Dealing with Insomnia

Everything You Need to Know

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Insomnia is one of the most common problems facing women today. It is especially common in the perimenopausal and menopausal periods of life. Most recent studies have indicated that Americans do not get enough sleep for good physical health and those who suffer from insomnia know this all too well. Even the most serious efforts to obtain adequate sleep can backfire. Here are several basic suggestions to improve sleep quality.

Caffeine: Caffeine is an obvious stimulant. Many patients find that, as they age, their tolerance to caffeine decreases. This is because the amount of caffeine that stays in the system lengthens with age. Caffeine is also a potent diuretic and having to get up at night to urinate can be the result of too much caffeine during the day. Many dietary aides that are over-the-counter contain caffeine and caffeine-like substances. They should not be used if insomnia is a problem.

Alcohol: Another sleep interrupter. Alcohol may seem to make one fall asleep, but once it is cleared from the body (usually within about 4 hours), there is actually a paradoxical stimulation, and early awakening can be a problem. Also, the type of sleep experienced while sedated under the influence of alcohol does not allow rapid eye movement-type sleep, where memories are sorted. This prevents restful sleeping and can promote fatigue during the day. Alcohol also increases night sweats or hot flashes.

Tobacco is a well-known stimulant. Many patients feel that nicotine relaxes them. However, nicotine most definitely disturbs sleep quality. Insomnia is one of the most common side effects seen in patients who use the nicotine patch and keep it on at night. If you suffer from insomnia, you should stop smoking.

Medications: Certain antihistamines, such as those with decongestants, can result in restlessness in sensitive patients. For example, Allegra D® should be thought of as a daytime drug. Some doctors will actually call it D for “day time,” even though the D is actually for decongestant. Some antidepressants, such as Wellbutrin (or Zyban), Prozac® and Zoloft® may inhibit sleep. However, depression itself can cause insomnia, so a careful balance needs to be maintained.

Anxiety disorders may also cause insomnia. Often anxiety sufferers will lie down at night, only to have relentless “racing thoughts.” There are many effective treatments for anxiety disorders, but long-term treatment is best in the hands of a specialist due to difficulties with medication adjustments.

Leg cramps and Restless Leg Syndrome: Two problems that often interrupt sleep in women with poor circulation. Adequate hydration and calcium supplementation, as well as gentle heat,
can help both of these bothersome conditions. For Restless Leg Syndrome, 6 ounces of tonic water, which is rich in quinine, has an amazingly calming effect on restless legs.

Anything that reduces stress or lowers tension, such as smells that remind you of a pleasant experience, may increase relaxation and improve sleep quality. Herbal teas, such as Celestial Seasonings® Sleepytime® tea can be gently sedating. A dark, quiet environment is extremely important. You may benefit from a silk or high quality eye mask. Linen sprays, such as those that have a calming scent, for example, lavender or light vanilla may be calming as well. Rituals at night, such as the same pattern of face washing, teeth brushing, darkening and quieting a room may also help to fall asleep. Reading before bedtime is sometimes stimulating, but many find it calming and sedating. Use your bed only for sleeping or intercourse. Using the bed as an office or a playground with small children may associate your bedroom with alertness.

Diet is also important. Try diets high in tryptophan, a natural amino acid that is used to produce mood-sedating compounds in the brain. Foods that are high in tryptophan include milk, peanut butter and turkey. Protein-deficient diets or those high in stimulating sugar and simple carbohydrates may actually reduce the quality of sleep, particularly in patients that are glucose-intolerant or hypoglycemic. Sweet desserts should be avoided after supper, as well as those that contain chocolate or caffeine. Avoiding food after 8:00 PM or 4 hours before bedtime helps improve gastric emptying, which prevents reflux or reflux-induced coughing during sleep.

Most importantly, getting a checkup from a healthcare professional is imperative to make sure there are no underlying medical problems, such as depression, thyroid disease or newly onset menopause. If a woman is overweight, she must seriously consider being assessed for sleep apnea. Even a woman with an ideal body weight may suffer from sleep apnea, particularly if she finds herself snoring at night or has been told by family members or loved ones that she snores. There are extremely successful treatments for sleep apnea that must be considered, as this condition can increase the risks of high blood pressure, stroke, heart disease and worsening obesity.

Over-the-counter sleep aids, such as Tylenol® PM, may be helpful and are not felt to be habit-forming. Down sides include drowsiness the next day and some patients do get a paradoxical stimulation from the antihistamine in Tylenol PM. Melatonin, an herbal supplement, can help some people with quality sleep. It appears to be safe and side effects are minimal.

All prescription sleeping pills are generally felt to be habit-forming and long-term use can result in addiction and other potential ill effects, such as short-term memory loss. Ambien® usually does not give a foggy “sleep hangover,” but it can be highly addictive and, again, long-term use may result in short-term memory loss.

Exercise is absolutely vital to overall physical health and well-being. Studies indicate that regular exercise improves sleep quality. It is felt that early morning exercise may be best, because when some individuals exercise, it will induce stress hormones in the late evening. However, evening exercise has recently been shown to be beneficial to sleep patterns.

Some women experience insomnia even in the absence of hot flashes as a result of low estrogen levels in menopause or late perimenopause. If all conservative efforts fail to improve sleep, you may want to consider hormone replacement therapy after discussing it with your healthcare professional.

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Toni G
I've been seeing Dr. Price for many years and have always had a great experience with her. Dr. Price has always listened to me and addressed all of my questions and concerns. My only complaint is with a former nurse I saw for medical issues who didn't further investigate them and it got progressively worse. Luckily the current nurse practitioner diagnosed me correctly and have received the correct treatment.
Morgan Miller
When I was looking for a gyno, Jeanette and Dr. Booth came highly recommended from family that see them and rightly so! Jeanette has the best bedside manner and takes the time to be thorough and understand the patient. When I had an issue outside of office hours, I was able to submit a question on the Follow My Health app and got a phone call in less than 30 minutes from the care team. They’re the best and I tell everyone about them!
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