Science fiction author Robert Heinlein never wrote truer words when he penned these: “Happiness consists in getting enough sleep. Just that, nothing more.” There are menopausal women everywhere nodding their tired heads in agreement, asking, “What do I have to do to get a decent night’s rest?!” One of the more disruptive symptoms of menopause is poor sleep quality and sleep disturbances due to hot flashes, depression and anxiety, and sleep apnea, according to Johns Hopkins Medicine.
In fact, one panel at the North American Menopause Society’s (NAMS) 2020 Conference, held virtually from September 30 to October 3, reports that sleep problems were so significant that in a study of 232 women, 27 percent of those who reported insomnia had tried using cannabis to manage symptoms.
“Sleep is vitally important for health, and menopause can have an adverse impact on sleep for a number of reasons.?Understanding and addressing sleep disruption in midlife women is critically important. Poor sleep can influence appetite regulation and can result in weight gain in midlife women.
Good sleep has a beneficial impact on mood and overall quality of life. Women with poor sleep should see their healthcare providers to rule out serious sleep problems and to learn about interventions to improve sleep,” says Stephanie S. Faubion, NAMS's medical director and Penny and Bill George Director for Center for Women's Health at the Mayo Clinic.
Top Takeaways About Menopause and Sleep From the NAMS Conference
1. Sleep, Appetite, and Weight Gain Are Linked; Adjusting Your Schedule May Help Improve Health
Kelly?G. Baron, PhD, MPH, an associate professor in the department of family and preventive medicine at the University of Utah in Salt Lake City, will present a summary of published data about the connection between sleep, appetite regulation, and obesity. It has been established that if you regularly sleep less than six hours a night and more than nine (optimal target is seven), you increase your risk of obesity. Sleep too little and you increase your insulin resistance, and crave sweet and salty foods; sleep too much and suffer poorer cardiometabolic health, according to epidemiologic studies, although?less is known about sleeping more than recommended amounts.
Studies also show a connection between weight gain, diabetes risk, and disruption of the natural circadian rhythm. “We found that night owls consume more fast food and full calorie sodas but fewer fruits and vegetables,” Baron says. Consider an earlier bedtime. If you are the type who likes to burn the midnight oil, shifting your sleep patterns back may be helpful in controlling weight and boosting health. A new area of research is looking at the promising results of shifting circadian rhythms to natural patterns and increasing sleep among short sleepers. These appear to lower appetite and decrease sugar intake. Other research suggests that increasing sleep helps lower high blood pressure.
2. Hot Flashes, When Combined With Migraines, Arthritis, or Diabetes, Lead to Greater Sleep Problems
By analyzing data from the Study of Women’s Health Across the Nation (SWAN) database from women in midlife, researchers, led by Risa Kagan, MD, a clinical professor of ob/gyn and reproductive sciences at the University of California in San Francisco, looked at comorbid conditions and how they affect sleep in this cohort of women. Similar to previous research, the study shows that?higher frequencies of VMS were associated with worse sleep outcomes.?Migraine headaches and arthritis also upped the risks significantly. Incidences of waking up during the night was compounded when VMS and diabetes were present than with women with only hot flashes. Interestingly, women with both hypertension or migraines and hot flashes were less likely to have disrupted sleep than women with just hot flashes.
3. Anti-Nausea Drug May Ease Sleep Problems Related to Hot Flashes
Hadine Joffe, MD, PhD, director of women's mental health division in the department of psychiatry at Brigham and Women’s Hospital in Boston, will present evidence from early trials that neurokinin receptor (NKR) antagonists, a class of drugs usually used to lessen nausea and vomiting due to chemotherapy, show promise in helping to suppress hot flashes in postmenopausal women. Better yet, at higher doses, NKR also produced improvement in mood, sleep, and quality of life.
4. Trauma Is Linked to Poor Sleep in Midlife Women: Tell Your Doctor if You’ve Experienced It
With or without VMS or other menopausal symptoms, women at midlife who suffered from trauma (such as domestic abuse, natural disaster, sexual assault) either as a child or an adult may have a greater risk of sleep problems. Karen Jakubowski, PhD, a postdoctoral scholar in the department of psychiatry at the University of Pittsburgh and a lead author of the study, reports that of the 166 participants in the study (women aged 40 to 60 years), 44 percent experienced childhood trauma, and 60 percent were traumatized as an adult. Women who experienced childhood trauma experienced awakening after sleep onset, and adult trauma was strongly associated with poor sleep quality. Neither group reported poor sleep duration. “That’s why it’s important for healthcare providers to be aware of all the factors that can affect a woman’s ability to sleep, including a history of trauma,” Dr. Faubion said in a press release.
5. There Is a Promising Drug for Treating Hot-Flash-Induced Insomnia
It’s been reported that 25 percent of menopausal women experience some form of insomnia during menopausal transition, with VMS as the main cause. A double-blind, randomized, placebo-controlled trial, led by Shadab A. Rahman, PhD, an instructor in the division of sleep medicine at Harvard Medical School and the division of sleep and circadian disorders at Brigham and Women’s Hospital, analyzed the effectiveness of the insomnia medication suvorexant on 60 midlife women with chronic insomnia. With menopause, levels of orexin-A, a neuropeptide that regulates wakefulness and arousal, increase. Suvorexant works against that increase. Further study is needed, but the researchers found that in this particular study “suvorexant therapy is a well-tolerated and effective treatment for VMS-associated insomnia in midlife women, with additional benefits for self-reported nighttime, but not daytime, VMS.”