Among the many complaints about menopause, insomnia and sleeplessness rank right up there with hot flashes and weight gain. But while insomnia may occur during menopause, menopause is not directly responsible for keeping you awake. Sleep disorders such as insomnia have been largely misunderstood until recently.

This third article in a three-part series discusses what role if any menopause plays in mid-life sleep disorders. At the 21st North American Menopause Society (NAMS) Annual Meeting, leading healthcare experts presented the latest findings in sleep disorder research to separate the myths from the facts.

Insomnia is defined as difficulty falling asleep, maintaining sleep, waking up too early, and having a non-restorative sleep or feeling tired during the day.

Dr. Timothy A. Roehrs of the Department of Psychiatry, SOM at Wayne State University in Detroit, Michigan is one of America’s leading sleep research experts. His dedication to unravelling the mysteries of sleep and sleeplessness are helping doctors and their patients understand the real causes of sleep disorders and insomnia.

Among some of Roehrs’ important findings in his paper Insomnia and Other Sleep Disturbances that examines problems associated with insomnia are that 95% of women will have sleep disturbances and 85% of women experience night sweats.

The logical conclusion many women make is that menopause must be to blame; many women report waking up during the night due to yet another night sweat. This is what Roehrs refers to as “a strong stimuli where women make the connection between waking up and night sweats. But Roerhs’ research indicates “The hot flashes did not trigger awakenings or arousal.” His research shows that more often than not women are actually in a state of wakefulness prior to the night sweat.

So do the night sweats wake you up or do your awakenings trigger the night sweats? Knowing which event occurs first is crucial to understanding sleep disorders.

Roehrs’ paper lists four common menopausal sleep disorders but this does not mean that menopause is the direct cause of those disorders. Rather, these disorders that occur during menopause may be due to a number of factors including:
*Vasomotor symptoms, linked to increased blood flow, such as those pesky night sweats
*Primary sleep disorders including sleep apnea or leg movements
*Primary insomnia meaning sleeplessness due to any number of underlying factors; this can be a pre-existing condition or may start to show up during mid-life
*Insomnia linked to mood and anxiety disorders brought on by increased stress levels which usually happen at the same time as menopause

Interestingly, when you have a night sweat may help sort out which comes first; the night sweat or the awakening. During a typical night, your body goes through four stages of sleep starting with the lightest stage known as Rapid Eye Movement (R.E.M.) and generally ending with the fourth or deepest sleep stage.

As you move through these stages throughout the night, your body temperature falls and rises. Temperature regulation varies between the stages, for example, in the deepest sleep stage your body temperature is not regulated compared to the R.E.M. stage where body temperature is lowered (hypothermic) but still under a form of regulation.

Roehrs explains that during a typical eight hour sleep cycle (to use as an example) the average person will sleep more lightly during the first half of the night. Typically this means sleeping more in the R.E.M. stage where the body temperature is lowered and in response, this is where the hormones may very well play a role. As the hormones work to deal with a cooler body temperature your body ‘heats up’ and the result is a night sweat. This means you are correct in saying that you were woken up thanks to a night sweat and that the night sweat did trigger the awakening.

But in the second half of the night, your body temperature is unregulated and the hormones are not working to compensate for that. Patients tend to wake up during this stage of sleep and then the night sweat occurs; the wakening is what triggered your body temperature thermostat to kick into gear. This sudden internal temperature switch triggers the sudden warming up of the body and your night sweat.

Researchers including Roehrs are working to determine what causes sleep disorders and insomnia for proper diagnoses and corresponding treatments. Instead of dismissing insomnia as a symptom of menopause and reaching for the hormonal treatments, doctors can learn the real reasons that are keeping you awake at night and then help deal with those healthcare issues. This approach to women’s healthcare will continue to separate the myths from the facts about menopause which means better healthcare solutions for women during menopause.

Visit the NAMS site www.menopause.org for more information about Dr. Roehrs' research and other healthcare issues related to menopause

Menopause, Your Doctor, and You