It’s no surprise that hot flashes and night sweats rank among the most important factors when it comes to poor sleep. However. less clear are the factors that may provide a buffer against the flashes. And aside from the usual suspects e.g., crankiness and moodiness or the inability to focus, poor sleep has been linked to heart disease and obesity, among other less desirable health conditions.
So, what can you do?
I’ve written about the benefits of physical activity and amelioration of menopausal symptoms many times on Flashfree. And, I imagine I will continue to do so. But what about sleep? There is evidence that physical activity can help bolster both sleep quality and sleep quantity. Yet, few people have examined the domino effect, i.e. fewer hot flashes ← physical activity → better sleep. Moreover, even fewer have considered the benefits of non-leisure physical activity, like housework.
Now, before you accuse me of setting women back 60 or 70 years, let’s consider exactly what I am suggesting.
According to research, women participate in less leisure time physical activity but greater levels of household physical activity than their male peers. This is apparently truer among ethnicities other than Caucasian (especially African American), who also tend to have greater levels of obesity and poorer sleep characteristics. So, it would follow that by increasing both, women might fare better in the sleep department, right?
In fact, when researchers took a small group of women participating in the larger SWAN study and evaluated their self-reported and scientifically measured sleep patterns for four nights, that is exactly what they found. The group, which was comprised of both White and African-American women, reported having flashes or sweats, were between the ages of 54 and 63, had an intact uterus and were not on medications that could affect hormone levels or symptoms. And while the number of women was quite small (only 52), they fit into the full spectrum of BMI targets (from normal to obese to overweight). In addition to sleep patterns, they also shared details of their most common daily physical activity (how often, how long and how intense) and household/caregiving responsibilities (time spent caregiving, preparing/cleaning up after meals, and routine chores as well the intensity of these activities).
Not surprisingly, women who had greater levels of leisure physical activity were 8 times more likely to report that their sleep quality was better than their less active peers. And, women who reported greater household, non-leisure physical activity awakened fewer times during the night, but only if their BMI levels were lower. Yet, the benefits were mostly seen more among White women. Even more troubling is that the researchers say that they could not determine the ‘why’ of these findings, even though they conducted several different types of analyses and comparisons.
The good news is that for some women, engaging in greater levels of household physical activity and leisure physical may reduce sleep disturbances, especially if they are not overweight. For others, especially my African-American sisters, the mystery remains. African-American women often report more severe hot flashes than their White peers. And while experts have pointed fingers towards rates of obesity or distinctions in estrogen levels or smoking history, the reasons remain unclear.
Meanwhile, while I am not necessarily suggesting that you increase your household responsibilities, I do believe that even with the limitations of this study, more physical activity may beget better sleep and possibly fewer or less severe hot flashes. Finally? Can we please find some effective and viable strategies for women of colour? Although the menopause experience may vary by ethnicity, as women, we need to find solutions that work for most of us, not some of us.Read More
Hot flashes and night sweats. Why is it that some women seem more prone to one or both and others simply sail through menopause with flying colours, that is, why are some women resilient to symptoms and others vulnerable? Are genetics or race or psychosocial factors at play? Moreover, are there ways to predict which camp you fall into before you start menopause so that you can employ preventive measures or mentally prepare for what may come?
By examining information collected on over 4,000 women across the UK, researchers believe that they may have found a few answers to why some women do and some don’t. Here’s the lowdown:
Researchers first grouped 23 menopausal symptoms into six unique clusters, psychological, sexual, general, musculoskeletal, menstrual and bloating. They then further divided them by frequency and severity. The results?
Resilience to hot flashes appeared to be bolstered by having experienced less bother during menstrual periods, having fewer general symptoms (such as breathlessness, a frequent need to urinate, headaches or dizziness) and the perception that menopause and its symptoms did not have a significant consequence on one’s life.
Conversely, vulnerability to hot flashes appeared to be related to having one or more children, having a higher (>25) BMI, experiencing night sweats and the perception that menopause and its symptoms had a moderate to highly significant life impact.
How’s your physical health? Evidently the worse it is, the more vulnerable you are to night sweats. If you have hot flashes, you may also be more vulnerable; accompanying muscle and joint aches So does having sleep difficulties or a perception that menopause has a significant impact on your life. Women who are resilient to night sweats don’t smoke, tend to rely on psychological strategies to help manage their symptoms and like their hot flash counterparts, don’t perceive menopause as having a significant impact on their lives.
If you are wondering why any of this is important or relevant, just think about it: having a greater perception that menopause has a negative overall impact on one’s life can impact resilience or vulnerability to some of its most troublesome symptoms: hot flashes and night sweats. This suggests that behavioral or psychological interventions, seeking social support or simply learning more about the ‘pause may potentially impact how bad (or good) it ultimately is. Moreover, clusters of these factors appeared to have a greater or lesser impact, which truly challenges the ‘one size fits all’ model of treatment.
Menopause and (and how we go through it) isn’t always our choice. But isn’t it refreshing to know that there are aspects about the ‘pause that ARE in your control? Stop smoking if you are a current smoker. Think about how you allowing aging to impact how you perceive your life and if there are steps that you can take to do a 180 attitude adjustment. Try to shed a few pounds if you can. And if you are in the premenopausal phase, take some steps now to shift the ‘tude when your period hits.
Resilient or vulnerable? It may be up to you, at least in part.
A lot of you have written to me back channel to see if there is any evidence that diet affects menopausal symptoms. Up until now, I have run across many articles but little evidence on the topic. Hence, I was heartened to read about the positive effect of dietary changes and weight loss on hot flashes and night sweats in the online edition of Menopause.
