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Insomnia/Fatigue

Menopause Oasis
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Are you sleep deprived? Do you suffer from one of many sleep disorders? Is fatigue your problem? There is help to be found on the web! I will only touch on the ‘Insomnia’ and 'Crashing Fatigue' here, but will give you a great site to help you begin your search about all of the rest of them. That site is Sleepnet, the link to it is: http://www.sleepnet.com . That site offers a "sleep test" that will help you determine what type of sleep disorder you may be suffering from. Much of our daytime discomfort is caused by not getting the right kind of sleep at night. You may be able to find some help!   I will give you some other web links at the bottom of the page!

     Insomnia
    Fatigue
    Related links:

Here is a list of the sleep disorders of which I am aware. There are probably more!
• Insomnia
• Restless leg syndrom
• Sleep Apnea
• Narcolepsy
• Bruxism
• Fibromyalgia
• Sleepwalking
• Hypersomnia
• Sleep Terrors

If you suffer from more than just the occasional night of insomnia you may find the following helpful. Before you try very many of the remedies listed below, please ask your doctor if any medication you are taking might be effecting your sleep.

These are some of the types of medications that may effect your sleep:
  Alertness medications
  Analgesics
  Antidepressants
  Arthritis medications
  Asthma medications
  Blood pressure medications
  Cold/allergy medications
  Diet pills

Sometimes sleep disruptions are purely menopause related; sometimes they are not.   Here are some of the things that ARE and what you can do to deal with them:

Reduced hormone progesterone production: Progesterone is the female hormone that helps to promote sleep, among other functions.  Sometime using a BCP or prescribed progesterone cream  to level out your supply of progesterone can help.
Hot flashes/night sweats: These can be controled using BCPs, HRT, or a few of the other things we have listed on our 'Natural remedies' page.
Mood disorders: We all know that if we are terribly upset about something we do not sleep well. Mood swings can be brought on by peri-menopause. If this is true for you please check out the 'Natural remedies' page for some hints on vitamins and supplements that can help with this too.
 
Now on to the non-menopausal related disruptions!

Experts recommend that you try to ‘set the stage’ for sleep so you can help get your mind and body into "sleep mode."

Prepare for sleep:

Establish a bed-time ritual.   Let your body know that it’s time to sleep by doing the same activities each night. Follow a routine to help relax and wind down before you go to bed, such as reading a book, listening to music, or taking a bath. You can also keep your biological clock steady by going to bed and waking at the same time every day (including weekends and holidays).
Maintain a relaxing atmosphere in the bedroom.   Make sure you have all the conditions you need for sleep - that it’s quiet, dark, cool, comfortable, and free of interruptions.
Ensure adequate exposure to natural light.   This is particularly important for older people who may not venture outside as frequently as children and adults. Light exposure helps maintain a healthy sleep-wake cycle.
Relax your body.   To reduce muscular tension, try techniques such as meditation, progressive relaxation, or even taking a warm bath.
Stop worrying.   Avoid solving your problems from your bed. Before going to bed, make a list of problems and list some "steps" for the following day.
Try a high-carb snack.   A light snack that is high in carbohydrates, such as a plain bagel, might help you relax.
Avoid heavy, spicy, or high-sugar foods.

Sleep assisters - some are indeed ‘Strange’ but sometimes helpful....

Food & Drink:
• Drink warm milk at bedtime.
• Eat a high-carb snack just before bedtime.
• Eat a protein snack just before bedtime.
• Eat something made with pumpkin before bedtime.
• Vinegar: Add 2 teaspoons of apple cider vinegar and two teaspoons of honey to a glass of boiling hot water. Drink.
• Hot citrus drink made with water and honey. (Lemon juice or orange juice or grapefruit juice)
• Eat something with the natural amino acid L-tryptophan in it**
• Try a banana milkshake (a banana and about a half a cup of milk put through the blender ‘til it's frothy). You can also add a few spoonfuls of your favorite fruit yogurt to this. It's a truly delicious and refreshing way to ingest L-tryptophan and the necessary sugars to help you get to sleep.

