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Menopause

Menopause marks an important transition in the reproductive states of women. Sleep disturbances are a major complaint of women transitioning menopause and have a far-reaching impact on the quality of life, mood, productivity, and physical health.The incidence of sleep disorders ranges from 16% to 47% at peri-menopause and 35%–60% at postmenopause.

Causes

Researchers are not unanimous about the primary cause of menopausal sleep disturbance.

  • Rapid change in S. FSH levels
  • Vasomotor symptoms
  • Fluctuations and decrease in reproductive hormone concentration
  • Restless Leg Syndrome
  • Aging itself
  • Depressive symptoms
  • Sleep disordered breathing
  • Primary sleep disorders
  • Systemic diseases
  • Medications
  • Psychosocial or behavioural factors

Importance

          Sleep problems are associated with negative impacts on healthcare utilisation, quality of life and work productivity. Menopausal sleep disturbances causes two to  three times increased risk of depression.Sleep deprivation is a risk factor for cardiovascular disease, diabetes, obesity and neurobehavioral dysfunction. It can cause cognitive impairment, deficits in immune functions and even malignancies.

Management

Formulating a strategy is dependent on a thorough investigation and evaluation of all contributing factors .

  • Strategies may include medications and lifestyle and behavioural modification 
  • The use of oestrogen, alone or in combination with a progestogen, has been shown to improve the subjective quality of sleep . Women with hot flushes treated with menopausal hormone therapy ( MHT) show a marked improvement in sleep quality .
  • Lower doses of antidepressants and SSRIs, including fluoxetine, paroxetine, and venlafaxine, can relieve menopausal symptoms, including hot flashes. Some, like Bazedoxifene, may relieve hot flashes while also increasing sleep quality.Hypnotics should not be used in situations other than for acute sleep problems because of their side effects, tolerance and withdrawal issues .
  • Endogenous melatonin, which declines with age, is an important factor in the maintenance of sleep cycle .The use of supplemental melatonin in rapid release formulations and light therapy (both at the appropriate time of day) have been shown to improve the circadian rhythm
  • Cognitive Behavioural Therapy, to include stimulus control and sleep restriction therapies have shown improvement in sleep .These approaches are shown to be equally efficacious to pharmacotherapy with longer term sustainability .

Lifestyle modification

  • Maintain healthy diet and weight
  • Avoid nicotine, caffeine and alcohol especially in evening.
  • Reduce stress
  • Develop a bedtime routine to lower stress like taking a bath, listening to music, meditation or deep breathing.
  • Sleep hygiene
  • Regular sleep schedule, going to bed and waking up at the same time everyday
  • Comfortable bedding and temperature.
  • Develop a routine for falling back to sleep if awake from a night sweat.

When to contact a doctor

  • trouble sleeping for months
  • insomnia is affecting daily life and making it hard to cope
  • changing habits and bedtime routine has not help

Sleep issues are a common experience of menopause, but there are many options for relieving them.

Disclaimer: This article is for informational purposes only and not a substitute for medical advice. Consult a healthcare professional for personalized guidance.

Author

  • Smitha Joy

    Dr Smitha Joy is chairing the Department of Obstetrics and Gynaecology at VPS Lakeshore Hospital. She did her MBBS from Govt Medical College Thrisssur and MS in Obstetrics and Gynaecology from T D Medical College Alappuzha. She was Associate Professor at Amrita Institute of Medical Sciences, Kochi.Her special area of interest are Advanced Laparoscopic surgeries and High risk pregnancy. She did advanced training in Colposcopy from Whittington Hospital , London.

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