Reports from various sources suggest up to 60% women experience sleep disturbance at some stage during the menopausal transition (rates before perimenopause are about half this).
Around a quarter of women have severe symptoms that effect daytime functioning, qualifying them for a diagnosis of insomnia (ie. no other sleep disorder present).
Insomnia disorder in the general population is linked with adverse mental and physical conditions, including depression and cardiovascular disease. It causes reduced functioning in all aspects of daily living including occupational functioning, and contributes to many accidents.
*Not all hot flushes are associated with waking, and not all periods of wakefulness are associated with hot flushes. However hot flushes strongly correlate with poor sleep.
Well, besides the obvious (feeling tired) there are a number of screening tools you could try:
Sleep Apnea screening: STOP BANG: https://www.healthysleep.net.au/stop-bang-sleep-apnea-screening-calculator/
Epworth Sleepiness Scale: https://qxmd.com/calculate/calculator_85/epworth-sleepiness-scale
Pittsburgh Sleep Quality Index: https://aurora.edu/documents/wellness/assessment.pdf
If you suffer from severe sleep problems and don’t have any improvement after the following measures then ask your GP for a referral to a sleep specialist.
There is often a huge behavioural component to sleep issues which must be addressed along with the medical ones. As quoted in the reference article below: “No matter what the precipitating factors for insomnia are, behavioural conditioning and sleep-associated behaviours may prolong insomnia; these behaviours need to be addressed in order to successfully treat insomnia.”
Take a systematic approach to the management of your sleep problems:
1. Identify and treat the contributing factors: Treat hot flushes, lose weight, see sleep specialist for MAS or CPAP, optimise treatment of anxiety/depression and other chronic conditions, make sure pain is adequately managed, etc.
2. Sleep hygiene- behavioural changes to improve sleep problems:
3. “Natural” sleep enhancers:
Cognitive Behavioural Therapy has the best evidence. Other interventions with modest benefit include high-intensity exercise, Yoga, Soy isoflavones.
There is only limited evidence for herbal remedies (see factsheet from the Sleep Health Foundation). This older paper states: “…melatonin… has been found to have a benefit in the treatment of circadian sleep disorders…. Valerian has also been found to improve sleep in some studies, but variability in extraction and formulation remains an issue. Other therapies that have shown promise in a limited number of studies include acupuncture, acupressure, yoga, meditation and Tai Chi.”
Earplugs also work great if noise or partner snoring is a problem!
After the workshop there were some questions specifically about the use of magnesium to help with sleep, and about the treatment of leg cramps. A brief Google Scholar search did reveal some evidence for sleep improvement with magnesium. Interestingly the evidence for its benefit in treating leg cramps however is poor, except in pregnant women. This article gives a rundown of the evidence related to treating nocturnal muscle cramps. It also states that estrogen treatment may make cramps worse.
4. Medical Options
Journal Article: “Sleep problems during the menopausal transition: prevalence, impact, and management challenges”: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810528/
AMS Information sheet: “Sleep disturbance and the Menopause” https://www.menopause.org.au/hp/information-sheets/949-sleep-disturbance-and-the-menopause2
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