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 CHANGES IN SLEEP PATTERNS
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Early Awakening
Trouble falling asleep
Medication approach
Philosophical reframing
Medical (AAPF) material
Sleep Complaints in Adults
Links

EARLY AWAKENING
Does anyone else suffer from this?  I wake up sometimes around 2-3 a.m. and never can get back to sleep!  Usually a case of hot flashes accompany this. Most of the menopausal symptoms, I can deal with, but the sleepless nights, I have got to find a remedy!  My kids and husband, I frequently find them spending more time at the other end of the house! (Marie)
(pddb) I used to have this all the time, and I really hated it.  I will leave it to others here to extoll the virtues of Increased Wakefulness.  I wasn't wakeful in any useful sense, and I wasn't asleep either. The only thing that really helped me was a weight-training program, which I am still following. Aerobic exercise tends to keep people awake unless done pretty early in the day, but while lifting weights wakes me up and makes me alert for a couple of hours, after that I sleep wonderfully well.
(anon) I found that when I was taking a weight-training class from 7:30-8:30pm, I couldn't get to sleep until 1AM. (My Pilates classes tend to be earlier in the day, so I haven't had a problem.) Blood flow is the key to life--but too much of it at the wrong time of day can be a problem!!!:) (anon)
I need about two and a half to three hours after the end of a weight-lifting session before I can go to sleep, but that's all. Other people might find it more of a problem. Kind of like caffeine, I suppose
Yeah. I can't drink caffeine after 1pm or so. I certainly  wasn't suggesting that I was a norm, just that it's  something to watch

(Jo) Many of us have or do suffer from this. In my case, I can't get to sleep at the 'accepted time' for doing so.  When I tried to fight it in order to get up at 7.30 for work at 9, I became incredibly irritable, tired and stressed.  I was fortunate in that I could move my work hours back this year though even so starting at 11 was also a struggle. But I have noticed that if I have a very slack week and can sleep whenever the need hits me, which it does and very hard, I get plenty of hours in the sack. If you are stuck with a 9-5 type day then all I can suggest is that you look very hard at whether or not you can change this. It may mean a drop in income but that in itself can be a learning experience.

Husbands and kids unless they are under 6 in mind or age can get themselves up and ready, eat the cornflakes you thoughtfully leave out, and get to work/school. If your kids are too young to get their alone try and negotiate with another parent to take and collect them in exchange for baby-sitting or whatever.

You've said that the family end up at the other end of the house, so it sounds as though they won't worry unduly if you sit them down and explain your need for personal space a] in which to while away the sleepless hours quietly hunched over your PC or a good book b] in which to go when you feel irritable and c] possibly in which to sleep at odd times. 

Worrying about waking a husband or sweating all over him could well exacerbate insomnia. I don't have one installed any longer [a husband] but we'd moved to separate rooms long before we divorced simply because I was an owl and he a lark. Now I can hardly bear to sleep with someone else. This doesn't prevent mucho hanky panky though.

So to sum up this long ramble, try and adapt to the insomnia rather than let it take you over. (Joanna)



(Pat K.) Oh, yeah. This, along with night sweats, was my first Big Clue that I was entering perimenopause, and it's plagued me on and off for a few years. Exactly the same sort of insomnia, too --I drop off just fine, and then awaken around 3 a.m. *wide* awake.

The only solution, for me, is to get out of bed; if I lie there tossing and turning, I become more and more uncomfortable, and I really don't want to associate bed with discomfort.

So I get up, have a little water or a cup of chamomile tea. Sometimes I read a little, or put some quiet music on; sometimes I turn on the computer and read this newsgroup.

I *don't* try to do anything productive, like house-cleaning, as I find that just tires me without making me sleepy.

Sometimes I go out on my back porch, sit in my old wicker rocker and watch the moon...

Now, all this is relatively easy for me because I live alone, so there's no one for me to disturb. Others here have reported that, when worst comes to worst, just lying quietly with one's eyes closed at least assures that you'll get some rest, if you don't get actual sleep.

The point, I think, is to try not to fight the insomnia, because the fight itself can be exhausting. 

