The Night Shift

Does anyone wake up in the middle of the night and find that you can’t go back to sleep? What do you do? The correct answer should be that you close your eyes and wait for slumber. The more common answer is you turn over and reach for the phone. Our cell phones are a walking, talking (hello Siri) box of information (it’s the library, the card catalog and a set of World Book Encyclopedias all rolled together with a hefty sprinkling of misinformation).

So now not only can’t you sleep, but you end up searching for info about what may have led to Nicole Kidman’s divorce. My insomnia has allowed me to learn about breaking news before most of the people in my life.  Of course, I can’t gossip with anyone at 2 a.m., because they are all where I want to be—asleep in their beds. (This statement is not totally true.  It is alarming how many friends I talk to who are also lying awake in their beds at the same time. Maybe book club can meet in the middle of the night.)

Many things cause insomnia. But right now, I am focusing on the insomnia that rears its ugly head in your 40s. Officially, insomnia is diagnosed when a sleep complaint is present 3 nights a week for 3 months. Although, I call it insomnia when I have been up for one night and I look like a zombie the next morning. Waiting for three months for the diagnosis, and I’d be looking like the picture below.

The author after two sleepless nights

Studies have shown that symptoms of insomnia increase with perimenopause and menopause. Perimenopause is the period before the onset of menopause, and menopause is the stage women enter after 12 consecutive months without a period. Sleep disturbances are more commonly associated with the symptoms of hot flashes, depression, and anxiety rather than with low estrogen levels in your blood. This is why it is recommended to treat sleeplessness based on your clinical symptoms instead of lab results. You are, after all, more than the numbers on a piece of paper.

What can you do to help your sleep? Well, first, put away the phones. Sure, you won’t know about the latest celebrity gossip (it will still be there in the morning), but you also won’t have that bright light shining in your face, waking up your brain. Establish a routine. Try to sleep and wake at the same time every day (but go ahead and get an hour or two extra on weekends—you deserve it). Try a relaxing routine before you go to bed. I would say take a long, luxurious bath with lavender-scented bath salts, but in my case, this would not work. First, I would have to scrub out my tub, and second, nothing would be relaxing about my family interrupting my peace and quiet with endless questions. And I will say the next thing knowing very well that I may not always follow this advice: Avoid alcohol. And if you do drink, just know that you will likely have disrupted sleep, so skip that glass of wine when you need a good slumber.

You can also talk to your doctor about hormone therapy to help with the hot flashes, which in turn will help your sleep. There are non-hormone therapies as well, like common antidepressants, which can decrease hot flashes, as well as anxiety and depression. There are other medications such as hypnotic sleep aids, but many people clear them slowly and, as a result, feel drowsy the next day.

The point of this, though, is to tell you insomnia sucks. And as perimenopausal women, you should NOT have to put up with it.  For the last twenty years, more often than not, middle-aged women have been told that there is nothing to do and to just tolerate their symptoms.  But not anymore.  As more and more doctors get properly trained in menopause and perimenopause care, women should ask for and expect compassionate care. And if you do not find it on the first visit, keep searching because you are worth it.

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