** milk, cheese, yogurt, buttermilk, turkey meat, poultry, eggs, tuna, bananas, figs, nuts, almonds, dates and soybeans are all ideal sources of tryptophan. Also some fruits and vegetables, such as green peas, spinach, lima beans, peanuts and peanut butter. Adding honey or other carbohydrates, like pasta or bread, facilitates the use of the natural tryptophan.

Scents:
  Passion Flower Incense
  Lavender
  Jasmine
  Use a small herbal sleep "pillow" - filled with lavender, rose petals and catnip.

Herbs & Supplements:
  Valerian  --  This product becomes more effective over time, so taking it nightly works best, rather than taking valerian only on random rough nights.
  Chamomile  --  the trick is to make sure you are brewing it properly. Use two or three teabags. Then put a lid on the pot to keep oils in the water -- so you get the medicinal effects of the tea. (Be aware that this may increase the risk of bleeding so people on blood thinners should exercise caution; and it may also increase blood pressure)
  Melatonin  --  If you tend to wake up in the middle of the night, use the 'extended release' formula before you go to bed. If you have trouble falling asleep, try 'immediate release' formula.  (However, there have been concerns about risks of bleeding especially in people taking blood-thinners like warfarin.)
  Vitamin B6. It aids in the absorption of L-tryptophan. But it should be taken earlier in the day as it can cause insomnia if taken later in the day.
  L-Tryptophan (5HTP) from Health food stores  -- The body uses this to form 5-HTP, which is used to form Serotonin which makes N-Acetyl-serotonin which produces Melatonin!!
  Kava  -- Best used for stress related insomnia - but only for people not using alcohol or medicines metabolized in the liver, including many cholesterol medicines.
  Magnesium  --  Calcium and magnesium combined produce a calming effects on the brain. They are essential for normal sleep. Calcium and magnesium taken 45 minutes before bedtime have a tranquilizing effect.

These have also been mentioned as possible helps:
  American scullcap (as a tea) (commonly combined with valerian)
  Bitter orange (as a tea)
  Catnip (as a tea)
  Hops (as a tea)
  Lavender (as a tea)
  Lemon balm (as a tea or 160 - 200 mg 30 minutes to one hour before bed)
  Passion flower (as a tea)

Now for the "other" sleep aids....

Sound - music(preferably played with a timed turn-off), do not use songs that you know words too, you'll be tempted to try to sing along!
Reduce light - sleep in a room as dark as possible.
Cool bedroom with fresh air - (we know the fresh air can be a problem in the wintertime) and a room temperature between 60-65 degrees will give you the best sleeping conditions.
Keep regular bedtime hours - select a bedtime and wake time and stick with them.
Take a Warm Bath - The key word is ‘warm’ not ‘hot’. Too long in hot water and your body is drained of vitality. Use bath salts, or throw in Epsom salts and baking soda - one cup of each. These will help you relax and also help rid your body of toxins.
Get a massage - at least a back rub if you have a significant other who will do it for you.
Sleep on Your Back - Supposedly this is the best position for relaxing. It allows all your internal organs to rest properly. If you ‘must’ sleep on your side, do it on your right side, not your left. Sleeping on the left side causes your lungs, stomach and liver to press against your heart, causing stress on an organ that most of us find quite useful. Never sleep on your stomach.
If You Can't Sleep, Get Up - Do not lie awake trying to get back to sleep any more than 30 minutes. Get up, do something quiet and non-stimulating. When you feel tired again, go back to bed.
Don't Sleep In - Get up at the same time every day, even on weekends and holidays. Once you have awakened, get up!
Keep Your Bed a Place for Sleep - Do not work, read, watch TV, work crossword puzzles, or any other ‘busy’ activity in your bed. Let your mind and body identify bed with sleeping only. (Well, maybe one other activity!!)
Avoid Naps - Yes they are tempting; but if you are having trouble sleeping at night skip the naps. You should be more tired at bedtime and better able to fall asleep. If you "must" nap, limit your nap time to 20 minutes.  You need to stay mentally alert and active throughout your day.
Avoid Illuminated Bedroom Clocks - They provide just one more source of aggravation to an already aggravated mind!
Exercise - to stay fit and relieve stress, but NOT within 3 hours of bedtime!

Some of these are strange sounding but, hey, if they help ......

