Got sleep?
How many nights do you lie awake, staring at the clock and just hoping for a wee bit of shut-eye?
If you are like many women in peri- or post-menopause, the answer is probably “a lot.” However, data presented at last month’s North American Menopause Society Annual meeting show that sleep problems do not change uniformly across menopause, which is why addressing them effectively can be difficult for some women.
Researchers examined the sleep patterns and symptoms of 286 women who participated in the Seattle Midlife Women’s Health Study. All participants completed daily menstrual calendars, which were used to track their experiences across the menopausal transition and rate the severity of all symptoms. For five years, they also provided the researchers with first-morning urine samples so that estrogen, fallopian stimulating hormone, and stress hormones could be measured.
The result? Depending on your sleep pattern, the relationship to certain factors changed. For example, nighttime awakening was mostly associated with age, being late in the menopausal transition (before moving into full-blown menopause), early menopause, hot flashe, depressed mood, joint pain and stress. Early morning awakening was associated with age, hot flashes, depressed mood, anxiety, joint pain, stress, and lower estrogen/higher FSH levels. On the otherhand, difficulty falling asleep was associated with menopausal symptoms in general, stress, and lower stress hormone levels.
However, regardless of whether women were having trouble falling asleep, awoke several times during the night or awoke in the early morning hours, sleep disruption was consistently associated with hot flashes, depression and stress.
In light of these findings, the researchers concluded that interventions to improve sleep might be more effective if they were targeted and focused, for example, towards night-time awakening and hot flashes, or difficulty falling asleep and depression, rather than clustered under the category of “sleep disruption” without examining exacerbating factors.
Of course, the greater implication here is that sleep-associated disorders during the menopause do not fall under the “one size fits all” approach and are better treated with individualized therapy. This is not to say, however, that certain interventions, like yoga or acupuncture can’t help address the cluster of sleep issues, hot flashes and stress, etc. Still, it’s best to consult with your practitioner before embarking on your own approach to solving the sleep woes. Personally, I find that I will be awake for hours in the nights preceding my menstrual period, regardless of the use of herbs, exercise or meditation. It just “is.” Yet, I’m glad to know there might be a better approach to addressing my specific woes.
What about you? What are you doing to get sleep?
Read MoreSleep matters
There’s no question that sleep during the menopausal transition can be difficult. Indeed, two studies published last year in the July 1 issue of the Sleep journal confirm that sleep complaints (e.g., difficulty falling and staying asleep) are related to declining and fluctuating hormone levels and symptoms such as hot flashes. What’s more, they tend to increase through the menopause transition.
I written previous posts outlining certain positive steps you can take to combat sleep disruption, including herbs, yoga, acupuncture and cognitive-behavioral therapy. Much to my chagrin, however, I’ve realized that I’ve ignored one of the most obvious – your pillow. Mind you, your pillow is not going to address estrogen decline, hot flashes or night sweats. But if you have a lousy pillow, well, you’re already facing a losing battle.
So, where am I going with this, you ask?
I was recently asked to review* two Tempur-Pedic® pillows:
- The Neck Pillow by Tempur-Pedic®
- The Comfort Pillow by Tempur-Pedic®
For those of you who are unfamiliar, Tempur® is a material that was originally used by NASA scientists to relieve the G-force of space travel. The Swedes then stepped in and perfected the material for sleep purposes, utilizing what they characterize as a “variable balance of pressure relieving and therapeutic support” layers. The material has also been engineered to respond to small changes in body temperature so that it conforms to the body.
Personally, I’ve never been attracted to the Tempur-Pedic® mattresses but I know many friends who swear by them. The pillows? That’s another story.
As someone who has experienced back issues her entire life, and neck and shoulder issues as a result of spending hours a day in front of the computer, well, a good pillow makes a huge difference in my life. In fact, I’ve never hesitated to invest in a good mattress, decent sheets and a nice pillow.
So what do I think about the Tempur-Pedic® pillows?
The Neck Pillow is a great pillow. It does everything that the Tempur® material claims it will do, from contouring to your neck and shoulders, to relieving pressure and allowing your spine to stay in proper alignment.