I have got to find a remedy!  My kids and husband, I frequently find them spending more time at the other end of the house!
Hey, let them. (-:

But seriously --it sounds as if your sleepless nights are leaving you exhausted and, perhaps, cranky, during the day. Do you work outside the home? If not, can you schedule some nap time during the day? (One of the things that drives me nuts about my own brand of insomnia is that it usually passes and I start getting sleepy by around 6 a.m. --right when I have to get up and get ready for work! Argh! On days when I can go back to bed till, say, 9, I'm fine).

There are, of course, a variety of drugs and herbal preparations intended to make you drowsy. I've never found one that doesn't leave me feeling "hungover" the next day, which to me is worse than the sleeplessness. But sometimes a cup of tea or warm milk can help.

So --no magic answer, sorry, but a lot of syympathy. For what it's worth, the almost nightly insomnia lasted, for me, about six months and then abruptly vanished. I now get occasional 3-4 day "reminders," usually when I've done something silly like stay up too late playing computer games and thrown my sleep cycle "off."

Pat Kight [email protected]


I have a walkman equipped with earbuds by the bed, and when I'm having trouble sleeping I plug myself into either a choral evensong or  Feather on The Breath of God - Hildegard von Byngen and find they are equally effective at stopping me thinking and inducing sleep. If the tape stops after two sides and I'm still awake, *then* I get up but not before. I chose these because they are soothing without jolts and are only brainwashing me in a positive direction! Anything which is thoroughly familiar to you and/or newagey would be a good place to start if you wanted to try it.

I have been wondering if calling our changed sleep patterns just that, rather than insomnia or sleep deprivation or anything else which has outright negative connotations wouldn't help in a subtle way? It wouldn't stop us trying things to change them back but it might be less anxiety producing. . Anxiety sure doesn't help sleep.

I found the instrumentation in Richard Souther's New Age reinterpretation of Hildegard von Bingen to be jarrlingly intrusive. This is a subjective judgment, and I don't want to impose my sense of what's better. However, you might want to look at the interpretations by the ensemble Sequentia: _Canticles of Ecstasy_ and  _Symphoniae_ are particularly serene; and _Ordo Virtutum_, arguably the first opera, has an all-woman cast with the exception of one male spoken part, that of the Devil.  This latter is not particularly serene in some spots. All three recordings are by Deutsche Harmonia Mundi. 

   Hildegard von Bingen was a canny politician who was able to make the most of the limited opportunities available to women. She would probably be an inspiration to many of us on this newsgroup. ([email protected])

Trouble falling asleep
Ok--I went to have my annual checkup today. I have not missed any periods yet, but I am 47 and I really "flood" during my periods now and I have trouble sleeping. I also experience the feeling like ants or whatever when I lay down--I can't stay still. (I refer to it as the heebie jeevies). So I feel confident that I am in perimenopause. At any rate, I haven't been watching this group long, but I  know there have been discussions about lack of sleep. I told my GYN that I couldn't ever get to sleep; it is often 4 a.m. or later before I finally drift off and he didn't think that had anything to do with perimenopause. He seemed to be indicating that it was common to wake up a lot during the night, but insomnia or not sleeping at all wasn't a common problem. Am I nuts, or is he?
(PatK) Well, *you're* certainly not nuts. He, however, sounds unenlightened.

Insomnia -- both the "can't get to sleep" sort andd the "drop right off but then wake up at 3-4 a.m." variety -- are common enough in peri that sometimes it seems as if almost every woman in this newsgroup has experienced one or the other to some degree.

The good news is that, for most of us, it's one of those transient signs --just about the time you think you'll kill someone if you don't start getting a decent night's sleep, it vanishes, and you do.

Then, of course, something else comes along. (-;

   P. S. --I have been trying to take Valerian Root (or something like that), but I don't think it helps. The only thing it may be doing is that the smell may be "knocking me out" temporarily. ;>)
Horrid, isn't it? Kind of like the rankest old sweat socks imaginable ....
I tried valerian tablets and didn't notice any difference except that I couldn't concentrate on asm when I did give up and get up :-)

We've discussed a ton of strategies for trying to get to sleep, or for coping when you simply can't, from various pharmaceutical and herbal remedies to just giving in to the insomnia and trying to rearrange your schedule so you can get a nap during the day. Different things seem to work for different people --and for some of us, nothing works but time.

