Dhurry well should be natural. Instead, for millions of women, especially after 45 years, sleep becomes a battlefield. According to data, Over 50% of menopause and postmenopausal women suffer from insomnia. A number destined to grow, thanks to the increase in female longevity and chronic stress that accompanies modern life.
Why do women sleep worse? And what does menopause have to do with it?
Insomnia has a genre, and affects the female sex harder, in particular in some moments of life in which hormones particularly affect: menstrual cycle, pregnancy, menopause. Neuroendocrine changes, decline in estrogen, increase inanxiety: it is an explosive mix that alters the sleep-wake rhythm and the quality of life.
Who is Dr. Laura Palagini
To understand why Insomnia can worsen in menopause and premenopause – and above all what we can do – we talked to with Laura Palagini, psychiatrist. The doctor is an expert in sleep medicine member of the board of the Italian Society of Sleep Medicine, ofEuropean Insomnia Networkfrom the Cognitive-Behaviour Treatment for Insomnia Academy And of different international task force on sleep and psychopathology. With her we explored the really effective causes and strategies to return to sleep well, even in menopause.
How widespread is Insomnia in premenopause and menopause?
Chronic insomnia is the most widespread sleep disorder and affects, in all stages of life, the female sex with one almost double prevalence compared to the male one: during the reproductive period, pregnancy and perimenopausal.
It is a stress-related pathologywhich develops in people predisposed after a stressful event. Hits about 10% of the population western, with one more than double frequency in menopause women.
The predisposing factors have a strong biological component, such as modifications or variants in the genes that regulate neurotransmitters involved in the sleep-wake cyclelike theorexin (which regulates the vigil) and the Gaba (sleep neurotransmitter). In perimopause women, gene variants related to the production of estrogen, associated with insomnia, have been identified.
Insomnia in women and men
During perimenopause an increase in different sleep disorders, including chronic insomnia, due to the disreguling of estrogen and progesterone, which alters the structure and the homeostatic and circadian sleep organization, is observed. In addition, the mechanisms that promote the vigil are most present in the female sex, with one greater sensitivity to light and one different adjustment of the circadian rhythms Compared to men. All these factors contribute to the Biological female preparation to insomnia. Biologically, female sleep tends to be more superficial: does this have to do even with the evolutionary role of the woman?
What are the mechanisms that bind the hormonal changes to sleep disorders?
The female hormonesas estrogen and progesterone, have a “awakening” action: they promote watter more than sleep. In addition, orexin, the peptide that promotes the vigil, seems to be more represented in the female sex.
This makes female biology more predisposed to insomnia and disturbed sleep. Also, during the luteal phase of the cycle And therefore monthly, sleep is altered in the Rem phase, the one that regulates emotions. In pregnancythe hormonal storm surfaces sleep. Often, in fact, there‘insomnia of perimenopause originates in pregnancy.
What does the temperature have to do with it?
In addition, deep sleep is also linked to one low internal body temperature (“Core temperatures”), but in perimenopause the hypothalamic control of the temperature becomes unstable, with vasomotor symptoms that compromise the quality of sleep. The genesis of insomnia in menopause is complex and the hormonal imbalance is, therefore, a crucial factor.
What distinguishes the insomnia of menopause from other forms of sleep disorder?
Insomnia is manifested as a night disorder, with difficulty falling asleep, night or early awakenings, or a combination of these problems, associated with daytime symptoms such as tiredness, difficulty concentration and irritability.
Unlike other sleep disorders, L‘insomnia is lived with suffering:: you would like to sleep desperately, but you can’t. Other common sleep disorders in perimenopause include theIncrease in snoring and the Restless legs syndrome (restlessness and cramps in the lower limbs). However, these do not cause the same subjective suffering as insomnia.
When to contact the specialist?
Acute insomnia is a physiological response to stress. However, if it does not resolve within 1-3 months, It is good to consult a specialist to prevent chronicize and become treatments resistant.
When can we talk about chronic insomnia?
When the night and daytime symptoms are presented At least 3 times a week for at least 3 months. A fixed thought on sleep is also developed: you constantly think about sleeping, you strive to sleep or you are afraid of not succeeding. These thoughts activate the mind, worsening insomnia.
What are the new guidelines on insomnia?
After 50 years of age, the insomnia of the central part of the night is the most frequent. In addition to the factors already discussed, this is due to physiological reduction of melatoninwho has his own peak right in the middle of the night. Its deficiency makes awakenings more likely.
The treatment is based on guidelines: the CBT-I (Cognitive behavioral therapy for insomnia) and, if necessary, specific drugs to be hired before going to sleep. Never take hypnotics in the middle of the night: Sleep physiology is altered and there is a risk of triggering insomnia the next night.
How much do they affect stress, anxiety and mood on menopause insomnia?