I tried the company’s standard size but I also own a small travel size that I bring with me whenever I’m away from home. Frankly, I never leave home without it.
What’s more, compared to other memory foam pillows that I’ve used (and I’ve used plenty), it maintains its integrity and continues to outlast the competition. While it certainly did not prevent me from awakening during my 4 am witching hour, I truly believe that since I’ve been using the pillow, I’ve had less trouble falling back asleep, mainly because I’ve been comfortable. In so far as temperature goes, I remain unconvinced that the pillow is cooler than other pillows for purposes of night sweats, per se. The material is not wicking so it’s not been constructed to repel moisture. Yet, the few nights that I had the sweats, I did not notice that the pillow retained any odor or remained damp. I love this pillow. Period.
I don’t feel as positive about the Comfort Pillow. I don’t know whether or not it’s just me but I find the Comfort Pillow to be anything but comfortable. In fact, despite several attempts to sleep on it, I tossed and turned and finally moved onto the neck pillow. So, what problems did I have?
I did not find that the Comfort Pillow molds to the head as easily as the Neck Pillow does. In fact, it barely contours as all (wouldn’t this seem to be impossible since it is constructed of the same Tempur® material as the other pillow)? It’s too heavy and cumbersome. And while it looks great and is obviously well-constructed, it is not for me. Ironically, I asked my partner, who is a tall and well-built, to try the pillow out and he felt the same. So, it’s not a size thing. Yet, he knows people who love the Comfort Pillow as much as I love the Neck Pillow. Go figure!
My main take-away is that good sleep hygiene matters. If you don’t like the pillow (or sheets for that matter) that you’re sleeping on, your sleep is going to be lousy regardless of the degree of havoc that hormones are wreaking on your body. Along with the other positive steps you can take, I believe that a good pillow is worth the investment.
What do you think? When it comes to sleep, what matters?
*Disclaimer: I was not paid to write this review. However, I agreed to try out the pillows because I feel that the topic is relevant. I’d love to hear your thoughts.
Read MoreWhat’s your sleep number?
[Rembrandt van Rijn, Sleeping Woman, 1658]
On a scale of 1 to 5 would you say that your sleep number (the quality of your sleep) is:
- nonexistent, I never sleep
- occasional, I sleep one or two nights a week
- obstructed, I sleep but I wake up regularly throughout the night
- pretty good, I rarely wake up
- great, I typically sleep through the night
If you are like most peri- post menopausal women, it’s likely that you rate the quality of your sleep about a “3. ” In fact, a review in the journal Current Neurology and Neuroscience Reports suggests that 28% to 64% of peri- or postmenopausal women have some form of sleep disturbances that may aggravated by sleep apnea, periodic limb movements syndrome (restless leg syndrome) and psychological distress (anxiety, major depression).
One of the primary causes of sleep disruption during menopause is declining estrogen levels, which increase peripheral and central temperature, dilate blood vessels and lead to hot flashes. Unfortunately data also suggest that hot flashes double the time spent awake although ironically, they often follow rather than proceed awake times.
More good news: both sleep apnea and periodic limb movements syndrome increase with age. Menopausal women are espeically at risk due to declining progesteron levels and increased body mass index (and associated increases in neck circumference). Both sleep apnea (in which the airways become partially or totally obstructed) and periodic limb movements obviously interefere with sleep quality. In fact, sleep researchers have documented apnea, restless leg syndrome or both in up to 53% of women between the ages of 44 and 56.
The evidence is less certain for mood disturbances and sleep, although studies have shown clear links between reproductive hormonal changes and clinical depression in women going through menopause. What’s more, women in menopause who are clinically depressed have reported more frequent and longer times awake than those who do not have any mood disturbances.
Steps to take
I’ve written previously on this issue and there are a variety of non-pharmacologic steps that might improve sleep quality including standardized herbs and acupuncture.
