Help for menopausal insomnia

Q: I am beginning to go through menopause, and for the first time in my life I’m having trouble sleeping. I’ve read that insomnia can be caused by menopause. Is this true? What can I do? I’ve tried valerian root and melatonin, but they’re not helping. Are sleeping pills a bad idea?

A: Sleep problems are the most annoying of menopausal difficulties. One question I always ask is, “How are you sleeping?” THe answer is often, “Terribly, but why did you ask? .”  We are not exactly sure of why sleep disturbances are so common at this age. My own theory is that with falling levels of estrogen, the part of the brain called the hypothalamus is turned on, trying to get the ovary to crank out more estrogen, which it really cannot do. The most active time of day for the hypothalamus happens to be about 1 or 2 am, just when everybody is awake – counting the dots on the ceiling or sweating. The hypothalamus also happens to sit right next to the sleep center in the brain, so it is logical that disturbances there don’t make your sleep life any easier.

If you feel comfortable with the concept of estrogen replacement therapy, that would be the likeliest way to get you a good night’s sleep. Most of my friends starting estrogen for sleep disturbances tell me they are sleeping well within a week. I would start with a low dose, and increase the amount until you are sleeping well.

If you are uncomfortable estrogen replacement therapy, some natural approaches may help. Although the scientific literature does not bear this out, many women tell me vitamin E, in doses of 400 to 800 units a day, helps them (and besides, you’ll be helping to prevent heart disease and cancer). Soy and flaxseed, with their phyto estrogens, can help also – and they’ll also give you the health benefits of cardiac and bone protection. Evening primrose oil, starting with two capsules a day, can help with many menopausal discomforts, including insomnia.

Sleeping pills are certainly a reasonable adjunct to break a poor sleep cycle, and can be used occasionally. The major problem with sleeping pills, of course, is addiction, which you really don’t want to have to deal with. Some over-the-counter remedies can help, with less addictive potential. But sleep is very important, and we have to get help somehow. Good luck.

What you have in your mind?