The original intent of this study of over 17,000 women was to assess how a low-fat diet might benefit heart disease, breast and colorectal cancer and fracture risk among postmenopausal women. Nearly half of the women were asked to reduce their fat intake to only 20% of total energy and increase daily fruits and veggies intake to at least 5 servings daily, and whole grains, to 6 servings daily. Over the course of 5 years, they also received regular, intensive behavioral training conducted by a nutritionists and registered dietitians. The other half of the women only received a copy of Dietary Guidelines for Americans and other health-related materials. All were between the ages of 50 and 79.
Although weight loss was not a study goal, per se, on average women who agreed to changes in their diet lost an average of 4 pounds in the first year. And these women were able to reduce night sweats and hot flashes. What’s more? Women who lost more than 10% of their overall weight were significantly likely to eliminate their symptoms entirely (note that only a small proportion of women — 1% — reported having severe night sweats or hot flashes and symptoms were mostly mild to moderate in intensity). But, the findings get even more granular. The researchers write that when they did an additional analysis that women who lost the most weight (22 lbs) had more than twice the odds of eliminating moderate or severe vasomotor symptoms compared with women who maintained their weight.
Although the reasons are unclear, weight loss may reduce the amount of adipose tissue -the tissue that stores fat — and by default, reduce its insulation-type, thereby boosting the body’s ability to attack excessive body heat. Regardless, there are many reasons to maintain weight as we age. If this is an additional benefit, I say bring on the fruits and vegs!
Be still my heart? Not this week. At least not as far as hot flashes and night sweats go. In fact, study findings that will be presented this coming weekend at the Endocrine Society ‘s 94th Annual Meeting suggest that hot flashes and night sweats that many women experience early in their menopause are not related to an increased risk for heart disease.
So what’s the 4-11?
Researchers have previously questioned whether or not timing of symptoms play a role in a woman’s increased risk for heart disease during menopause. They’ve found that experiencing symptoms only around the time menopause begins may actually reduce the risk for heart disease, or the risk of stroke, heart attack or death (compared with women who experience symptoms later). (If you’d like more about heart disease, aging and menopause, an archive of posts can be found here). To learn more, they have now analyzed the presence of markers in the body that have been linked to heart disease risk (e.g. high blood pressure, cholesterol, blood sugar, insulin, and specific blood markers that might indicate inflammation), in almost 60,000 women who were in menopause and had participated in the Women’s Health Initiative Observation Study.
These women were separated into groups, depending on the presence and timing of vasomotor symptoms:
1) No symptoms
2) Symptoms at start of menopause but not at the start of the study
3) Symptoms both at the start of menopause and the start of the study
4) Symptoms at the start of the study but not at the start of menopause
Importantly, women who had symptoms early in their menopause but not late did not appear to have elevated markers that may indicate heart disease risk. In comparison to this group, women whose vasomotor symptoms occurred only late in menopause appeared to have increased risk, mainly due to higher blood pressure and higher white blood cell counts. Those whose symptoms started early and persisted appeared to have higher levels of glucose and insulin, which indicated an increase in the risk for diabetes.
The researchers, who harken from Northwestern University, note that it’s unclear why timing of symptoms may influence heart disease, although the lead investigator, Dr. Emily D. Szmuilowicz has speculated that symptoms that occur long after menopause begin may indicated some sort of blood vessel abnormality. And while she and her colleagues have not suggested a strategy to attenuate this risk, it is clear that due diligence is needed. If your symptoms persist well into your menopause, see your health practitioner and ask him or her to run some tests. More importantly, hindsight is 20-20; be sure to instill lasting heart healthy habits early and maintain them while you age.
What are the odds that I would run across yet another cooling product? Seriously, it’s like a flash went off in someone’s brain that every menopausal woman in the United States needed to solve her issues through cooling. Mind you, I do believe that thermoregulation is an interesting strategy to combat the body’s out of whack thermometer. But when does the menopausosphere reach its saturation point?
Evidently, not yet.
This week, I bring you the Polar Pillow, guaranteed to “calm, cool and soothe you into the best sleep of your life” (as well as soothe hot flashes and night sweats).
This nifty 12+ pound pillow contains cooling gel infused with micro air beads and according to the manufacturer, works on its own by absorbing coolness from the air and then releasing it upon contact. The ‘science’ behind the Polar Pillow is an abstract presented at the Associated Professional Sleep Society 2011 meeting. In this study, researchers asked 12 people with insomnia to wear a cap that contained circulating water at cooling and varied temperatures. With the cap on, study participants with sleep issues took an average of 13 minutes to fall asleep (compared to 16 minutes for the healthy comparators) and they slept for about 89% of the time that they were in bed. Theoretically, the benefits are related to the fact that the brain (namely the frontal lobe) remains too hot to sleep and by cooling it down, one can turn down processes that keep the brain active and alert.
So, where do the night sweats and flashes come in?
At least not in the small pilot research that was conducted thus far.
However, rather than asking you to take my cynical word on the Polar Pillow, I decided to ask my friend Richard Laermer (who I inadvertently learned has used the pillow) to weigh in. And while Richard told me that he likes it because he’s a “hot” sleeper and it does cool him, he said that “it’s ugly and it seems to smell sometimes,” adding that it’s not him since he’s “fairly clean!” But here’s the rub:
” There are really really rough pointy edges that almost blinded my partner,” said Richard. “Go figure. Meanwhile, I wouldn’t recommend it…we can do better for a hundred bucks.” (Richard received it as a gift.)
So, let’s see:
- It’s ugly
- It smells
- It has really rough pointy edges making its utility in bed dangerous for one’s partner
And while it may cool the average hot sleeper, it has not actually been shown to help menopausal women. (Clearly, Richard is neither a women or menopausal.) And, despite being the target hot sleeper, Richard still wouldn’t recommend the Polar Pillow.
My take away?
Thermal is in. Cool is the new black. Enough said.