The Wisdom of Menopause

by Christiane Northrup

  Many menopausal women have been dismayed when they find that the amount of sleep that sustained them a year or two earlier seems inadequate now. I personally found that I needed much more sleep during perimenopause than I did a few years before. I knew that this was my body’s way of getting the restoration it needed, given all the changes that were happening in my life. During both adolescence and perimenopause, it is a biological truth that we need more sleep than at other times in our lives. It is important for a woman to recognize this, honor it, and get the rest she needs, any way she can. For many, this means eight to ten hours a night. When I’ve been traveling or in times of stress, I often sleep for ten to twelve hours. And I no longer feel guilty about it.

  Tips for Better Sleep

  The following are some suggestions for better sleep during perimenopause. What works for one person may or may not work for another, so you should expect to go through some trial and error. Experiment with such sleep aids as meditation, deep relaxation exercises, listening to soothing music, or sipping a mug of warm chamomile tea. Whatever your routine, be sure to keep it free of “performance anxiety”—don’t think about how few hours of rest you’ll get if you don’t fall asleep right away, don’t look at the clock, and above all don’t give in to your mental to-do list and get busy. You might end up establishing a night-owl habit that will be that much harder to break in the long run.

  ~ COOL YOUR HOT FLASHES. Hot flashes and night sweats are by far the most common reasons for sleep deprivation during menopause. Unless you’re able to grab a nap during the day, your first priority should be to cool your hot flashes so that you can get the rest you need at night.

  As I’ve explained, hot flashes and night sweats are triggered by neurotransmitter changes in the brain that result, in part, from erratic estrogen levels or by wide deviations in the balance between estrogen and progesterone levels (even when total estrogen is normal). In addition to maintaining hormonal balance, progesterone has a calming effect on the central nervous system, particularly on the brain.5 It follows, then, that unbalanced estrogen can be a cerebral irritant, affecting the body in much the same way as adrenaline does.

  Sleep disturbances are one of the most common reasons that I recommend natural progesterone cream, estrogen replacement, acupuncture, or herbal remedies (alone or in combination) to help a woman stabilize her hormone levels. But keep in mind that erratic hormones are not the only factor in sleep disturbances. Hot flashes are also exacerbated by underlying unresolved stress and anxiety and the unfinished business that fuels these symptoms.

  ~ CHILL OUT! Sometimes the only thing necessary to cool hot flashes is a cold pillow. I’m a big fan of the Chillow, a foam pillow into which you put water, which absorbs and then dissipates heat, keeping you cool naturally (see www.chillowstore.com). It keeps your face cool all night, thus helping prevent a hot flash from waking you up.

  ~ EAT FOR BETTER SLEEP. High blood sugar and insulin are often associated with poor sleep because they result in cellular inflammation throughout the body—including the brain. Following the diet outlined in chapter 7 (and adding foods rich in phytoestrogens, such as soy, or taking supplements such as Pueraria mirifica, see PUERARIA MIRIFICA) will often result in a good night’s sleep. The number-one rule of thumb is: do not go to bed on a full stomach. Lying horizontal when your stomach is full can cause gastric reflux, which occurs when pressure from the stomach’s contents overwhelms the lower esophageal sphincter and food (or stomach acid) comes back up the esophagus. The result is heartburn, sour stomach, a bad taste in the mouth, and, possibly, asthma-like respiratory distress. The ideal is to wait three hours after eating before going to bed (or reclining on the couch).

  On the other hand, a carefully chosen snack before going to bed can be good for you. A snack that is relatively high in protein and low in carbohydrates, or high in complex (unrefined) carbohydrates, is usually well tolerated. This would include fresh fruit, cheese, brown rice, a baked potato, lean meat, tofu, or cottage cheese. Notice what this list does not include: a Ring Ding, cookies, leftover pie, brownies, pizza, ice cream, Oreos, or potato chips. Refined and processed foods simply do not promote rest, relaxation, and the sort of deposits that need to be made in your health bank while you’re rejuvenating yourself for the next day.

