Is your sleep elusive?

Posted by 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.


  1. 11-5-2010

    My doc (and my body) say I’m nowhere near menopause, but my sleep patterns say otherwise. I fall asleep quite easily, but after a few hours, I awaken throughout the night, finally giving up around 5:30 or 6:00 am. Sadly, my brain and body want to sleep until 7:30 or so. It’s frustrating. Temporary solution – more liptstick and sunglasses!

    • 11-5-2010

      Alexandra – some of that is stress. And some of that is aging (sorry!). I think that it comes down to learning to live with new patterns, and fixing what we can!

  2. 11-5-2010


    I’m no doc, but your experiences with sleep remind me of my experiences with stress and anxiety. I’d fall asleep like a baby and then wake up several hours later, seemingly unable to get back to sleep. However, we often “misremember” periods of sleep (, especially when dealing with periods of insomnia, and keeping that in mind has been a big help for me late at night. I also write in my journal when I can’t sleep and that helps as well. If all else fails, reading a book in a chair with a warm blanket and hot water bottle does a pretty good job. I might not feel the best when I wake up, but at least I slept–and lipstick helps as well!

    • 11-5-2010

      Andi – It is so true that we also misremember periods of sleep and that’s something that I’ve been learning by using Zeo. And BTW – lipstick always helps!

  3. 11-5-2010

    Nice pithy post, Liz. As a clinician in a research environment the definitions in studies are the devil. Patients hearing about these studies in the MSM really can’t understand what’s real and what isn’t.

    • 11-5-2010

      Thank you. I appreciate that. Sleep has so many confounding factors that it is often difficult to separate the wheat from the chaff. I have always been, and continue to be, an advocate of individualizing therapeutic strategies, i.e. let’s look at works for the masses, and then let’s look at what may work for you based on your confounders. Really appreciate your comment.

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