The Quest for Rest

At menopause, many women say hot flashes and night sweats ruin their sleep--although recent research suggests the brain mechanism behind these arousals may be more complicated. In any case, women often find relief by using fans or air conditioners at night, wearing lightweight pajamas and keeping some cold water on the night table. Hormone therapy may also work for some women, although there are risks.

But fluctuating estrogen isn't the only culprit. As scientists learn more about the nature of sleep itself, they're beginning to identify and treat specific sleep disorders in women. One of the most common is apnea, in which people stop breathing briefly during sleep. Apnea becomes more common in women after menopause, when many gain some fat in their neck. That can be enough to obstruct breathing. Younger women with apnea are often overweight or have an abnormal facial structure, says Kryger. Pregnant women can also develop snoring and other characteristics of apnea as the baby pushes up on the mother's diaphragm; they should be monitored to make sure they aren't developing high blood pressure. Treatment for apnea may be as simple as using CPAP, but in other cases, patients get better by losing weight or simply sleeping on their sides instead of their backs. That side position tends to keep the airway open.

Another sleep disorder gaining new attention is restless-legs syndrome, which afflicts more women than men. Patients feel an unpleasant creepy or crawly sensation in their legs, accompanied by an irresistible urge to keep the legs moving or walk around. Restless legs are associated with low levels of serum ferritin, the storage form of iron. Those low iron levels--which may be caused by heavy menstruation or pregnancy--could explain why restless-legs syndrome is more prevalent in women. Excessive blood donation or a vegetarian diet can also sometimes lead to iron deficiency, Kryger says. Restoring iron usually resolves the problem, but that can take many months, depending on the severity of the iron loss. Requip, a new drug for restless legs, works by stimulating dopamine receptors in the brain, an effect also used to treat Parkinson's disease.

If a medical exam rules out a physical disorder, women often get more rest when they improve what doctors call "sleep hygiene." Basically, that covers everything involved in the process of getting to bed. "A huge amount of insomnia is induced by behaviors that can be quickly fixed," says Dr. Jean Matheson, medical director of the Sleep Disorders Center at Beth Israel Deaconess Medical Center in Boston.

Sleep experts say you should use the bedroom only for sleep and sex--not as an auxiliary office or entertainment center with the TV blaring into the night. Take a hot shower before bed and keep your room cool (the temperature change induces sleepiness). Try to relax just before bedtime. Don't do anything that might raise anxiety--like paying bills or watching a horror movie. Go to bed and wake up at the same time every day, even on weekends. If you vary those times more than 90 minutes, you can mess up your sleep-wake cycle. Try to lower the lights as you get ready for bed and get some bright sun in the morning to let your brain know when it's night and day. Don't use alcohol to help you sleep. And cut down on caffeine--especially in the afternoon and evening. Finally getting the rest you need is worth extra effort.

With Anne Underwood and Karen Springen

© 2006