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 MoreWednesday Bubble: Hot flashes? Try a little mindfulness…
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No bubble bursting or woo woo. I’m talking the real deal. And if mindfulness doesn’t lead to a wee bit of tenderness, well, I don’t know what will. But enough of me taking poetic license with Otis.
Back in January, I wrote about a piece about the relaxation response and how a daily relaxation practice can actually alter gene structure and induce cellular changes believed to promote health. In the post, I said that “both inner and outer psychological states and environmental factors play a role in how women experience peri and post-menopause, their self-esteem, attitudes and severity of symptoms. If a daily practice of some sort of relaxation strategy can actually alter genes in a way that improves health and well-being, why can’t that daily practice also improve the menopausal/midlife experience?”
Guess what?
It appears that I might have been correct.
Writing in the Advanced Online edition of Menopause, researchers say that women who learn to recognize and more accurately discriminate the components that make up an experience, e.g. thoughts, feelings and sensations, or more specifically, the degree of bother and stress related to hot flashes, may be able to reduce the impact of the flashes on wellbeing.
In this 20 week study, women who were late into the transition into full menopause or in early menopause who reported experiencing, on average, 5 or more moderate to severe hot flashes/night sweats a week were assigned to 8 weekly mindfulness-based stress reduction classes plus one, all day weekend class or to a waiting list. These classes, which lasted 2.5 hours at a time, involved the following:
- Focused awareness of gradually moving thoughts through one’s body from the feet to head while lying down, paying close attention to bodily sensations
- A sitting meditation focusing on breathing
- Mindful stretching
- Learning materials that discussed how to apply mindful stress reduction practice to everyday life and specifically in response to distressing symptoms and situations.
All participants also completed daily hot flash diaries to rate how bothersome their hot flashes were throughout the study period. Additionally, the researchers analyzed the intensity of hot flashes, quality of life, sleep quality, anxiety and perceived stress, as well as medical history, smoking, previous experience with mindfulness practices, and factors directly related to flashes such as smoking, body mass index, alcohol use and physical activity.
Granted, this study is a small one. But the researchers found that mindful stress reduction practice significantly reduced hot flash bother over time by almost as much as 15% after nine weeks and by almost 22% by 20 weeks, compared to at least half as much in women who were on the wait list. Moreover, sleep quality improved considerably!
Overall, the researchers say that their findings truly highlight the role that stress in general, and mental stress in particular, play in how we perceive hot flashes, how much we are bothered by them, and even their severity and frequency. However, they also say that the fact that mindfulness practice did not affect the intensity of hot flashes shows that it might simply help women cope better with them. Less clear is how the degree to which the placebo effect played a role; studies of pharmaceutical treatments report a subjective placebo effect of up to 30% so it’s not out of the realm of possibility.
Still, they believe that their data show that mindfulness stress reduction may be a significant resource for reducing the bother of hot flashes. Overall, it’s a win-win. Calm the mind; calm the body. Why not try a little tenderness with yourself?
Read MoreWednesday Bubble: Holy Hot Flash Menopause Woman!
Bet you never thought you’d hear holy and hot flash in the same sentence! However, it appears that menopausal hot flashes, those bothersome, sweat inducing, embarassment producing, change of clothing inducing symptoms might actually deliver something better than a whole lotta dread. And so, dear readers, after the bad breast cancer news that I delivered on Monday, I’m happy to report some good!
You mean I WANT hot flashes? Well not exactly. But there sure is a interesting paradigm hidden somewhere in the diminishing returns of estrogen, that is, severe, wake you in the middle of the night or interrupt your meeting hot flashes might actually reduce risk for invasive breast cancer.
As we know all too well, menopausal symptoms often occur as estrogen and progesterone levels fluctuate and the ovaries cease to function reproductively. However, utilizing data culled from a study whose original intent was to evaluate the link between hormone therapy and risks of different types of breast cancer, researchers have actually uncovered some positivity! In this study, women between the ages of 50 and 74 were randomly selected based on confirmed invasive breast cancer and then matched by age to healthy women. All were interviewed about their reproductive history, menstruation/menopause history, use of hormones, BMI, medical history, family history of cancer and use of alcohol. They were also asked specifically about their experience with menopausal symptoms, including hot flashes, night sweats, vaginal dryness, bladder issues, irregular menstruation, depression, anxiety, emotional distress and insomnia and requested to rate them based on their frequency and severity.
