by Dr. Hartmut Schneider
For women who are going through menopause and struggling with sleep problems, the night and the day are often torture. Does this sound familiar to you? Then this article will certainly provide you with important background information and the prospect of a remedy.
A sleep time of 7–9 hours and good sleep quality is the prerequisite for a productive, happy and healthy life. As stated by the philosopher Arthur Schopenhauer in the eighteenth century: “But especially give the brain the full measure of sleep necessary for its function; for sleep is to the whole person what winding is to the clock.” A full measure of sleep is provided by having the right quantity and quality of sleep. Even if you manage to get the recommended 7–9 hours of sleep at night, if your sleep quality is poor, you wake up feeling tired the next day. Sleep quality is important for your brain health. Good quality sleep is required for memory consolidation – sorting out and storing memories in the right places for us to be able to access them in the future. Undisturbed sleep is required to recharge the brain cells and detoxify both brain cells and muscles. Thus, adequate and undisturbed sleep structure provides the foundation for mental and physical health.
Sleep problems can have negative health consequences and make daily life more difficult.
In contrast, reduced sleep time (less than 7 hours) and a disturbed sleep structure leads to poor quality rest, which has been recognized to lead to difficulties in concentrating or recalling memories. Over time, poor sleep can increase the risk of your brain aging prematurely, and even developing dementia. Moreover, the American Heart Association (AHA) established poor sleep quantity and quality as major risk factors for developing metabolic and cardiovascular diseases. Detecting sleep problems and improving sleep time and structure have become as important as controlling traditional, well-known risk factors – such as high cholesterol, diabetes, obesity and arterial hypertension – in preserving health and longevity. A recent study demonstrated that 65% of women (and only 50% of men) with unexpected myocardial infarction had no traditional risk factors, highlighting the need for better care for woman. Sleep medicine can provide that care and also help women to achieve a healthy and high-quality life for meeting their individual goals.
A variety of restrictions to a healthy life happen during menopause
In the following section, we address women’s specific sleep problems: most of them are not applicable to men and are often overlooked.
The first is that most woman suffer from lack of sleep and chronic sleep loss due to their social commitments. Particularly, professional women and mothers often sacrifice sleep time to meet the needs of family and business. For decades, chronic sleep loss and shift work have been recognized by the WHO as a risk factor for mental disorders such as depression and anxiety disorders, developing stress disorders and even breast cancer. Only recently the medical community discovered that lack of sleep contributes to obesity. With sleep loss, all efforts to lose weight during the day are undone and counterbalanced during the night. The inability to lose weight is not only frustrating and a sign of sleep loss, but increased weight also induces further sleep loss through snoring, creating a vicious cycle: poor sleep leads to obesity, obesity to snoring and poor sleep. Improving sleep will break that cycle, which then is not only the start of successful weight loss, but also for maintaining mental and physical health.
Second, compared to men, women have better reflexes to defend their breathing when they snore. Snoring is common in overweight men and women. Snoring is caused by a relaxation of the muscles in the throat leading to a narrowing or obstruction of the airway, which limits the airflow during inspiration. Snoring means that people cannot get the airflow they need, and there is a risk of oxygen levels dropping. Men usually live with snoring and they develop low oxygen levels and then wake up unconsciously to restore their oxygen levels. When that happens, snoring is called obstructive sleep apnea. Women wake up unconsciously from snoring before there is a significant fall in oxygen. Through this mechanism, they protect their brains and bodies from having low oxygen levels, but the downside is that they wake up more often. As a result, women often have a normal oxygen levels throughout the night but poor sleep quality. Thus, when women snore and feel tired during the day they should seek a sleep specialist who can identify and treat those unconscious awakenings. Unfortunately, the female “fighting” response to snoring gets lost with entering menopause: women essentially become like men, with drops in their oxygen levels from snoring, which leads to obstructive sleep apnea, increasing the risk of developing cardiovascular diseases as mentioned above.
Third, women going through menopause experience other specific sleep problems: a sudden inability to initiate sleep, nocturnal awakenings from hot flashes leading to difficulties maintaining sleep, and no way to extend morning sleep time. The day becomes miserable: lack of energy and depressed mood are common, together with the emotional and physical changes of menopause. At the beginning, some women just want to escape that dilemma. Why not take a break from work and even family commitments? Why not take hormone replacement therapy and accept the risks? Why not just sleep through it? Later on, sleep loss creeps into daily life, and each day becomes more difficult to enjoy; it is hard to master daily tasks and chores. Women often hear from their peers and even their doctors that they just have to “live with it” until menopause is over.
However, a sleep specialist can almost always help women get through menopause not only feeling less sleepy but also healthier. How so? Menopause is associated with a number of organic (intrinsic) conditions that trigger difficulties in initiating and maintaining sleep but also poor sleep quality. The most common condition is snoring and obstructive sleep apnea. As a result, even with sufficient sleep time, sleep structure is markedly disturbed, and women do not feel rested upon awakening, are unable to concentrate and feel sleepy during the day. Years of poor sleep during menopause reduce mental readiness and wear out the physical body, both through increased weight gain and through nightly exposure to cardiovascular stress. Unfortunately, medical attention is often paid too late, when these women have already developed either psychological problems, such as anxiety disorders, depression and burn-out syndrome, or physical stress disorders such as arterial hypertension, chronic fatigue, diabetes or even early onset of atrial fibrillation, the main cause for heart failure and stroke. Early detection of unconscious awakening and sleep apnea is therefore important for preventing adverse events of menopause. A sleep study is required to detect the reasons and provide treatment to preserve the health and quality of life of women in menopause.
Sleep medicine starts at the right place to provide help and solve problems.
Sleep medicine has primarily focused on diagnosing and treating sleep and sleep-related breathing disorders (snoring) in men, due to early data in the 1990s showing that women are less likely to snore. As highlighted above, this is not actually true. Through research on how women differ from men in their responses to snoring and through implementing this knowledge into diagnostic devices, it is now possible to diagnose women’s sleep and impending health risks, even at home. Only a small fraction of women need a full diagnostic assessment in a sleep laboratory. I am confident that in the near future women will no longer receive less attention in preventive cardiology and sleep medicine. Rather, I believe that sleep assessments should be part of health screenings, particularly for women going through menopause and those who suffer from lack of concentration and daytime sleepiness.
Well-intentioned advice is sometimes counterproductive. Therefore, a sleep doctor should definitely be involved.
Progress has also been made in treating women. Once the diagnosis is established, there are now several treatments available, most of which do not require drugs or medical devices for a long period of time. In my experience, it is almost always possible to reverse sleep abnormality and thus provide a foundation for maintaining health and for healthy aging. Particularly if diagnosed early, novel treatments provide the energy and mental strength, as well as health, to cope with a patient’s workload and potential extraordinary life events, and finally, for those in retirement, to live a life without elevated health risks and with the mental capacity to enjoy the last decades of life.
My advice: If you have some of the problems described, do not hesitate to seek appropriate medical sleep examinations and be persistent in requesting them. In this way, you can avoid torturous and disturbing moments full of sorrow and suffering in your life with the prospect of a safer and more pleasant life.
Professor Doctor Hartmut Schneider has been working scientifically for better internal (sleep) medicine since 1987. His more than 20 years of research at Johns Hopkins University in Baltimore in the field of sleep and internal diseases have earned him significant national and international recognition. For example, he has developed new treatment methods for children and adults with lung diseases. If you live in Europe, you have the opportunity to contact him. In addition to his research work, he runs a sleep medicine clinic in Frankfurt am Main.
Disclaimer: This article is for information purposes only. FAWCO does not endorse any specific physicians, clinics or treatments.