Sleep Disturbance in Middle Age Women

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As if hot flashes, irritability, and difficulty concentrating weren’t enough, poor-quality sleep usually accompanies the symptoms of menopause. Sleep disturbance is a common problem for women experiencing the transition into menopause.  Although we may not fully understand why we need to sleep, most experts agree that sleep is critical to energy level, alertness, productivity and an overall sense of well being. Disturbed sleep affects as many as 39% to 47% of perimenopausal women and up to 60% of menopausal women as reported by the National Institute of Health.

Disturbed sleep is often reported as difficulty falling asleep, waking up in the middle of the night or waking up in the early morning.  Research shows that complaints of hot flushes, depression, anxiety, joint and back pain often accompany sleep problems in midlife women. 

Why is sleep important?

According to  a sleep study that compared people who had 8 hours, 6 hours and 4 hours of sleep with people who had 3 days of complete sleep deprivation, those who were restricted to 4 hours  of sleep performed as poorly on math and motor tasks as those who did not sleep for 2 days.  The only difference was that the people who were restricted to the number of hours of sleep per night reported less daytime sleepiness.   Results underscore a very important finding.  While restricted sleep has significant neurobehavioral effects, we are largely unaware of the deficits since we don’t feel sleepy in the daytime.   Although we cannot prove that disturbed sleep is the cause of disease, there is evidence for a relationship between sleep deprivation and a number of medical problems in peri and post menopausal women. These included fibromyalgia, chronic pain, high blood pressure, cancer, thyroid dysfunction, gastroesophageal reflux disease and obesity.

The Current Treatment Options

HRT or estrogen replacement therapy, has been shown to reduce the symptoms of menopause and have beneficial effects on sleep.  However, many studies have shown that there is an increase in heart related events in healthy women, such as a heart attack after 1 year of use, and an increased risk in stroke after 3 years of continuous use.  Long term HRT use also increases the risk of a venous clot, gallbladder disease and breast cancer.  Due to the significant risks of HRT, practitioners have also tried antidepressants and hypnotic medications in the treatment of sleep disorders in perimenopausal women.  

Combination therapies that include an antidepressant and melatonin supplements, has also proven to be effective in some women.   In some cases, the beneficial effects continued even when the antidepressant was weaned off.  This is great finding since antidepressants are often linked with a potential for weight gain and other undesirable side effects.

A Holistic Approach to the Treatment of Sleep Disturbance in Middle-Aged Women

Acupuncture has been shown to be of value for insomnia and represents an alternative to traditional medications such as benzodiazapines in some patients. Melatonin is an agent naturally produced by the body.  The release of melatonin over a 24 hour period is widely accepted as a measure of circadian activity (sleep-wake cycle) in humans.  Insomnia results when this pattern is disrupted.  Night time levels of melatonin are decreased in people who suffer from insomnia compared to people who sleep well.   In a study that investigated people who reported insomnia, acupuncture treatment 2 times a week over a 5 week course was shown to increase the night time release of melatonin in the body as measured by urine samples. There were also significant improvements according to objective measures in the time needed to fall asleep, total sleep time, number of times subjects woke up in the night and sleep efficiency.   Patients also reported a decrease in anxiety and depression in self assessments.

In addition to melatonin, complementary plant-derived therapies such as isoflavones and valerian have also been used to treat sleep disturbance.  Complementary therapies are often useful among women who have a contraindication to HRT and traditional medication and women seeking natural treatment alternatives.  Isoflavones have shown to improve measured sleep efficiency, reduce insomnia and reduce the frequency of hot flushes in postmenopausal women when compared with placebo. Valerian supplementation resulted in a significantly greater improvement in subjective sleep quality when compared to placebo.

Therapeutic massage and yoga have also been studied for their beneficial effects on sleep disturbance in women undergoing the menopausal transition.   Massage and yoga, when performed at least twice a week over a 4-month period have shown to improve depression and overall quality of life when compared with passive movement or no intervention at all. The adjunctive therapies have been used by women with an aversion to medications, women with associated muscle aches and joint pain and women interested in a stress-reduction benefit.

For more information on sleep disorders or any of therapies discussed in this article, please visit or contact Dr. Quan Nguyen at 630.344.9302.

Calibrate Health is a new chiropractic and wellness center located inside of Prudential Real Estate building at 1867 Bay Scott Circle, Naperville, IL 60540.


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