Bedtime Story

For millions of us, getting a good night’s sleep is an elusive dream. And for women—who are twice as likely as men to suffer from insomnia—falling asleep or staying asleep each night can be a nightmare.

Sleep is not just a brief reprieve from daily life—it’s essential for our physical and mental restoration. Without it, people feel tired, irritable, depressed, stressed and unable to concentrate. What’s worse, research shows that people who don’t get enough sleep every night are more likely to have weakened immune systems, become obese, and develop type 2 diabetes and hypertension. The Harvard Nurses’ Health Study, published in the January 2003 issue of the Archives of Internal Medicine, found that women who don’t get enough sleep are at an increased risk of developing coronary heart disease—the number one killer of women.

As women age, physical, emotional and hormonal changes affect sleep. Menstruation, pregnancy, perimenopause and menopause also alter the way women sleep. “In addition to fluctuating hormones, which can wreak havoc on slumber, women juggle the daily responsibilities and stresses of career and family,” says sleep disorder specialist Susan Zafarlotfi, PhD, clinical director of the Institute for Sleep/Wake Disorders at Hackensack University Medical Center, Hackensack, New Jersey. “Generally speaking, women think a lot more about things than men do, and they bring their worries to bed,” says Jane Dyonzak, PhD, a Glenview, Illinois-board-certified sleep specialist and fellow of the American Academy of Sleep Medicine. “When they do, it’s nearly impossible to get a good night’s sleep. Without a doubt, stress and anxiety are great risk factors for insomnia.”

Physical or emotional problems, a diet filled with high-fat, sugary or spicy foods, too much caffeine and alcohol, smoking and living a sedentary life can also lead to insomnia, explains Carl E. Hunt, MD, director of the National Center on Sleep Disorders Research, a division of the National Heart, Lung, and Blood Institute at the National Institutes of Health (NIH). There are two kinds of insomnia: primary and secondary. Primary insomnia—the inability to fall or stay asleep without apparent cause—isn’t associated with medical conditions. However, secondary insomnia, the more common form, is the inability to sleep as a result of underlying medical problems. “For instance, people who have arthritis might not be able to sleep because of pain or discomfort,” Hunt says.

Childbearing Years

Whether because of career stress or fluctuating hormones caused by menstrual cycles and pregnancy, many women first experience insomnia in their 20s and 30s. That’s what happened to Laura Duese 2 years ago. “It was a horrible time. I had just started my own business and was obsessed with work and financial responsibilities,” says the 32-year-old Chicagoan. “Because I was always on the run, I would drink a pot of coffee in the morning to keep me going, skip breakfast and lunch and grab a Lean Cuisine for dinner,” she says.

Even though Duese fell asleep shortly after going to bed, she’d wake up at one or two in the morning, unable to fall back to sleep. “I’d be exhausted all day, and I’d get debilitating leg cramps,” she says. After trying to get the situation under control by herself, Duese sought the help of nutrition and exercise specialist Amy Baltes, RD, at the Wellness Institute at Chicago’s Northwestern Memorial Hospital. Within weeks, Duese was eating three meals a day, drinking water throughout the day and walking regularly. She was also sleeping throughout the night and waking up refreshed and energetic. “I didn’t realize I was dehydrated—which not only caused my insomnia, but also my severe leg cramps. Once I started drinking water regularly, the cramps were gone, I felt rested and I could sleep all night,” she says.

Altering your diet may lessen the frequency of insomnia. “You’d be surprised how many women suffer from insomnia simply because they eat the wrong foods, rarely exercise, don’t drink enough water and rely too heavily on caffeine and alcohol,” says Baltes. “The first step is to make sure you’re well hydrated by drinking at least eight 8-ounce glasses of water every day.”

Hormones ebb and peak throughout the menstrual cycle. A 1998 poll by the Washington, DC-based National Sleep Foundation (NSF) found that 36 percent of women said their sleep was most disturbed during the first few days of their periods, when their hormone levels are lowest, and 50 percent reported menstrual bloating that disturbed their sleep for two to three days each month. “Most women just accept their painful periods and PMS symptoms,” says functional nutritionist and naturopathic practitioner Judy Fulop, ND, MS, of the Center for Integrative Medicine at Northwestern Memorial Hospital in Chicago. “But there’s no reason to suffer at all. By eating healthily, avoiding high-fat foods and sugar, and getting enough omega-3 and omega-6 essential fatty acids, most women can have pain-free periods every month,” she says. Smooth sailing through your menstrual cycle will, in turn, help you sleep better.

Fulop also recommends supplementing with vitamin B6 (100 to 200 mg), magnesium (300 to 900 mg), calcium aspartate or calcium malate (800 to 1,000 mg) and 400 IUs of vitamin E daily. And exercise is another great way to keep insomnia at bay. Studies show that women who exercise regularly experience less severe PMS symptoms and increase their amount of deep sleep.

Pregnancy’s Effect

The NSF poll also reported that nearly 80 percent of pregnant women have disturbed sleep. In addition to hormones gone haywire, physical and emotional symptoms such as body aches, nausea, heartburn, anxiety and depression can interfere with sleep. By the third trimester of pregnancy, 97 percent of women wake up during the night. Moms-to-be who engage in physical activity reap the benefits of exercise because it helps improve circulation and reduce leg cramps. People who exercise—just 30 minutes of brisk walking four times a week—fall asleep sooner, sleep better and wake up feeling rested, compared to those who don’t exercise regularly.