Interesting enough, women who reported menopausal symptoms had a 40% to 60% lower risk of the type of invasive breast cancer that starts in the milk ducts (i.e., invasive ductal carcinoma or IDC) and invasive breast cancer that starts in the glands at the end of the milk ducts (i.e. invasive lobular carcinoma or ILC). Moreover, reduced risk for these cancers as well as the mixed ductal/lobular type was especially pronounced among women who experienced hot flashes with perspiration or whose hot flashes woke them up compared to women who had hot flashes without perspiration or others symptoms with awakening during the night.
The researchers say that they believe that menopausal symptoms may be markers for hormonal changes that precipitate breast cancer. In other words, pronounced the changes in reproductive hormones may actually be related to breast cancer risk. Less clear are the direct connections between individual symptoms and risk. However, they noted that the relationship between symptoms and risk did not change when hormone use, age when menopause began or BMI were factored into the equation.
Clearly, this is only one study so no firm conclusions can be drawn, at least not yet. But with all the bad news about hormone therapy and breast cancer risk, it’s heartening to learn that the hormones that are wreaking havoc on our lives may actually be protecting us from harm.
Holy hot flash indeed!
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?
Read MoreThere ain’t no men in menopause…and other musings for a Friday
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Have I got your attention now? Hope so. ‘I’ve said it before and I’ll say it again. More times than those two and a half men can sing “men.”
It’s. Not. All. About. You.
Here’s some information from an earlier post:
There’s a misnomer going around (can a misnomer go around?). It’s called “male menopause.” Now mind you, I’ve got no beef with da guyz but to call a gradual decline in testosterone “menopause,” seems a bit extreme. So, what’s the buzz about?
According to the Mayo Clinic, menopause and “andropause” are two distinct animals. During menopause, women undergo a cessation of menstruation and a rapid plummet in hormone production. On the other hand, men experience gradual declines in testosterone production after age 40. However, some men continue to produce high levels of testosterone well into their older years. What’s more, the problem does not appear to be universal; symptoms of testosterone decline, which may include reduced sexual desire and spontaneous erection, swollen breasts, a loss of hair from the body and around the genitals, loss of muscle mass, depression, and rarely, hot flashes and sweats vary from man to man and some men never experience any symptoms whatsoever.
In fact, back in October, I cited data suggesting that there is insufficient evidence supporting a decline in androgen in a majority of men and that “the extent to which an age-dependent decline in androgen levels leads to health problems that might affect or alter the quality of life remains under debate.”
Further, the medical community is not only in disagreement over “male menopause” but also its treatment.
There’s lots of controversy over testosterone replacement therapy and whether or not it actually helps the symptoms of androgen deficiency. What’s more, research suggests that a large majority of men experiencing symptoms of androgen deficiency do not seek care. (No surprise there, right?!)
Okay, so now that we’ve got that straight, may I reiterate that it’s not all about you?
I ran across a disturbing piece in this past Tuesday’s Washington Post about how and why the country’s economic crisis is taking a greater toll on men. Entitled “Economic Crisis Hits Men Harder,“ the article relies on the psychotherapist and author Jed Diamond who is at the forefront of the male menopause movement. In addition to expounding on the distinction between male menopause and irritable male syndrome (for which Diamond continues to claim that he has supportive data) Diamond says:
“The loss of jobs, economic situations, crashing — it affects men in a profound way. The chaos is affecting men in very, very powerful and negative ways…Men have a less resilient emotional system; women’s brains are more networked from left to right. They are balanced socially. Men tend to be more isolated” (and therefore, don’t have as much social support).
I agree with Diamond’s point that women tend to turn to social support in times of stress and therefore, may be able to deal with it more effectively than their male counterparts. However, to minimize the impact on a majority of the population, many of whom work multiple jobs while simultaneously caring for families, well, that’s just wrong. In fact, economic development expert Sara Gould writes that “the current instability roiling Wall Street’s markets will lead to an increasingly dire economic situation for women. This is especially true for low-income women, women of color, single mothers and others who have long experienced the disproportionate impact of flawed economic policies.”
So, if women are bearing the brunt of the crisis and are facing increasingly dire situations, is it accurate to say that the economic crisis hits men harder? And likewise, is it reasonable to take a life transition that is as natural to women as breasts and recreate it in the male image?
What do you think? I smell a rat and his name is Jed.
[You can find this post and other goodies on BitchBuzz]
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