In women, sleep disorders are more common in all age groups than in men. Sleep disorders are often lifelong and should be monitored throughout the life. In a woman’s life, menstruation, pregnancy and giving birth to a baby, and menopause, or about ten years of symptomatic period in the middle of the menopause, or the end of menstruation, have many effects on fatigue and sleep.
During the menstrual cycle, the quality of sleep varies slightly. Exceptions are women with painful menstruation, ie dysmenorrhea or pre-menstrual PMS or premenstrual syndrome. They experience symptoms of impaired sleep quality, and they might have insomnia, nightmares, a feeling of unrest and fatigue.
Deterioration in sleep quality is also reflected in measurements. The anti-inflammatory drugs (NSAIDs) that prevent menstrual pain improve both the quality of the sleep experienced and the objectively measured quality of sleep.
Insomnia during pregnancy
Pregnancy is in many ways a challenge to a woman’s body. Fatigue occurs at all stages of pregnancy. Experienced sleep quality deteriorates in pregnancy already from the first trimester of pregnancy. This deterioration is also evident in polysomnography (PSG). Breathing breaks during sleep and sleep apnea are also possible during pregnancy and their treatment is also important for the baby’s health. Untreated, these things can be a danger to both the mother and the unborn child. Pregnant women are not recommended to use sleeping pills or melatonin or other self-care products for the treatment of insomnia.
During pregnancy, sleep movement disorders, such as restless legs syndrome and periodic limb movements, increase and may cause sleep disturbances. Iron deficiencies can be found behind these ailments either as a cause or an aggravator. Therefore, it is advisable to take care of the availability of iron and folic acid, especially during the pregnancy. Non-medicated treatments such as foot massage, stretching, thermal treatments or walking and relaxation can help with movement disorders.
The newborn baby, of course, also affects the father, but for the new mother, baby time is more tiring for hormonal reasons, especially when the mother is breastfeeding her baby. Night time awakenings will interrupt your sleep and may also cause trouble falling asleep. Use of sleeping pills is not recommended for nursing mothers. Also, in mothers using bottle feeding, sleeping pills should only be used for special reasons, as they may cause drowsiness, which makes it difficult to take care of the baby.
Insomnia after baby
Unfortunately, the fatigue of mothers of young children is often considered so natural that it can mask sleep disorders caused by other causes, such as sleep apnea.
Anna tells how she explained her exhaustion with her children.
“My spouse had been complaining about snoring for a couple of years, and I remember that at the beginning of 2014, I noticed that I was really tired, but I thought it was related to breastfeeding and similar family things, and maybe it was a part of it. In addition to snoring, the symptom was that the sleep didn’t feel refreshing. When I woke up in the morning, I was really exhausted, and in the evening I often fell asleep when I was putting children to bed. The attempts to “sleep fatigue away” failed. Most of my life I’ve gone to bed pretty late and, if necessary, accustomed to work at nights, so that was a big change. However, I didn’t fall asleep during work or driving my car during the day, so the results of the sleep apnea survey were not very significant. It was difficult to give a very clear estimate of the quality of sleep at night, because night-time waking up of children and night-time work mixed up the night, and shortening the night’s sleep was not always my choice.
Because I was very tired, the jobs were piling up and it was hard to concentrate. In the morning, waking up and taking the children to the day care center sometimes felt overwhelming. It was really difficult to get up on time or motivate the children to wake up when I was tired and barely awake. In addition, I ate too much to maintain the energy level. Exercising helped a bit, and apparently improved sleep quality the next night, but especially in the morning waking up seemed really exhausting.
I myself just didn’t know about sleep apnea and I didn’t suspect it. I assumed that the disorder included clear breathing breaks or disorientation during the day. My spouse knew both sleep apnea patients and those who received CPAP therapy, so he started paying attention to snoring as well.
I myself remember wondering – and someone I know asked – whether I might be on the verge of burnout or somehow otherwise mentally ill. It was so strange that it seemed somehow that I was more insane and exhausted than I could have expected from the workload and life situation. Sure, sometimes family life can be tiring and consuming, but somehow it seemed I was too tired.
When I was 41, my spouse told me to go for a sleep apnea test. I contacted an occupational physician who took me seriously as a result of fatigue and intermittent snoring and sent me to a local hospital. From there, I first got the results of the oxygen saturation test, which I didn’t realize to get worried about, but the doctor called after the test and recommended CPAP therapy, which I started in a few months, in October 2016. At the same time, the occupational physician wondered a bit about my autumn sickness and sent to a blood test, which found out that vitamin D was really low. I received a recommendation to take a 100 microgram of vitamin D treatment per day. It was time before I got into treatment, partly I was very busy at work and that forced me to pass medical visits a couple of times. I got a diagnosis in June and CPAP in October. I got a mask covering both the nose and the mouth – it seemed impossible to “commit” to being able to breathe through the mouth.