Hypnosis, relaxation techniques that include breathing and/or biofeedback) may also assist. These strategies are part of a larger approach called cognitive-behavioral therapy for insomnia (CBT-I) which in a small study, was found to significantly improve anxiety, depression, partner relationships, sexuality and hot flashes in menopausal women.
Notably, the benefit of HRT for sleep/mood disturbances remains unclear and studies are inconclusive.
As with any issue associated with menopause, it’s critical to speak to a health practitioner about the issue so that the course of therapy can be safely individualized and personalized.
What about you? How’s your sleep? And what are you doing about it?
Read MoreMore great news about needles
Tis the Season for needles…pine and otherwise!
Norwegian researchers are reporting that acupuncture plus self-care can reduce the frequency of hot flashes substantially in postmenopausal women! Now that’s a gift I can get my arms around!
In this study, published in the December 4 advanced, online edition of Menopause, 267 postmenopausal women who experienced at least 7 hot flashes every 24 hours for at least 7 consecutive days received:
1) 10 acupuncture treatments plus an informational brochure on self-care for menopause symptoms, or
2) An informational brochure on self-care for menopause symptoms only
The results showed that hot flash frequency decreased by 50% over 24 hours in women receiving acupuncture compared to those who only received self-care instructions. The researchers aso noted significant improvements in vasomotor (e.g. night sweats) , sleep and emotional/psychological symptoms among women receiving acupuncture.
I’ve written about the value of acupuncture for hot flashes and improved sleep quality previously. I’m glad to see that more evidence is accruing supporting this wonderful, safe modality to improve menopausal symptoms.
The American Association of Acupuncture and Oriental Medicine is also an excellent source for more information and help finding a qualified practitioner.
Read MoreAwake again…naturally
[Pablo Picasso, Sleeping Woman]
When was the last time you slept through the night? Depending who you are, the stage of menopause you’re in and well, your symptoms, the answer to that question can vary. Add stress to the mix and it adds up to a lot of lost zzzs for some of us.
Experts continue to be challenged by the “s” word when it comes to the transition, with numerous recommendations ranging from yoga to hormone therapy to black cohosh to exercise to deep breathing. But again, whether or not these steps work depends on you.
I decided to delve a bit deeper into this issue and what I’m finding are many studies that don’t necessarily jive with each other. One of the latest bits of research comes from Brazil and is published in the November issue of Maturitas.
In this 6-month study, researchers examined two postmenopausal women with insomnia. Each woman participated in indivdiual therapy programs involving 1.5 hours/biweekly sessions comprising stretching, strengthening, massage and relaxation.
One woman experienced significant increases in REM and total time spent asleep, while the other had a reduction in the time it took to fall asleep and enter the initial stages of sleep (non-REM).
Both woman reported overall improvements in their insomnia.
Now mind you, I know a few women who have suffered insomnia most of their adult lives. So, I’m not certain whether or not exercise and/or relaxation truly improves overall sleep patterns when hormones and symptoms are wreaking havoc. At the same time, however, I continue to see studies extolling the benefits of exercise and relaxation on sleep patterns, with very few reporting negative findings.
I’d love to hear your thoughts and what works or doesn’t work for you.
Read MoreHot Flasher
[youtube=http://www.youtube.com/watch?v=glAPFCKiB6g]
[Disclosure 1: just substitute the words “hot flasher!” Disclosure 2: This song has been on my mind lately so needed to find a way to work it into the blog – thanks for indulging me!]
A new study published in the online edition of Menopause Journal has shown that hot flashes influence sleep in a stepwise or graduated fashion.
In this study, researchers analyzed data from 217 postmenopausal women between the ages of 40 and 60 years; information about hot flash frequency and severity was recorded in a daily diary, and sleep-wake patterns measured over an average of seven 24-hour periods in a subset of 112 women.
The results showed an association between moderate to severe insomnia frequency and severity of hot flashes and:
- Greater nighttime wakefulness
- A higher number of long wake episodes
So what can you do?
I’ve posted previously about the wonders of yoga to both sleep disturbance and flashes. Acupuncture might also help. And of course, that old black magic…cohosh.
Short of that…well, nothing like a little Pat Benatar…
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