Onion - Cut up and onion and put it in a jar. As you go to bed, open the jar, sniff the onion and then close it and place it on your bed stand. (Not sure why it needs to sit beside you all night!!!)
Wear mittens and socks - This warms extremities - hands and feet - and helps improve blood flow throughout the body.
Sleep with Your Head Facing North - This aligns your body with the magnetic field of the planet, bringing your own energies into harmony with those of the Earth.
Toe Wiggling - Lie on your back and wiggle your toes up and down 12 times ( both feet at the same time). This will relax your entire body, inside and out.
Tummy Rub - This soothes the digestive system and helps to bring about a deeper relaxation. An extra benefit is that it helps you to lose weight by improving the functioning of the digestive system. Simply lie on your back and place your hand on your navel. Begin by making small clockwise circles, gently gliding your hand over your tummy. Gradually increase the size of your circles until you run out of tummy to rub. Then gradually reduce their size until you are back at your navel again. Then reverse the direction (to counter-clockwise) and do the same thing again. Repeat this whole series with your other hand. Do this several times. (If nothing else, the repetitive motion may put you to sleep!!)
Visualization - Concentrate on something peaceful or something boring.
Imagine it is time to get up - or tell yourself that you ‘can not/must not’ sleep. Remember the lullaby from Mary Poppins "Stay awake, don't rest your head"? It worked for the kids!!

Things to avoid:

Exercise - Avoid exercising within three hours of bedtime. Although exercise earlier in the day my help tire you out enough to induce sleep.
Smoking - Nicotine is a stimulant that can keep you awake. Avoid smoking in the six hours before your bedtime. (Heck, in that case you may as well quit!!)
Alcohol - Although alcohol may seem to help you fall asleep, it can disrupt your normal sleep pattern during the second half of the night and leave you feeling unrested.
Caffeine - Caffeine can delay your sleep and cause you to wake up during the night. Avoid caffeinated drinks and foods (coffee, tea, cola, chocolate) after noon.
Liquids - Avoid drinking fluids before bedtime to decrease the chance of having the urge to go to the bathroom during the night.
Ginseng - For some a common side effects is the inability to sleep.
Niacin -  This can cause insomnia, especially when taken in high doses.
Green tea -  For those with sleep disorders the caffeine in this can increase the problem. 
All "B" vitamins -  Should be taken by early afternoon. Taking them late in the day may interfere with sleep.
Vitamin C - Can act as a stimulant for many.
Phenylalanine (which produces tyrosine) - Can cause overstimulation, restlessness, anxiety, insomnia, and heart palpitations. They should not be taken late in the day.
St. John's wort - Although some people take St. John's wort to help with sleep problems, some users have reported insomnia as a side effect. So it may be beneficial to take it earlier in the day if you are having trouble with insomnia.
SAM-e  - This product can interfere with sleep if taken later in the day.
CoQ10  - A product that can cause insomnia in some patients and fatigue in others - try taking it early in the day if you suffer with insomnia.

Foods to avoid late in the day:
   Red meats - red meat is one of the hardest foods for the body to digest. All that extra effort requires waking time, so you'll be better off eating lighter fare in the late evening.
   Lean meat of any kind - Lean protein can actually make you more alert and provide a boost of energy.
   Cheap Chinese food - the kind laced with MSG can trigger a number of digestive problems, and people who are especially sensitive to MSG will find it very difficult to get a good night's sleep. Avoid the heavy, deep-fried and oily Chinese entrees if you plan to hit the hay early.
   Breakfast cereal - the kind with a high sugar content will keep you up for longer than necessary and may even cause you to gain weight. Try a healthy one; Kashi, oatmeal or other healthier selections with low sugar content are your best bets.
   Canned soup - most contain too much salt, preservatives and additives that can trigger food allergies; these are often mild, but will prevent your from falling asleep naturally.
   Spicy foods - these can cause digestive distress and keep your brain running on full power late into the night.
   Beans - the high fiber content of beans, lentils and sprouts are great for the heart but eating beans late at night can tax the digestive system and leave you with indigestion or cramps.