At the beginning, the mask straps annoyed, but after the first short night, I noticed the difference. The first thing that disappeared was the swollen feeling of the eyes and the sinuses, as well as the extraordinary feeling of weight of the limbs. The introduction of the mask occurred at a bad time because I had a sinus infection for many weeks and was advised not to wear the mask. After the initial illness, the CPAP has not irritated the respiratory tract, nor have I needed a humidifier. At times, the mask went off, or I woke up that the blow was too strong, but when I found that the device just needs to be turned off, the use has gone quite well.
I have now been using CPAP treatment for about four months and the results have been good.
The quality of sleep in a family with children still suffers and the workload is increasing, but my health is much better than before starting treatment. I notice that three things work together: CPAP treatment, vitamin D and exercise, whenever I have the opportunity to do it. I feel that due to sleep apnea treatment, I pay more attention to my children and I can read to them or play with them much more than I was able to do earlier. I usually don’t fall sleep anymore as I’m putting children to bed and I can still do something on most evenings for the majority of time after the children have gone to sleep. Going to the day care and other similar morning activities are much easier, and I’m more efficient at work.
Although the CPAP device may seem worryingly troublesome, its help is overwhelming. Apparently, the introduction of others requires longer training, I had immediate benefit and the problems were quite small.”
Menopause and insomnia
Woman’s sleep during menopause is in many ways different from men. Problems are also increasing in men with age, but menopause brings additional problems for women because of the mixed symptoms of various problems, especially sleep apnea, with menopausal symptoms. Among menopausal symptoms, especially hot flushes, sweating, palpitations and mood symptoms are associated with sleep disorders. Sleep apnea and partial sleep apnea are becoming more common after menopause. Therefore, it would be important to have clarity about the cause of the symptoms. For example, if night sweats start only years after the end of menstruation, it is probably caused by sleep apnea not menopause.
In women, sleep disorders occur more often than men in all age groups. Night time movement disorders, especially restless legs syndrome, and various pain conditions such as fibromyalgia, are also increasing with age. Pain often interferes with sleep, while poor quality of sleep can aggravate pain. In addition to fibromyalgia, chronic pelvic pain, lower back pain, joint pain and tension headaches cause sleep disturbances. Many long-term illnesses or drugs used in them can cause or aggravate sleep disorders. Examples of such diseases include epilepsy of neurological diseases and Parkinson’s disease, asthma and pulmonary disease of the lungs, hypertension of cardiovascular diseases, heart failure and atrial fibrillation, diabetes and thyroid dysfunction. In women, mood symptoms are more common than in men.
During the menopause, reduced estrogen production may cause or contribute to the development of mood disorders, either directly through the production of brain neurotransmitters, especially serotonin, or indirectly through other menopausal symptoms, especially hot flushes and sweating. Heavy workload can also impair the quality of sleep either independently or through depressive symptoms. Although hormone replacement therapy has mild depressive effects and often relieves menopause, it only works as an ancillary treatment for depressed patients and antidepressant therapy is often required.
Sleep problems, especially sleep apnea, are easily confused with menopausal symptoms.
Night time sleep movement disorders are associated with reduced dopamine production. Women with these symptoms also have sweating and hot flushes more often. Estrogen accelerates the production of dopamine, but hormone replacement therapy cannot treat night time movement disorders. However, hormone replacement therapy is not excluded for those suffering from movement disorders.
One study compared sleep and sleep quality in women aged 46 and 53 to 58 years. The study found that the sleep of women in menopausal age was more restless and intermittent than younger ones, ie they woke up more often than younger women who had not yet reached menopause.
Symptoms of depression are also a major cause of the decline in sleep quality in menopausal women. The reason for depression may also be the poor quality of sleep and the resulting fatigue that affects the woman’s life in many ways. In addition to depression, anxiety is often associated with sleep disorders in menopause.
Poor sleep seems to be associated with work-related stress, as women in menopausal age report more problems during their working week than during their leisure time. Women can sleep well in their spare time, but work-related stress factors degrade sleep quality. A sufficient number of days off will guarantee recovery for those who work on a regular basis. Of course, ask what happens to those women whose working life is irregular, shift work, project-like or creative and who don’t work the eight-hour working day five days a week.
On working days, women in the menopause age had more difficulty falling asleep, more nocturnal awakening, and they slept less than younger women. On holidays, the quality of sleep improved, and only difficulty falling asleep was more common in menopausal women compared to younger women.
Women in menopausal age may be more sensitive to the effects of work-related stress than younger women, this is reflected in poor quality of sleep during working days. It would be important to have enough freetime to recover from the workload.
There is therefore a clear link between work requirements, sleep and menopause, which emphasizes the importance of addressing the problems of the sleep. During menopause, stress factors, such as work stress, can degrade sleep quality. The researcher believes that more attention should be paid to the quality of sleep in menopausal women, because the work of many requires, among other things, the learning of new things, which cannot be done after a bad night’s sleep. Western women still have 10 to 15 years of working life after the menopause. There is a lot of talk about the need for longer careers. It cannot succeed unless women are being treated for sleep disorders and their causes.