There's an interesting perspective on insomnia, by a former a.s.m. poster, at http://www.oxford.net/~tishy/wakeful.html

Her approach may or may not be your cup of tea, but it should give you something to think about.

You might also want to visit www.deja.com and do a Power Search of this newsgroup for the words "insomnia" and "sleeplessness" to get a look at some previous discussions of the subject.

Oh, and as for that doctor -let him know that, whatever his textbooks may have taught him, many women do report insomnia as a part of the whole menopausal journey.--Pat Kight [email protected]


(Jo)I f you are nuts, so am I! That has been my typical type of insomnia, especially earlier in the great voyage. I don't think you'll find one type of sleeplessness described in this newsgroup, we probably have had the whole gamut between us. Neither do the classic patterns of stress causing this and depression causing the other [can't remember which was which] seem to apply.

If you _can_ alter your lifestyle or work patterns to suit when you are able to sleep this could be the most helpful thing you can do. One poster here who does work full-time has negotiated working Wednesdays at home so she can catch up on that day. For that and other reasons I shifted my hours to a 11 am start whenever possible. Another alternative would be to do what another poster here does and take a night job! If you don't work outside the home then my advice would be to stop fighting it and use the hours, taking sleep when you can.

Thanks for enlightening me about my (or his) mental state.

I doubt he's nuts just hasn't heard of this before. Many of us who were taught that getting up early [and therefore going to bed early too] was a sign of hard-work and a strong character are loathe to admit to our night-time existence.



 (Cathy) Well, we seem to be in the minority. I'm 49 and my form of menopausal insomnia is the inability to get to sleep to begin with -once I am asleep, I usually stay asleep. I had mild insomnia of the same form during the last couple of years of peri, but it got a lot worse once my periods stopped. If I fall asleep by 1:00 AM, I consider myself lucky. There's the occasional night when I don't fall asleep until 3, 4, or even 6 -which is *really* annoying -and exhausting, esp. when one has to get up for work at 7:00! Everyone else with peri-menopausal insomnia (as your doctor noted) seems to fall asleep fine, but then zap awake around 3:00 AM or wake up several times during the night; not me -or you. BTW -I also tried valerian (tastes horrendous, I think) and Melatonin - neither of which worked for me)..


(Jane W) Sleep? My sleep patterns have been the main drivers of my belief that I was getting closer to menopause. The earliest one was a sound like rushing in my ears the night before my period would start, beginning about age 38. Then the sleepless nights started about age 46. Now I sometimes sleep well, sometimes can't nod off, and frequently awake in the middle of the night. I don't worry about it any more. I do something relaxing and then just go back to bed and either sleep, or completely relax so my body feels somewhat rested.

  I find that simple hot skim milk with a teaspoon of cocoa and a small amount of something to sweeten it really does the trick if I drink it about 15 minutes before trying to nod off. And surfing the web lulls me --right now I'm suddenly ready for bed, and 1/2 hour ago I was zinging.

I have spent some sleepless nights, though, and usually the next day I'm wired and then the next night I sleep like a baby.

MEDICATION APPROACH

In response to a post making explicit recommendations for a variety of drugs containing the phrase:
Lots of people get irate at the suggestion of taking a drug to sleep. 

I don't get irate at the idea that somebody makes such a choice -but I do object to somebody telling others to do so, particularly if complete with variety and dosage. It's getting perilously close to practising medicine without a licence, though happily a real MD is necessary for the actual prescribing (assuming there are no trips over the border or iffy online pharmacies involved). Maybe *you* didn't intend to do this, but that's the way it struck me -so possibly others too. Tishy

Me too. I think it's also important to note that the sleep one gets with drugs is less useful than undrugged sleep, since drugs interfere with the stages of sleep and tend to shorten or even eliminate REM sleep. Of course if the choice is drugs or no sleep at all, then short term occasional use of hypnotics is reasonable. Unfortunately almost all of the products currently on the market have the side effect of rebound insomnia - while many are not addictive in the physical or psychological sense, this effect is another kind of addiction, just as otc nasal sprays cause rebound congestion which makes their use necessary. Terri

