation actually impairs functioning and leads to weight gain.
So, what’s in a good night’s sleep? Apparently, sleep provides a means by which we are able to conserve enough energy to support other important functions that we need to survive. However, the challenge lies in that magic 8 hours, which appears to be constantly interrupted during the menopausal period. If only we could put that energy to good use and figure out the answer to this particular dilemma that plagues us as we age.
Any thoughts?
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