"Sleep tight - Menopause and a good night’s rest – is it possible?"
When women who are 40 and older get together, the conversation seems to inevitably turn to sleep issues. Middle-aged women are sleep deprived, often because of symptoms related to menopause or perimenopause, a time of transition that occurs shortly before menopause begins.
“It’s a significant problem among women of a certain age,” says Dr. Anne Souter, who’s been a family doctor for 30 years and is with the London Family Health Team.
“When women are 45 to 55 years of age and going through menopause or perimenopause, symptoms like flushing become problematic for some.”
She explains that waking up several times during the night from flushing – what many call ‘night sweats’ – and needing to change one’s bedclothes or sheets can cause fatigue, which can lead to other symptoms, including depression.
Since Chris Yurchuk’s sleep started to be interrupted nightly because of night sweats four to five years ago, she tried taking melatonin, Gravol, and lorazepam. Now 55, Yurchuk reports rarely getting a full night’s sleep.
“If I can stretch it to two or three hours of good, solid sleep before starting over again (getting to sleep), that’s a good night,” she says.
Her gynecologist prescribed Hormone Replacement Therapy (HRT), which she took for a year and found that it helped with the sweats. However, as the owner of The Fitting Room – a store in Sarnia that sells breast forms and mastectomy bras – and a certified mastectomy fitter, she comes into contact with many women working through the effects of breast cancer, and Yurchuk became uncomfortable continuing to take HRT because of its perceived association with higher rates of cancer.
For some women, the symptoms of menopause become so acute that their doctor refers them to a specialist.
According to Dr. Marcus Povitz, the sleep clinic at London Health Sciences Centre receives 250 referrals a month and many of those are for women between 40 and 60 years of age.
“Very few come to me specifically about their sleep issues relating to menopause, but often that becomes apparent when we go over their issues,” he says.
At the clinic, a sleep study is often part of the protocol, as is a physical exam.
“We help people change their behaviors around sleep and their perceptions to break the cycle of insomnia,” Dr. Povitz explains. He adds that if they’re anxious about not sleeping, they don’t sleep, which can cause a negative cycle.
Dr. Souter agrees. Before referral to a sleep clinic or consideration of drug therapy of any kind, she walks the patient through other treatment options. “If they are having hot flashes, are they wearing light cotton sleep clothes and using a fan or air conditioning? Have they gained weight, so breathing has become a problem?” She discusses their lifestyle habits like drinking excessive amounts of caffeine or alcohol or consuming nicotine. She asks if they are eating heavy or spicy meals too late at night.
"Others feel that it’s a matter of mind over matter"
After advising on these kinds of issues and discussing non-drug remedies, Dr. Souter sometimes prescribes Clonidine for those suffering from night sweats, which she says is effective 30 to 40 per cent of the time. Other options she finds are effective for some women are Ditropan or a SSRI. She also prescribes Hormone Replacement Therapy for women who have issues with flushing but also experience other negative symptoms of menopause like vaginal dryness, painful intercourse and mood swings.
“In the past, HRT was prescribed much more extensively than it is nowadays. This was due to a study that found HRT increased the risk of breast cancer, heart attacks, stroke, DVT and pulmonary emboli. Re-analysis of this data, however, revealed that HRT is quite a safe and effective medication in the younger women in the perimenopausal age group as long as they have been appropriately screened for risk factors and are informed about the benefits, side effects and risks of HRT. We prescribe the lowest effective dose for the shortest amount of time required to alleviate the symptoms,” says Dr. Souter.
As a homeopath, Joanna Rogister also uses the smallest amount of medicine to treat the patient’s problem. Her treatments start with a two-hour session that includes taking a medical history and examination of the issues surrounding sleep problems. “There are a variety of remedies that we can try, and (patients) will know within a matter of weeks if the remedy is successful,” she explains.
Rogister says she feels that “the menopause years are packed with changes – children growing up and leaving, job changes, changes in relationships – and can be some of the most productive in a woman’s life. Treating sleep issues is important to being happy and productive,” so she uses nutritional counselling and homeopathic treatments.
Others feel that it’s a matter of mind over matter. Empowerment coach Beth Sutherland says she feels that you need to change your mind to change your behaviour. She has a treatment program that can include interrupting behaviours to get different results. “Maybe something as simple as sleeping with your head at the opposite end of the bed will help. It’s about re-patterning the brain.”