Crashing fatigue during menopause is a debilitating and complex disorder that causes body exhaustion and extremely poor stamina. Such disorders are not relieved by bed rest and may even be worsened by physical or mental activity. In other words, crashing fatigue during menopause is an endless, overwhelming feeling of tiredness. The common signs of crashing fatigue during menopause are indicated below:
• Overall weariness; a general feeling of being worn-out
• A lack of energy; a feeling of dragging
• Daytime sleepiness
• A desire for afternoon naps
• Mood changes, especially more "down" days
• Increasing irritability
• Difficulty managing your normal routine

It could be a psychological issue - if you are suffering anxiety, emotional stress, or trying to do too much. If these issues are not controlled, they could lead to emotional instability and this can, in turn cause an imbalance in bodily functioning - resulting in crashing fatigue during menopause. Crashing fatigue brought on by these causes are usually temporary and will stop when periods of stress end.

It could also be a physical issue - brought on by the decrease of estrogen, which usually regulates the body's cortisol levels. High levels of cortisol can lead to crashing fatigue. Or it could be a progesterone imbalance that can create chaos in the central nervous system.

What can help?
1. Life style changes:
• Learn relaxation skills: practice deep breathing, progressive relaxation techniques, or yoga.
• If your fatigue is caused by lack of sleep please visit our sections on insomnia and night sweats for many suggestions on how to cope with those.
• Eat more alkaline-forming foods (figs, dates, almonds,beets, leafy greans and parsley). They will help balance your body's PH levels. And do not eat close to bedtime as this could cause heartburn that will interfere with your sleep.
• Try to eat less 'processed foods' - the additives in them can often effect our body in adverse ways.  The more 'natural' foods you can eat, the better. Make sure your diet is well balanced.
• Stop excessive use of caffeine.
• Exercise(even 30 minutes of quiet walking helps!), but no strenuous exercise within three hours of bed time.
• If your body "insists" on a nap - give in.  But make it a short (15 to 20 minute) nap...set a timer!  It will serve you body better than fighting that nap for a couple of hours!
• Try alternative medicine such as accupuncture, biofeedback, massage, or aromatherapy.
• Consider herbal supplements - talk with your doctor about using black cohosh or valerian or other herbals.
• Talk with your doctor about the following herbs as well:
    Gotu Kola - An Ayurvedic Indian herb which contains no caffeine but does have other stimulant properties that effectively treat feelings of fatigue. Gotu kola has also been shown to boost mood and outlook, and eliminate the depression which has been shown to be linked to chronic fatigue in menopausal women. 
    Licorice root - Women with fatigue often fail to produce enough adrenal hormones, a condition which licorice root counteracts. But be careful as large doses will increase blood pressure, so be sure not to take it if you have hypertension or related conditions. 
    Ginger - This appears to increase energy by stimulating the immune system.
    America, Asian, or Siberian ginseng - On varying levels, members of the ginseng family attack the stress fatigue while boosting circulation. Do not take ginseng with caffeine, however, as you may become over stimulated and jittery. 
    Blue Green Algae and Wheat Grass - Used as components of energy smoothies and shakes, both algae and wheat grass have large quantities of magnesium, a deficiency of which can cause fatigue.

2. More help needed?
• Ask your doctor to check your vitamin and mineral levels - especially your iron. If you are lacking in any of them this could be a simple help!
• Ask your doctor to check you adrenalin levels.
• Ask your doctor about the possibility of using:
    * Some form of HRT (if you are post menopausal)
    * An antidepressant
    * Birth control pills
    * Natural progesterone cream
    * A CPAP unit if sleep apnea is part of your problem

Here are some very good Insomnia Links:

Sleep Insomnia Program
http://www.iris-publishing.com/sleep.html

Shuteye Online
http://www.shuteye.com/

A "Redbook" article on "why mom’s can’t sleep" - lots of helpful info:
http://www.redbookmag.com/home/moms-cant-sleep

Isleepless.com (Support, Comfort & Remedies For the Sleep-Challenged Soul)
http://www.nvo.com/isleepless

Other iVillage helps:
 
Insomnia & Sleep Problems Board
 
Sleep disorders quiz
 
8 Natural Remedies for Insomnia
 
Here are some helpful "Energy" links at iVillage:
 
 
 

Menopause Sleep Problems? 10 Fixes To Try Now
http://www.ivillage.com/use-your-bed-only-sleep-and-sex/4-b-210743