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This is known as the vulnerable period with regards to sleep quality.1 Sleep disturbance is one of the core symptoms of menopause.2
The facts on menopause and sleep disturbances
The Study of Women’s Health Across the Nation (SWAN) showed that menopause is associated with the onset of sleep disturbances.1 Sleep problems were present in 46% to 48% of menopausal women and 38% in pre-menopausal women.1 A different study demonstrated that 25% of women between the ages of 50 to 64 years had sleep problems.1 Sleep disturbances severely affects quality of life.1
The symptoms and causes
Signs of menopause are the onset of irregular menses, hot flushes and sleep disturbances.2 Other symptoms include change in behaviour for example mood swings, anxiety, stress and forgetfulness.2
Common causes of this type of insomnia include vasomotor symptoms (hot flushes),changes in estrogen and progesterone levels, circadian rhythm abnormalities, mood disorders, medical conditions and lifestyle.2
Let’s take a closer look at the causes of sleep disturbances
Vasomotor symptoms (VMS)/hot flushes
Vasomotor symptoms also known as hot flushes are caused by reduced estrogen levels.2 This causes women to experience an intense heat with palpitations during the night. It can also lead to frequent awakenings accompanied by sweating (night sweats).1,2 Studies have shown that hot flushes are the primary predictor of sleep problems in menopausal women.
Estrogen
Estrogen can have an indirect effect on sleep quality.2 The declining levels of estrogen can lead to sexual dysfunction.2 This can play a role in the psychological factor of depression, which can lead to sleep disturbance in menopausal and postmenopausal women.2
Progesterone
Decreased levels of progesterone levels can lead to sleep disturbance.2 It has sedative and anxiolyctic effects, stimulating receptors, which plays an important role in the sleep cycle.2
Age and medical conditions
Age related medical conditions can disturb sleep in postmenopausal women.2 Conditions include obesity, heart problems, gastrointestinal problems, urinary problems, chronic pain problems and the use of neuroactive medications among others.2 Pain plays an important role in sleep disturbances.2 Rheumatoid arthritis is associated with poor sleep quality.2 Perimenopausal women may experience headaches when waking up at night.2
Treatment with melatonin
Melatonin is released from the pineal gland and plays a part in the circadian rhythm, which is synchronized with our hours of sleep.2 The daily increase of melatonin secretion is correlated with the steepest increase nocturnal sleepiness.2 Endogenous secretion of melatonin is significantly reduced in menopausal women.2
Treatment with melatonin has demonstrated clinical efficacy in the improvement of sleep latency, overall sleep efficiency and reduced sleep fragmentation in menopausal women.3
For more information on insomnia visit www.sleepless.co.za and download your free sleep diary.
Ask your Doctor for the only registered and prolonged-release melatonin available in South Africa.4,5
References:
1. Andenaes R, Smastuen MC, Misvaer N, et al. Associations between menopausal hormone therapy and sleep disturbances in women during the menopausal transition and post-menopause: data form the Norwegian prescription database and the HUNT study. BMC Women’s Health 2020:20(64):1-9.
2. Jehan S, Masters-Isarilov A, Salifu I, et al. Sleep Disorders in Post-menopausal Women. J Sleep Disord Ther 2015;4(5):1-18.
3. Treister-Goltzman Y, Peleg R. Melatonin and the health of menopausal women: a systemic review. J Pineal Res 2021:9;e12743. doi: 10.1111/jpi.12743.
4. Wade A, Ford I, Crawford G, McMahon A, Nir T, Laudon M et al. Efficacy of prolonged release melatonin in insomnia patients aged 55–80 years: quality of sleep and next-day alertness outcomes. Current Medical Research and Opinion. 2007;23(10):2597-2605.
5. MIMS. Monthly Index of Medical Specialities. 2022.
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