Responses to a post that an allergist had suggested Benadryl as a sleeping potion - and that he knew of no side effects.
(anon2) My son was given this when he was a child for an insect bite. Sent him right up the wall! Not a sign of drowsiness.
(anon) I took it for a while, but I got used to it very quickly and it no longer made me sleepy.
(pddb) It does make me sleepy, but since I awaken desperately thirsty and extremely groggy, even long after the dose should have worn off, I'm very wary of Benadryl.
(PatK) And if any of you are have been diagnosed with glaucoma (as I have, early stage and in "watchful waiting" mode per my ophthalmologist), check with your doctor before taking Benadryl or any other antihistimine. 
(pddb) Very good point.  That may be the other reason I quit taking it, now that you mention it.  I expected to have glaucoma, frankly.  I hadn't been to an eye doctor for twenty years. 
(Terri) Benadryl (diphenhydramine HCL) is the active ingredient in otc sleeping pills such as sominex. It is also sold on its own under the trade name Benadryl and many stores have their own store brand. It causes drowziness, but also causes dry mouth. Although it's primary use is to control allergic reactions, one can be allergic to the drug itself. No drug is free of side effects and Benadryl is no exception.


See http://www.mayohealth.org/mayo/9705/htm/otc.htm  for article on over the counter sleep aids


Valerian
http://www.biopsychiatry.com/valerian.html
Valerian is a good example of both the negative and positive aspects of herbal drugs. The considerable variation in its composition and content as well as the instability of some of its constituents pose serious problems for standardization but the range of components which contribute to its overall activity suggest that it may correct a variety of underlying causes of conditions which necessitate a general sedative or tranquillizing effect.


Note: The problem of standardization and composition is further addressed in the ConsumerLab report at http://www.consumerlab.com/results/valerian.asp
[Extract]

In October and November 2000, ConsumerLab.com purchased a total of 17 valerian products <snip> Among the seventeen products tested, only nine passed. Out of the eight that failed, four products had no detectable levels of the expected valerenic acids and another four had only about half the expected or claimed amounts. The six products that were made exclusively from root "powder" had the worst results — only one passed - while four of the seven products made from extract alone passed. All four of the combined powder/extract products passed.
http://www.primenet.com/~camilla/valerian.txt
This herb is described as a "medium strength herb with some  chronic toxicity". (2) Large doses can cause vomiting, stupor,  dizziness and, if used for too long, depression (1). Other toxic  side-effects include headaches and palpitations (3). Toxic  effects will likely be seen if valerian is used continuously for  more than 2 or 3 weeks (2, 3). [see URL above for numbered references]
Melatonin

Study Casts Doubt That Melatonin Goes Down As Age Goes Up: Older Buyers Take Note
Extract from http://www.sciencedaily.com/releases/1999/11/991108090055.htm

"Wake up refreshed and full of energy," says one advertisement for melatonin. Other ads promote use of the compound for a host of health problems from obesity to insomnia. Many advertisements target older people and encourage them to take commercial melatonin preparations to restore levels lost with aging. Older Americans who do, however, have responded to a false premise in the salesman's cry, according to results of a new study that contradicts the popular notion that melatonin levels in older people fall with age.


Extracts from http://www.pharminfo.com/drugfaq/mela_faq.html

QUESTION 1: Pharmacist inquiry: What do you know about Melatonin? 
ANSWER #1: Melatonin is still in the preliminary stages of development and we are unable to determine the potential side and metabolic effects associated with taking this hormone......

This is what we DO know about melatonin. It is a hormone produced naturally in our bodies. Melatonin is made by the pineal gland which is a small pea-sized gland in the mid-brain. During nighttime, melatonin is produced to help our bodies regulate our sleep-wake cycles....... Currently melatonin is sold in health food stores in the United States and not pharmacies.  [In Canada it is illegal to offer it for sale, but not illegal to possess it. Tishy]

This is what we DO NOT know about melatonin. It is unknown to us what the best dose should be. Researchers have used between 3 milligrams and 6000 milligrams of melatonin on their subjects! Currently no one understands what the potential side effects are with this agent. In the USA, melatonin is not regulated by our Food and Drug Administration (FDA), therefore there is no assurance of the quality of the products that are being sold. ......  Current research is being conducted on melatonin's effect as an anti-oxidant, immuno-modulator in cancer, delayed sleep-phase disorders, and jet lag. But until clinical studies are performed, the extent of therapeutic and adverse effects of melatonin can not be fully elucidated.   University of Maryland Drug Information Service 



