Sleep and menopause – going ‘pausal
When was the last time you got a full night’s sleep? A full 8, glorious hours of zzz’s?
Bet you can’t remember.
When was the last time you went ‘pausal™?
Bet you can remember!
It seems that I can’t stop writing about sleep on Flashfree. Additionally, it appears that I continue to write about depression. And the link; it’s more common than you may imagine.
Let me break it down for you: not only does a third of the population have sleep problems, but, by the time midlife and menopause come along, it’s not out of the range of probabilities that women alone comprise that third. Okay, I exaggerate but I am sure that you can understand where I’m going here.
A number of factors affect sleep, including marital status, general health, lack of exercise and caffeine and alcohol. However, according to a recent study in Sleep Medicine, psychological factors rank amongst the highest. In fact, when researchers assessed self-reported information from almost 150,000 women enrolled in the famous Women’s Health Study, they found that the better that women felt in terms of emotional wellbeing and calmness, the better their sleep. On the flip side? Of all the factors potentially associated with the reverse, i.e., severe sleep disruption, the biggest culprits were:
- feeling restless during the day
- depression or poor emotional wellbeing
- general symptoms of feeling poorly (bloating, clumsiness, stomach issues, dizziness, back pain, nausea)
Moreover, these factors did not need to reach the level where they would have been associated with established psychiatric disease. And, they were most closely associated with wakening earlier than expected and then trying to fall back asleep.
Depression is fairly common in midlife, with as many as 40% of women who are in menopause going through some sort of blue period. Anger and hostility, and the inability to express both, can also contribute to depressive symptoms, as can discontent and resentment. This menopausal rage appears to affect many women and may be related to hormonal shifts, especially in perimenopause when imbalances and extremes occur. The key appears to be finding ways to reinstate balance, both inward and outward, which means working through hormone issues and personal issues with a licensed health professional or professionals while also maintaining regular physical activity and surrounding oneself with things that help boost an overall sense of wellbeing.
If you look at the list above, the largest culprits in general insomnia appear to be controllable. Start keeping regular tabs on the following:
- Am I constantly feeling angry?
- What appears to ‘set me off?’
- Do I feel blue?
- Do I feel as though my life is out of control?
- Am I feeling achy, sick, blah most of the time?
- Am I falling asleep and awakening? How often am I able to get back to sleep
- How’s my diet? My physical activity?
It can be difficult to discern the forest from the trees when you are caught up in the daily grind and the emotional rollercoaster of life. Add hormones to the mix and it’s a veritable ‘going pausal™’ waiting to happen. However, take comfort in knowing that you are not alone and there ARE solutions. You simply need to find the best ones for you. Start small and aim big. You may stop counting sheep and dreaming about them again before you know it.
Read MoreDepression: Walking the Walk
I’m always on the look out for evidence-based alternatives to drug therapy — not because I believe that drugs are bad — but because I believe that sometimes there are safer ways to manage certain conditions, ways that may minimize side effects or interactions. Moreover? We are a society that relies on a quick fix and sometimes, that quick fix brings on a host of other issues.
Depression and hormonal imbalance go hand in hand as much as love and marriage, babies and carriages, and yin and yang. As many as 40% of women are affected by depression during menopause, but there are other factors that come into play, including gender (women are 1.5 to 3 times likelier than men to report a lifetime history of depression), stress, family life, general health issues, a lack of exercise and genetics. Moreover, research has shown that how women perceive the effect of menopause and its symptoms on their physical health can significantly affect whether or not they develop depression at the start of the ‘pause.
When you think ‘depression,’ you probably think melancholy, sadness, feeling blue and out of sorts. But depression can also affect working memory and bring on persistent negative moods, which may not be easily resolved by drugs alone or by behavioral/psychotherapy alone. Consequently, being aware of alternative strategies may be helpful for some people. That’s why I was so intrigued by the concept of Attention Restoration Therapy (ART).
ART examines attention and divides it into two parts:
- Involuntary attention, in which our attention is somehow captured by some sort of stimulus that stands out
- Voluntary or directed attention, which is directed by specific mental processes and intellect
According to ART (which is backed and validated by scientific research) interacting with certain types of environments can promote or invoke involuntary attention; this allows our directed attention a replenishing respite, one that people with depression, who incidentally are more likely to be mentally and attentionally fatigued may benefit. Natural environments in particular, have been shown boost this attention shifting process in healthy individuals. More importantly, a small study that appears in the Journal of Affective Disorders shows that the same benefits may be obtained by clinically depressed persons. In fact, when both women and men were asked to take a 50 to 55 minute walk in an aboretum or an urban setting and deliberately asked to ruminate on a painful memory, they still scored higher on cognitive and attentional testing. After a second walk in an entirely different setting, nature walks were shown to boost both memory and mood.