Stress, anxiety and bad mood are important triggers of insomnia in predisposed subjects. In menopause, these factors add to biological ones, creating a “domino” effect: stress, depression and insomnia reinforce each other.
For this, treating insomnia is essential to stop the vicious circle.
What role play lifestyle, nutrition, exercise and exposure to sunlight in regulating sleep-wake rhythm?
We build a good sleep during the day. The natural light of the morning, the regular rhythms of nutrition, physical activity, socialization and work help to synchronize the brain’s central biological watch (master clock), which will then make us sleep at night. If these inputs are missing or are irregular, the clock is deepened, with consequences on sleep.
Is it useful to resort to melatonin or natural supplements? When is the drug therapy instead serve?
There are no clinical indications for generic use of melatonin or natural supplements in the treatment of insomnia. Instead the Melatonin 2 mg prolonged release It is indicated to treat insomnia over 55 years, Because its physiological production decreases and its integration is useful.
This formulation is a drug, supported by scientific studies, and recommended by national and international guidelines.
What are the most suitable drugs today to treat chronic insomnia, especially in this phase of life?
First choice drugs according to international guidelines are the Dual orexin receptor antagonist (Dora). They regulate orexin, the vigil hormone, which is thought to be hyperativated in the female sex and in cases of insomnia.
In Europe and in Italy a Dora is available: Daridorexant, the latest novelty of this class of drugs. It can also be used for long periods, from 3 months up to a year. Personally I have data that support use up to two years. Insomnia is in fact a chronic and persistent condition, and requires long -term treatments.
The drugs instead so -called Benzodiazepine hypnotic sedatives e Z Drugs can be used Only in the short term No more than 4 weeks excluded Eszopiclone which has data up to six months. In addition to these drugs, also melatonin 2 mg per slow release is recommended by the guidelines.
All the rest antidepressants, neuroleptics, herbs and supplements, CBD oil are not indicated in the treatment of insomnia.
What is the role of benzodiazepines? Is it true that their abuse can lead to cognitive decline?
It is important to take care of insomnia, because it is precisely sleep disorder, if not treated, to represent a stronger risk factor for cognitive decline than the targeted use of drugs that act on the Gaba, such as benzodiazepines.
However, abuse or prolonged use-especially if you do-it-yourself, without medical supervision-is contraindicated: it can worsen cognitive functions and negatively alter neuronal plasticity during sleep, further compromising the quality of rest.
Can hormonal replacement therapy (Tos) improve sleep quality? In which cases is it indicated?
The Tos is not recommended in the guidelines for the treatment of insomnia and the data available on its direct effects on sleep are still conflicting. However, by improving vasomotor symptoms and contributing to greater hormonal stability, it can indirectly help to reduce the impact of their discomfort on sleep.
Having said that, insomnia is a complex condition, which in women already manifests itself from puberty and involves alterations of neurotransmitters such as Orexin, Melatonin and Gaba. However, female hormones always have a “alarming” effect, the Tos can contribute to regularizing the hormonal component, but alone – as well as integration – does not represent a resolutive therapy for insomnia and, in some cases, can contribute to its chronicization.
What is the role of progesterone in menopause sleep disorders?
The progesterone, like estrogen, has a promise action the vigil. This probably has to do with the role of women in the family and in society who must always be ready, on alert for the needs of the children and this involves a more superficial and disturbed sleep.
Even if it is stated that the progesterone has an effect similar to benzodiazepine – for example, in the first months of pregnancy it can induce sleepiness – actually tends to reduce REM sleepthe phase that helps to positively process emotions.
During the luteal phase of the menstrual cycle, when progesterone is predominant, sleep is often more disturbed for this reason. At the moment there are not enough data to recommend progesterone as a treatment for insomnia. The TOS, if indicated, can help to regularize the physiological action of progesterone, but does not eliminate the biological predisposition of women to a more fragmented sleep.
Chronic insomnia can have consequences on general – cardiovascular, metabolic, cognitive health. What do scientific studies tell us today?
Yes, chronic insomnia is recognized as a risk factor for cardiovascular, metabolic and cognitive pathologies, because it is associated with hyperactivation of the stress system and neurophanymming. The good news is that it is a modifiable factor: cure insomnia correctly can prevent or significantly reduce these risks.
A final message for women who feel parade, unheeded or who think “is it normal to sleep badly at a certain age”?
It is true that there are biological factors that make women more vulnerable to insomnia, but this does not mean it should be endured. Insomnia is a condition that can be cured, Just as it happens for other moments of life, such as pregnancy. Unfortunately, there are still a lot of wrong information that push to underestimate the disorder or to resort to do-it-yourself. Instead, a targeted and personalized treatment It can really make the difference in improving the quality of life.
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