Posts Tagged "Sleep"

Got Sleep? You may want to consider valerian

Posted by Liz on Sep 2, 2011 in aging, herbal medicine, sleep disturbance | 2 comments

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.

Insomnia and menopause. Awake again…naturally

Posted by Liz on Apr 11, 2011 in sleep disturbance | 1 comment

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…

Are you getting the sleep you need?

Posted by Liz on Feb 14, 2011 in sleep disturbance | 4 comments

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? `

Is your sleep elusive?

Posted by Liz on Nov 5, 2010 in sleep disturbance | 6 comments

Ever since I discovered Zeo, I’ve become pretty interested in sleep and in discovering the reasons why my sleep (and so many other women’s that I know) is lousy. What I’ve learned is that it’s while it’s easy to define the problem, it’s not so easy to assign an overriding factor. In fact, it appears that the more researchers delve into this elusive but necessary component of our lives, the less they truly understand.

Sleep issues tend to plague both men and women as they age. Indeed, deep sleep (or at least its electrical representation, also known as “electroencephalographic wave amplitudes”) has been shown to dwindle was we grow older, resulting in lighter and frequently interrupted sleep. Add factors such as hormones, health, life strain/midlife issues and psychological stress and you may end up exacerbating an already existing sleep deficiency or creating an entirely new problem. Moreover, researchers have shown that distinct sleep patterns might be associated with different influencing factors. For example:

• Difficulty falling asleep may be associated with menopausal symptoms in general, stress, and lower stress hormone levels.
• Awakening during the night might 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 may be associated with age, hot flashes, depressed mood, anxiety, joint pain, stress, and lower estrogen/higher fallopian stimulating hormone (FSH)  levels.

Let’s add to the confusion, shall we?

In a study appearing in the upcoming November/December Menopause journal, researchers evaluated health, menopausal status and sleep difficulties in 962 women who were assessed annually from birth through the ages of 48 to 54. The findings?

• The percentage of women experiencing moderate (trouble sleeping a little) or severe (trouble sleeping a lot) sleeping difficulties increased by more than 10% between the ages of 48 and 54.
• Menopause status (i.e. perimenopausal, postmenopausal, perimenopausal, early menopause due to hysterectomy or initiation of hormone therapy) appeared to be related to the presence/severity of sleeping difficulties. In fact, women who had had a hysterectomy, were postmenopausal or had started hormone therapy in the previous year had 2 to 3.5 times greater odds of severe sleep difficulty compared to premenopausal women. Of note, some of these women had not experienced poorer physical or psychological stress than their peers.
• However, with regard to moderate sleep difficulties it becomes more difficult to pin down: once the researchers accounted for certain factors that might skew the results, such as psychological stress, vasomotor symptoms/hot flashes and depression, only women who had had a hysterectomy remained at risk. Although the reasons for this are not entirely clear, the researchers say that sleep difficulties among these women in particular may be related to underlying health before they entered menopause.

The key take-away of this study is that for some women, menopause transitions (i.e. hormonal shifts as they go from pre to perimenopause, and then from peri to postmenopause) influence the severity of sleep disturbances regardless of age or other life or emotional factors. This finding is in line with findings from other studies, which have linked specific hormone-related symptoms such as night sweats to sleep disturbance/fragmented sleep.

However, having had a hysterectomy appears to lead to moderate interruptions in sleep, possibly as a result of prior health issues. So, severe sleep issues = menopause, and moderate sleep issues = ???

The downside of this research truly lies with semantics: how do you define moderate sleep disturbances and in turn, treat them? Do you look for  and address the cause or influencing factors? As noted in an accompanying editorial, multiple factors in various combinations in certain women may very well contribute to overall sleep quality.

In other words, when it comes to sleep, treat the individual, not the masses. Aging, life, hormones all come into play in certain individuals at certain times.

When it comes to sleep, one size does not fit all.

Got Zzzzz’s? And the winner is….

Posted by Liz on Oct 12, 2010 in sleep disturbance | 1 comment

Last week I posted about sleep and a new personal sleep coach that I’m trying out – Zeo. I offered to give away a bedside monitor in exchange for a blog comment about sleep, and a willingness to share your thoughts about Zeo on Flashfree in a month’s time. I only received a few comments but I did the old hat trick and pulled out one name:

Meryl K. Evans! Congratulations Meryl – send me your mailing address and I will ship the unit out to you this week.

As a special thank you to Peg and Heather, Zeo has graciously offered free shipping on all units ordered through October 31. Just use FREESHIP at checkout for ground orders.

I’ve got one more night of collecting baseline data and then I start the regular program. So far, I am fascinated and hopeful that it may identify specific factors that are screwing up my sleep. Stay tuned.