Mind you, researchers still don’t know how long lasting the effects of nature are on depression, and if it matters if the person actually lives most of the time in a rural or urban setting. However, it does appear that when it comes to depression, walking the walk, especially if it’s in a natural setting, may boost mood and functioning and give attention a much needed rest.
Read MoreChasing the blues: music and mood
It’s widely accepted that depression affects as many as 20% to 40% of women during menopause. However, what’s also true is that gender differences in depression evidently begin well before the menopause and women are 1.5 to 3 times likelier than men to report a lifetime history of depression. Moreover, these distinctions start as early as the teen years and continue until the mid 50s, a time that corresponds to female reproductivity. Still, hormones are only one factor and mood can also be affected by stress, family life, general health issues, a lack of exercise and genetics. Moreover, research has shown that how women perceive the effect of menopause and its symptoms on their physical health can significantly affect whether or not they develop depression at the start of the ‘pause.
One thing that is fascinating about depression is while drugs have long been considered first line therapy, other alternatives, such as physical activity, have been shown to alleviate depression to a certain extent or at the very least, boost the effectiveness of pharmaceuticals. Listening to music may also be beneficial.
There are several theories behind the use of music in healing. One is that the slower, homeostatic rhythm of music slows down any elevated body rhythms. Another is that music actually alters psychological responses so that health outcomes, like depressed mood, are improved.
However, is there any muscle behind the claims that music can heal? A study appearing last year in Complementary Therapies in Medicine suggests it can. When researchers scoured nine databases, they identified data from 9, scientifically sound studies that enrolled participants in a wide range of ages from 18 to 95 years. And while there was no rhyme or reason the the duration of each listening session (30 to 60 min) or frequency of listening (2 to 3 times a day to once a week), nor was there a consistency between type of music listened to, 11 studies showed the listening to music improved depression and some demonstrated significant improvements, with scores improving by as much as 47% after 4 months. In some trials, improvements were seen as early as two weeks. Moreover? These improvements were measured by several different validated scales and were not based solely on participant recall.
While the studies did not necessarily examine music type, one compared the difference between rock and classical and found positive results in mothers who had become withdrawn. Others showed that having a choice helps; here, the researchers point out that choice helps the body to adapt and adopt musical patterns because the “listener is more in-tune” with preferred music.” (Pun intended!)
Clearly, there are distinctions between the data drawn from these studies which makes it impossible to draw any firm conclusions. At the same time, there is enough evidence to support the role of music as therapy in mood disorders. For me, a dose of prevention is worth a pound of cure. And this is the type of prevention that’s just ‘music to my ears!’
If music be the cure of mood, play on.
Read More“Severe depression? Apathy? Psychomotor retardation?” How about a bennie?
Every now and then, a post deserves a second viewing. This week, I’m bursting the bubble again on vintage advertising. Nothing like an upper for the mid-week blues, right?
“In the severe depressions of the menopause, marked by apathy and psychomotor retardation…”just use a bennie. You’ll be speeding through your day in no time! (And will probably lose that extra weight too!)
Really! What WERE they thinking?!
When was the last time you slept
…like a baby?
Yawning again? It’s not daylight savings time, promise! In fact, it may very well be your mood, at least in part.
I’ve been writing about sleep (or lack thereof) and menopause since first starting this blog in 2008. Click on the link and you’ll see posts about causes, solutions, pillows, sheets, you name it. And yet, I wouldn’t be surprised if sleep eludes you from time to time as much as it does me. More importantly, I imagine that some of you in the Flashfree universe don’t sleep much at all.
What gives?
Anxiety. And depression. That’s what. At least according to new data appearing in the online version of Maturitas journal. This time, researchers in search of some answers about sleep difficulties in midlife examined medical records of 237 women in peri- and postmenopause, all of who were on average, 52 years old. More specifically, they delved into answer that the women had provided to previous questionnaires about their life quality (based on physical and mental health, life satisfaction and social involvement) and degree of anxiety and/or depression. Within these questionnaires were measures of menopause-specific symptoms as well as sleep issues, including difficulty falling asleep and sleep that was non-restorative.
Overall, and unsurprisingly, about 36% of the women expressed difficulty falling asleep and 44% nonrestorative sleep during at least half the week. Almost a third experienced both issues at least 3 nights a week. Yet, sleep difficulties were less associated with menopausal symptoms (night sweats, hot flashes, nausea, dizziness, muscle/joint pain, headaches) and rather, with psychological statse of being. Indeed, trouble falling asleep seemed to be mostly correlated with anxiety, while non-restorative sleep was linked to depression.
This is not the first time that researchers have linked mood disorders to sleep issues. And although the progression is not entirely clear, i.e. the time course over which depression and anxiety develop during the transition to influence sleep, what is clear is that treating the underlying issues may ultimately help improve sleep quality.
What about you? Do you find that feeling blue or anxious tends to rob you of much needed zzzs? Or are you more convinced that waking up drenched in sweat is what is messing with obtaining restorative sleep?
Inquiring minds…
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