Menopausal insomnia can occur in conjunction with menopause which is a stage in a woman’s life when her ovaries stop producing the hormones estrogen and progesterone and she stops having her monthly menstrual cycle (her period). It is a normal part of aging and marks the end of a woman’s reproductive years. Menopause typically occurs in a woman’s late 40′s to early 50′s. It can also lead to menopause sleep problems.
When the ovaries no longer produce adequate amounts of estrogen and progesterone (as in menopause), the loss of these hormones can bring about various symptoms including hot flashes (a sudden feeling of warmth that spreads over the body) and sweating (which is related to hot flashes) and poor sleep.
Approximately 75-85% of menopausal women experience hot flashes, which can last for five years. Hot flashes and sweating can make it difficult to sleep. According to the National Sleep Foundation, approximately 61% of menopausal women have related menopausal sleep problems. Sleeping difficulties can lead to other problems, such as daytime drowsiness.
How Can I Treat Sleep Problems Related to Menopause?
The traditional treatment for the symptoms related to menopause — like hot flashes and insomnia — has been hormone replacement therapy (HRT). HRT consists of estrogen given as a pill, patch, or vaginal cream, either alone or combined with progesterone (for women who still have their uterus). However, results from a large study, the Women’s Health Initiative, showed that long term use of estrogen-progesterone combination therapy caused an increased risk of breast cancer, heart disease, blood clots, and stroke.
Estrogen alone did not increase breast cancer or heart disease, but the study also found that therapy with estrogen alone increases the risk of blood clots and stroke.
The latest recommendation for use of HRT for severe menopause symptoms is to use the lowest possible dose for the shortest possible time, with regular follow-up with your doctor.
If you are not a candidate for HRT, if your symptoms are not severe, or if you simply decide not to use HRT, the following tips might keep you cooler at night and help you sleep better without the use of hormones.
- Wear loose clothing to bed.
- Keep your bedroom cool and well-ventilated.
- Avoid certain foods that may cause sweating (such as spicy foods), especially right before bed.
Other practices that may ease menopausal sleep problems include:
- Maintain a regular bedtime schedule, including going to bed at the same time every night
- Exercise regularly but not right before sleep
- Avoid excessive caffeine
- Avoid naps during the day, which can prevent you from sleeping well at night
- Talk to your doctor about prescription medications that can help you sleep
What Alternative Treatments Are Available to Treat Hot Flashes?
Alternative treatments for treating hot flashes and improve sleep have included soy products such as tofu and soybeans. Soy products contain a plant hormone called phytoestrogen that acts as a weak estrogen. Studies in general do not show significant hot flash reduction with soy products.
Black cohosh, a perennial plant that is a member of the buttercup family, has also been used to treat hot flashes. In several studies, menopausal women who took black cohosh experienced relief from hot flashes and sweating, although most of these studies have been short-term, and used varying amounts of black cohosh from different sources. More studies are underway to determine if black cohosh reduces the frequency of hot flashes and other menopausal sleep symptoms.
Keep in mind that alternative treatment products are not regulated or controlled by the Food and Drug Administration, and the long-term benefits and risks of these therapies are unknown. Talk to your doctor before you take any of these products.
Doctors in primary care fields often hear their patients complain of night sweats. Night sweats refer to any excess sweating occurring during the night. However, if your bedroom is unusually hot or you are using too many bedclothes, you may begin to sweat during sleep — and this is normal.
In order to distinguish night sweats that arise from medical causes from those that occur because one’s surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment.
In one study of 2,267 patients visiting a primary care physician, 41% reported experiencing night sweats during the previous month, so the perception of excessive sweating at night is fairly common. It is important to note that flushing (a warmth and redness of the face or trunk) may also be hard to distinguish from true night sweats.
There are many different night sweats causes. To determine what is causing night sweats in a particular individual, a doctor must obtain a detailed medical history and order tests to decide if an underlying medical condition is responsible for the night sweats. Some of the known conditions that can cause night sweats are:
- Menopause — The hot flashes that accompany the menopausal transition can occur at night and cause sweating. This is a very common cause of night sweats in women around the time of menopause.
- Idiopathic hyperhidrosis — Idiopathic hyperhidrosis is a condition in which the body chronically produces too much sweat without any identifiable medical cause.
- Infections — Classically, tuberculosis is the infection most commonly associated with night sweats. However, bacterial infections, such as endocarditis (inflammation of the heart valves), osteomyelitis (inflammation within the bones), and abscesses all may result in night sweats. Night sweats are also a symptom of AIDS virus (HIV) infection.
- Cancers — Night sweats are an early symptom of some cancers. The most common type of cancer associated with night sweats is lymphoma. However, people who have an undiagnosed cancer frequently have other symptoms as well, such as unexplained weight loss and fevers.
- Medications — Taking certain medications can lead to night sweats. In cases without other physical symptoms or signs of tumor or infection, drug side effects are often determined to be the cause of night sweats. Antidepressant medications are a common type of drug that can lead to night sweats. All types of antidepressants can cause night sweats as a side effect, with a range in incidence from 8% to 22% of persons taking antidepressant drugs. Other psychiatric drugs have also been associated with night sweats. Medicines taken to lower fever such as aspirin and acetaminophen can sometimes lead to sweating. Other types of drugs can cause flushing, which, as mentioned above, may be confused with night sweats. Some of the many drugs that can cause flushing include:
- niacin (taken in the higher doses used for lipid disorders),
- tamoxifen,
- hydralazine,
- nitroglycerine, and
- Viagra.
Many other drugs not mentioned above, including cortisone medications such as prednisone and prednisolone, may also be associated with flushing or night sweats.
- Hypoglycemia — Low blood sugar can cause sweating. People who are taking insulin or oral anti-diabetic medications may experience hypoglycemia at night that is accompanied by sweating.
- Hormone disorders — Sweating or flushing can be seen with several hormone disorders, including pheochromocytoma, carcinoid syndrome, and hyperthyroidism.
- Neurologic conditions — Uncommonly, neurologic conditions including autonomic dysreflexia, post-traumatic syringomyelia, stroke, and autonomic neuropathy may cause increased sweating and possibly lead to night sweats.
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