Ellen came to me and answered my first question with, “The worst thing about menopause is that I am so forgetful and cranky all of the time!” She had not had a period in over eight months. While her hot flashes were happening less, she still complained of getting hot and sweaty every night. “My husband is freezing, while I need the air conditioner and two fans just to fall asleep,” she said. “I wake up at 1:30 or 2:00 a.m., and while he sleeps like a baby, I lie there and can’t get back to sleep.”
Ellen’s complaints are all too common, and like her, many women are losing sleep and being robbed of happy and productive days. Inadequate sleep, night sweats, and mood changes are common symptoms of menopause. Eighty percent of women experience these symptoms sometime during their menopause transition, and approximately half experience dysfunction due to the symptoms.
The root cause of menopausal symptoms is the loss of estrogen, caused by the ovary going into retirement. When the body’s level of estrogen decreases, the thermostat becomes ultra sensitive to any change in temperature such as getting into your pajamas and climbing into bed. A hot flash or night sweat is your body’s air conditioner coming on, and the shivers which can follow is your heater coming on to correct for the chilling effect of the AC. So, it continues — from 2:00 a.m. until the alarm goes off.
As estrogen drops, so does a key brain chemical called serotonin. Some women make so much serotonin they do not notice estrogen-related changes, while some women notice even the smallest drop. When serotonin levels are low, it can cause small mood changes, such as forgetfulness or irritability, or a decreased desire to do anything fun. More serious serotonin-related mood changes include depression or anxiety, which can affect relationships, work, or daily function. Women are at greater risk if they previously experienced PMS or postpartum depression.
As I tell my patients, women do not have to suffer! First, please know you are not alone, not crazy and not likely developing Alzheimer’s. Mood and sleep changes can be mild and go away after a short time, or can cause suffering to the point when waiting it out is not possible. There are many options.
Options include prescription estrogen therapy for the hot flashes and night sweats (to find out if you are a candidate for hormones, go to menopause.org), low dose brain chemical medication (anti-depressants, selective serotonin reuptake-inhibitors or SSRIs), or over-the-counter supplements such as St. John’s Wort, Vitamin B Complex, or the herb Valerian. Both the estrogen and SSRIs can be safe and taken for a short time to get you through the worst symptoms. For such treatment, find a Certified Menopause Practitioner in your area at menopause.org (operated by the non-profit North American Menopause Society). St. John’s Wort has been shown to be safe in small doses for mood changes associated with menopause, and Vitamin B Complex and Valerian have been shown to have mixed results for sleep. Sleep aids, such as antihistamines, and sleep-aid drugs, like Zolpidem, should not be used long term but can be helpful in the short term under the supervision of a health care provider.
Before trying medication, or in conjunction with medication to keep the dose low, I recommend some simple, back-to-the-basics lifestyle habits. I call them SEEDS®, or the Seven Essential Elements of Daily Success:
- Adequate water (total water minus caffeine to equal 60-80 oz. per day)
- Sleep (49 hours per week)
- Vitamins (including a multi-vitamin and Vitamin D)
- A balanced diet with very few simple carbohydrates like white bread or treats
- Exercise, including stretching, strength training and aerobic activity
- Adequate fiber
- Metered breathing
Inadequate water and sleep, as well as too much sugar and/or alcohol, can trigger hot flashes and night sweats, leading to more sleep deprivation. Metered breathing can stop hot flashes and night sweats in their tracks.
Many of my patients have resisted trying metered breathing, but they often turn to it in desperation. Here’s how it works: Just before going to sleep, find a quiet spot in your home, turn on a low light to avoid total darkness, and sit comfortably. Rest your hands on your knees, close your mouth, open your eyes, stare at a spot, and breathe. If you have thoughts, think on them for a second, let them go, and return to the sound of your breath. Go on for five minutes if you can; it takes practice. Then, go to bed. If you cannot fall asleep, get back up, go to your spot, and do it again. You are calming your mind, turning down the worry machine, and allowing your mind to rest. When you wake in the night, go to the bathroom, get a drink, go to your spot, and do metered breathing for five minutes. In the first nights of practice, good sleep might require several visits to your “spot.”
As Ellen learned, sleep is everything. She planted the SEEDS® back into her life, took a short course of an SSRI for night sweats, and mastered nightly metered breathing. Before she knew it, she was sleeping seven hours a night and felt like herself again.
Photo Credit: Shutterstock.com/karuka