ANSWER #2: Melatonin is a naturally occuring chemical which acts as a sleep aid. The dose which seems effective to date is 300mcg. Products on the market may contain 3mg or more which is ten times the recommended dose. Melatonin production decreases in the body with age therefore a supplement of the chemical appears to help the body maintain a normal level. Until the long term effects are defined I would only recommend no more that 300mcg per day.  John Keegan R.Ph.

http://www.melatonin.com/home.html is a commercial site but has a code of ethics online which includes "I will not engage in false or misleading advertising. " 

The Association of American Family Physicians (AAFP) has numerous patient "handouts" available on its website. Here is an extract from the insomnia one at http://www.aafp.org/afp/990401ap/990401g.html
Insomnia: What to Do When You Can't Sleep
     This handout describes some simple things that you can do to help your insomnia. Follow these tips each night. Don't be worried if it takes a week or two before you can tell a difference. 

     Be sure to talk to your doctor about your sleep problem. Insomnia can be caused by many medical conditions.  Treating the medical condition may be necessary before you can sleep better. Your doctor may also prescribe medicine to help you sleep. These medicines can help, but they should only be used for a short time (less than 4 weeks). 

  • Change your lifestyle to promote good sleep.
  • Improve your sleep environment. 
  • Slow down your mind at bedtime.
  • Follow these rules for healthy sleep.
  • [go to the URL above to read suggestions on how to achieve the four conditions listed above. Tishy]


    On the same site there is a long professional article on insomnia. I have copied the introductory paragraph below.
    http://www.aafp.org/afp/990401ap/1911.html
    Insomnia 
    MARK EDDY, PH.D., and GORDON S. WALBROEHL, M.D. Wright State University School of Medicine, Dayton, Ohio
                       Insomnia is a common complaint with potentially significant medical and psychologic complications. In some cases insomnia presents as a symptom of another underlying medical, psychiatric or environmental condition. In these cases, management of insomnia depends on accurate diagnosis and successful treatment of the underlying condition. In other cases, insomnia is a primary disorder requiring  direct treatment. Pharmacologic treatments include nonprescription medications, sedating tricyclic  antidepressants, benzodiazepines and related drugs. Behavior management methods that may be administered in the office setting include stimulus control therapy, sleep restriction therapy and sleep hygiene education. Although prescription medications and behavior therapy have similar short-term efficacy, behavior interventions are recommended as the first line of treatment for primary insomnia because of their greater safety and long-term efficacy. 
    The rest of the article goes into the above topics in considerable detail, with interesting tables.


    Also see http://www.mayohealth.org/mayo/9910/htm/sleepwell.htm for 10 tips for better sleep
    Snippets from a detailed and interesting site at http://www.hlth.gov.bc.ca/msp/protoguides/gps/sleepcomp.pdf
    Protocol for Primary Care Management of Sleep Complaints in Adults
    This protocol was developed by the Guidelines and Protocols Advisory Committee under the auspices of the British Columbia Medical Association, the Medical Services Commission, and the Government of British Columbia. 
    Scope This protocol applies to the primary care management of a non-respiratory sleep disorder in adults and follows the DSM-IV classification of sleep disorders. It does not address the specific management of circadian rhythm disorders (shift work intolerance and delayed sleep phase syndrome) and the relatively rare parasomnia, REM Sleep Behaviour Disorder.

    The most common sleep complaint is insomnia. For mild to moderate insomnia a behavioural intervention is preferred over treatment with hypnotics. Research and clinical experience indicate that restricting the time spent in bed through techniques known as stimulus control and sleep restriction helps consolidate and deepen sleep and often is the only treatment required.

    "Stimulus control" and "sleep restriction" (mentioned above) are described; there is reference to hypersomnia and parasomnia. The site also includes the Rules of Sleep Hygiene, a template for a sleep diary, and a case history.
    For a comprehensive list of links about all sorts of sleep disorders visit Sleepless in Cyberspace at http://news.bmn.com/hmsbeagle/104/reviews/insituFree registration may be required.
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