Hormonal imbalances aren't the only cause of sleep disruption for women in perimenopause and menopause. Depression and anxiety are common contributors to sleeplessness. Remember, these problems feed each other. The less rested you are, the more powerful your negative feelings become, and the less able you are to see your way through them. Stress — an enemy of women at any age — can also severely inhibit your ability to enjoy deep, restful sleep. A late-night trip to the bathroom, for example, may be followed by hours of sleeplessness brought on by stress-induced worry. If you awaken due to pain, or have a tendency to “snap” awake at 4 a.m. for no good reason, and lie in bed worrying about vague concerns or relatively inconsequential issues until the alarm goes off at 7 A.M., stress is playing a role in your sleep disturbance. All of these triggers can combine to create a powerful enemy of your good health as you approach and pass through menopause.

Chapter 8 offers you some valuable techniques for recognizing and combating stress and emotional states that can contribute to (and feed on) sleeplessness. Acknowledging that sleep disturbance is part of this overall pattern is an important first step in any treatment. The next step is to talk with health professional about these problems and their solution.

Your sleep problems may have nothing to do with stress, anxiety, or tension, but could have physical sources. One in four women over fifty, for example, suffers from sleep apnea, a sleep disorder in which the sleeper stops breathing for frequent, short periods throughout the night. Snoring and daytime sleepiness are clues that you might be suffering from sleep apnea. Snoring can increase with weight gain — particularly when you gain weight around your neck. If you have a problem with daytime sleepiness and your partner complains that your snoring is becoming louder, see your doctor. Sleep apnea is associated with other medical problems, including high blood pressure and cardiovascular disease, so it isn't something to blow off (so to speak).

More women than men suffer pain-related sleep problems. Pain from arthritis, migraine headaches, tension, chronic fatigue syndrome, and fibromyalgia have been linked to sleep disruption in women. Pain can make falling asleep and staying asleep more difficult, but many people fail to report (or recognize) sleeplessness as a problem. If pain is interrupting your sleep, ask your health care professional about pain management options.

Travel can wreak havoc with sleep quality and quantity, too. Many menopausal and perimenopausal women are in professional positions that require them to travel frequently. Hopping from time zone to time zone, spending long hours in airports and on planes, and sleeping in one hotel after another can seriously damage the quality and quantity of anyone's sleep. If you're already dealing with fluctuating hormones and subsequent hot flashes, night sweats, and periodic anxiety attacks, this kind of disruption can make your sleep problems even more severe.

IsYour Lifestyle Keeping You Awake?

Simple lifestyle choices may be at the root of many sleep disturbances. Although you may be following the same practices you've followed for years, as your body changes in perimenopause and menopause, you may have to become more protective of your body's natural ability to sleep. Here are some of the most common daily habits that can interfere with good, restful sleep:

• Alcohol. You may think a nightcap will help you sleep, but it probably won't. Drinking alcohol right before bedtime may help you fall asleep, but it's also likely to wake you up hours before you're ready to rise. Avoid alcohol for at least two to four hours before heading for bed.

• Caffeine. Caffeine can stimulate your brain and make it difficult for you to go to sleep and stay asleep. Limit the amount of caffeine you consume during the day, and confine that consumption to the morning or early afternoon hours. Or cut out the caffeine altogether.

• Exercising at night. Yes, exercise is essential for good health, but it's a powerful mind and body stimulant. Exercise regularly to help put your body on a natural schedule, but don't exercise in the two to three hours before bedtime.

• Smoking. Nicotine is a stimulant. As you already know, your good health requires that you quit altogether. If you continue to smoke, however, stop at least two to three hours before bedtime.

• Your sleep environment. If your partner snores; if your cat or dog walks all over you through the night; if your room is too hot, too cold, too noisy, or too bright, you won't sleep well. Keep the sleeping room temperature between 65 and 70 degrees. Use light-blocking window shades or wear a sleep mask. And finally, consider sleeping apart from disruptive sleep partners of any species (a difficult step, but perhaps essential).

Putting Sleep Disorders to Rest

You can't control your body's evolution, and you probably aren't willing to tell your boss, “No travel until after menopause,” so what can you do? The most important way to promote and protect healthy sleep patterns is to pay attention to sleep problems when they arise and then take action to resolve them. If the lifestyle changes suggested in the preceding section don't alleviate your sleep problems, seek professional help. Although polls report that many people describe sleep problems as common experiences, many of those same people will say that they don't suffer from sleep disorders. You may think that missing an hour or two of sleep now and then isn't a problem, but if you aren't getting enough sleep — and that means at least eight hours a day for most adults — your physical and emotional health will suffer.

Prescription Medications

You and your medical provider may decide that your insomnia is serious enough to warrant trying medication. There are a number of choices, depending on your history and the severity of your insomnia. Some of the choices are:

• Hypnotic-Sedatives. These valium-like medications help with falling and staying asleep. Older types can be habit forming, while newer “non-benzodiazapine” hypnotics seem to be as effective without being habit forming. None of these are recommended for long-term use.

• Sedating antidepressants. These are usually the “tricyclic” antidepressants. While they do have some uncomfortable side effects, they are sometimes chosen because they also help with pain management, and may be a good choice for treating depression and insomnia at the same time.

• Over-the-counter sedatives. These are typically some form of antihistamine, and may be useful for occasional insomnia, but their “hangover” effects of sleepiness and motor impairment need to be evaluated for their impact on your ability to function well the day after using them.

So, if you have trouble falling asleep or are awakening frequently during the night, and none of the lifestyle changes you've made have helped, talk to a health care professional. You have a number of options for resolving sleep problems, including changing your diet or exercise schedule, medications, hormone therapy, relaxation techniques, biofeedback, and psychological counseling. Though sleep disturbances may be a short episode in your passage to menopause, you shouldn't allow them to get the upper hand — for any length of time. Protect your sleep so that you can protect your health.