Workload assessment and new work arrangements as well as cognitive sleep therapy may improve or at least reduce sleep problems.
Menopause and sleep
A French study looked at women’s sleep during menopause. According to the study, a quarter of women aged 50-64 reported having suffered from sleep problems: 15% of them had severe problems. During menopause, problems increased. Menopausal women may suffer from all forms of insomnia: difficulty falling asleep, night-time awakening and early morning awakening? It is clear that these different sleep problems cause fatigue during the day and make life difficult in many ways. Fatigue hampers both in the morning and in the daytime, efficiency is impaired, quality of life is decreasing and overall morbidity and susceptibility to accidents increase. That is why we need to find a solution to menopause problems.
Sleep disorders may increase or become more difficult during menopause without other illnesses or related diseases. Typical symptoms of menopause, ie hot flushes and sweating, are often associated with sleep disorders. Hot waves occur in sleep disorders also in women who do not suffer from them during the day. Sweating is a familiar symptom especially for sleep apnea patients. When you wake up in the middle of a night and your pillow is wet, take your time to get back to sleep after changing equipment. Among other things, the fragmentation of sleep due to this reason, makes you feel tired the next morning. In addition to awakening and the fragmentation of sleep, the sleep stages vary and the effectiveness of sleep decreases.
Although insomnia is a common menopause disorder, researchers do not have a clear idea of how much menopause actually affects sleep quality measured by polysomnography. In addition, it is not known how much difference is between the quality of sleep experienced and the objective measurements. For example, the depth of the discomfort caused by sleep apnea is not always reflected in the meters. Someone may that their sleep is strongly disturbed, even though the meter does not show it or vice versa.
Women in menopausal age should pay special attention to their sleeping environment. A comfortable bed and bedding and nightwear made of natural materials are basic things. The bedroom should preferably be cool, calm and dark, so that the light from the outside does not mess with sleep. Regular sleep rhythm and short naps as well as avoidance of stimulants in the evening, such as coffee, alcohol and cola drinks are important.
Hormone replacement therapy
Hormone replacement therapy is the primary treatment for menopausal sleep disorders, unless it is contraindicated, that is, a woman has not suffered from breast or uterine cancer, venous thrombosis, cardiovascular disease, cerebrovascular disease, severe liver failure, or abnormal uterus bleeding.
Hormone replacement therapy should not be started when women are over 60 years of age or on women who have had menstruation more than ten years ago.
The primary treatment for menopause sleep disorders is hormone replacement therapy.
Hormone replacement therapy improves and relieves insomnia. Falling asleep is easier and sleep is calmer, awakenings are reduced and overall sleep quality improves. Morning and daytime fatigue are also reduced. The positive effect of hormone replacement therapy is particularly evident in women who also benefit from other menopause symptoms such as hot flushes and sweating.
In addition to insomnia, some women do not have other menopausal symptoms. These women may also get help with their insomnia from hormone replacement therapy. In these cases, the hormones can directly affect the factors that control sleep.
The basics of using hormone replacement therapy
Menopausal symptoms include not only the poor quality of sleep, sweating and hot flushes, but also mood symptoms and dryness of mucous membranes. The symptoms last for an average of seven years and are usually the strongest at the beginning of the menopause. Some women have strong symptoms that impair the quality of life and work ability, even over the age of 70, and other women have no symptoms at all. The initiation of treatment should be accurate, taking into account the individual situation of the woman and the current and past history of the disease.
Hormone replacement therapy facilitates menopause symptoms at any age. However, treatment should start at the beginning of the menopause and no later than 10 years after the end of the menstrual period. Late treatment, initiated over the age of 60, may be harmful to the cardiovascular system, in particular, although it has been found to reduce heart related diseases in the past. Hormone replacement therapy has proven beneficial effects. Increased risk of breast cancer causes many to avoid hormone replacement therapies. Over three years of hormone replacement therapy increases the risk of breast cancer. Just estrogen also increases the risk of uterine cancer and more than five years of treatment for ovarian cancer. Remember, however, that the risk of cancer is further increased by, among other things, high alcohol consumption, smoking, overweight and immobility. There are quantified health benefits: among others, the incidence of type 2 diabetes, Alzheimer’s disease and colon cancer is reduced. Hormone replacement therapy also prevents osteoporosis and bone fractures typical of older women.
Despite the slight increase in breast cancer risk, hormone replacement therapy is the best treatment option for patients with severe menopause. It is essential that the lowest dose giving the benefit and the appropriate route of administration be sought for hormone replacement therapy. Hormones administered through the skin have fewer side effects than the oral tablets.
Many experts believe that hormone replacement therapy is a specific treatment not only for hot flashes and sweating, but also for sleep problems.