Avoiding spicy, acidic, fried and fatty foods also can ease sleeplessness because many pregnant women have trouble digesting them, thus disrupting their sleep cycles. Many women don’t suffer from insomnia until after they give birth, when sleep is interrupted by a drop in estrogen and progesterone levels, breastfeeding, crying babies and a new slew of worries. “Most new mothers try to nap whenever their babies sleep. While this might be tempting, it can throw your body’s circadian rhythm out of whack,” warns Zafarlotfi. Your circadian rhythm—your body’s internal clock-is regulated in part by light and darkness. It signals the secretion of various hormones to regulate your sleep and wake cycles. “That’s why it’s a much better idea to develop a routine and stick with it,” says Zafarlotfi. Otherwise, when your baby finally starts sleeping through the night, you’ll be stuck staring at the ceiling.

The Mid-Life Years

As women age, sleep becomes even more elusive. Insomnia increases in women after age 40. “Even though through adulthood our need for sleep remains constant-about 8 hours-our ability to sleep worsens as we get older,” says Dyonzak. “Estrogen levels fluctuate tremendously, and we experience all sorts of changes in our bodies, including our first night sweats and mood swings,” she says.

Irene Phelps, 50, knows all too well what it’s like to live without sleep. About 6 years ago, the Chicago resident started having problems sleeping. While she’d fall asleep without much difficulty, Phelps would wake up between 2 a.m. and 4:30 a.m. “I couldn’t fall back to sleep, so I’d get out of bed, start the coffee, pay bills, exercise and go to work. By the end of the day, I’d be too exhausted to move,” she says.

After Phelps, head of a family foundation, started forgetting people’s names, she sought the help of licensed acupuncturist and herbalist Andrea Friedman Ishikawa at the Center for Integrative Medicine at Chicago’s Northwestern Memorial Hospital. “It wasn’t until the night sweats began that I realized I was in the throes of perimenopause. But just a few weeks after starting acupuncture and Chinese herbs, I began sleeping and feeling much better,” she says.

“Acupuncture is one of the best ways to relieve anxiety by stimulating the body’s production of endorphins, which calm the mind and promote sleep,” says Friedman Ishikawa. NIH recognizes acupuncture as a useful treatment for chronic pain such as arthritis as well as other conditions such as depression. A 1995 review study from China’s Shanghai Second Medical University and published in the journal Psychiatry and Clinical Neurosciences reports that 90 percent of patients suffering with insomnia were successfully treated with acupuncture. Another study published in March 2000 in the World Journal of Acupuncture-Moxibustion reports that 95 percent of the participants in its insomnia study overcame their insomnia, and 3 percent of the remaining 5 percent improved.

“As women age, reduced estrogen levels cause sleep to become fragmented. Our inner clocks, or circadian rhythms, change, and we don’t experience deep sleep anymore. We might even start dozing off during the day during perimenopause,” says Zafarlotfi. “Sometimes simple life-style or behavioral changes can alleviate sleep problems associated with perimenopause,” says Fulop. “For instance, it’s important to keep your bedroom cool and dark. Eliminate foods that may have estrogenic properties such as alcohol, caffeine and chocolate-foods that deplete the body of magnesium, calcium and B vitamins, which contribute to sleep.”

How Menopause Affects Sleep

Those who escape insomnia during perimenopause may lose the ability to sleep well once they reach menopause. Oftentimes women say they wake up several times a night because of hot flashes, which can last anywhere from 30 seconds to five minutes. According to the NSF, women report the most sleeping problems during menopause. In one NSF poll, 36 percent of menopausal and postmenopausal women reported hot flashes that interrupted their sleep 5 days each month and also caused daytime fatigue.

It wasn’t long ago that many women relied on hormone replacement therapy (HRT) to treat all their perimenopausal and menopausal woes. But in light of the fact that last July 2002, the National Heart, Lung, and Blood Institute of NIH halted a major clinical trial of HRT due to an increased risk of invasive breast cancer, more and more women are treating their symptoms with lifestyle, dietary and herbal modifications.

“Studies show that women who exercise tend to have fewer hot flashes and night sweats, which means they sleep better,” says Fulop. Eating a well-balanced diet with lots of fruits and vegetables can also help. “You might also want to add a little soy to your diet. Many women have found that supplementing their diets with soy foods such as soymilk and tofu has helped relieve their menopausal symptoms,” says Zafarlotfi. Soy’s isoflavones—beneficial plant hormones that behave like estrogen—may help stabilize blood-vessel changes that lead to hot flashes. An Australian study published in 1995 in the journal Maturitas reported that women who consumed 45 grams of soy flour daily for 12 weeks reduced their hot flashes by 40 percent.

Supplements may also help women sleep. “Older women, especially postmenopausal women who secrete less melatonin-a body chemical that helps regulate the sleep/wake cycle-find it helpful to supplement with a very low dosage of melatonin, up to 1.0 to 1.5 mg,” says Zafarlotfi. Some people have experienced side effects such as vomiting or rashes when the dosage is too high. “Just remember that since melatonin isn’t a sleep-inducing agent, it may take a week or two before it starts working,” she says.

Phelps—who sought and found relief from insomnia with acupuncture—is now in menopause. “Sometimes I wake up in the middle of the night for any number of reasons, but I’m able to fall right back to sleep. I know everything’s easier, and my hot flashes are much milder because I exercise regularly, eat a low-fat diet with lots of fruits and vegetables and have acupuncture once a month,” she says, “I feel great—better than I have in ages.”