  Taking antioxidant supplements twice a day can also support refreshing sleep.

  ~ AVOID CAFFEINE. Even one cup of coffee in the morning can disrupt sleep that night. Caffeine is cleared from the system much more slowly in women than in men. In addition to its effects on the central nervous system, caffeine, especially in coffee, is a bladder irritant: it will wake you up at night to urinate.

  ~ AVOID ALCOHOL. Alcohol is a sedative, but it also disrupts the brain-stem sleep mechanism, resulting in rebound insomnia—meaning that you are more apt to awaken in the middle of the night because your body will need more sedative to get back to sleep.

  ~ GET REGULAR EXERCISE. Among a host of other benefits, regular exercise improves one’s ability to get a good night’s sleep. However, vigorous exercise within three to six hours of bedtime may be counterproductive. The increased activity boosts the metabolism and stimulates the central nervous system, making restful sleep more difficult to achieve. Relaxation exercises, on the other hand, such as hatha yoga and meditation, can be very helpful. Experiment with your own body’s response to before-bed activities. As a general rule, the hour or two prior to bedtime is best spent winding down.

  ~ SLEEP IN THE DARK. Electric lights, headlights of passing autos, even moonlight streaming through your window can disrupt a good night’s sleep. If lack of pure darkness is disturbing your sleep, pull your shades down and make sure that you can’t read the face of your alarm clock. Seeing what time it is can cause anxiety if you have a tendency toward insomnia. You might want to try wearing an eye pillow, as I do, if I’m in a place where I can’t make the room dark. For added comfort, I scent mine with calming lavender oil.

  REVERSE THE DAMAGE OF ELECTROMAGNETIC POLLUTION

  WITH VITAMIN G (GROUND)

  Electromagnetic pollution (or electropollution) is caused by excess electromagnetic frequencies from microwave ovens, cell phones, televisions, computers, and other everyday household appliances. Overexposure can damage our health when these frequencies clash with our body’s own low-frequency bioenergetic fields. In fact, this electropollution is a major cause of insomnia. In the most susceptible individuals, electromagnetic pollution can also contribute to headaches, arthritis pain, anxiety, and even arrhythmia. Children, the elderly, and people with compromised immune systems seem to be at the most risk.

  One way to discharge electrical pollution is to connect with the earth—literally. The surface of the earth contains free-flowing electrons constantly replenished by solar radiation and lightning. This subtle electric signal is actually health-giving, helping to keep our bodies in a state of bioenergetic balance. Because modern life leaves us disconnected from the earth, thanks to rubber-and plastic-soled shoes and the fact that we no longer sleep on the ground the way our forebearers once did, that balance can get out of whack. Electropollution exponentially magnifies the problem.

  However, the remedy is as close as your back door. Walking barefoot on dirt, sand, or grass will electrically ground you. If you suffer from insomnia, turn off your cell phone as much as possible and make sure cordless phones, TVs, and other electrical appliances (even lamps) are unplugged at night.

  For more information, read Earthing: The Most Important Health Discovery Ever? by Clinton Ober; Stephen T. Sinatra, M.D.; and Martin Zucker (Basic Health Publications, 2010), or visit Dr. Sinatra’s website at www.HeartMDInstitute.com.

  ~ COVER YOUR BEDROOM MIRRORS AT NIGHT, OR REMOVE THEM. If you have mirrors in the bedroom that you can see when lying down, they can be a deterrent to sleep. The reflections in them can make you feel jumpy and unsafe. According to the principles of feng shui, the ancient Asian art of working with the environment, mirrors enliven a room and
increase the energy flow in it. Obviously, this is exactly the opposite of what you want in a place designed for sleep and relaxation. One solution is to put curtains over your mirrors that can be drawn back during the day.

  ~ DEVELOP, AND ADHERE TO, A GOING-TO-SLEEP RITUAL. Sleep aids such as melatonin, valerian, and other natural remedies (see NATURAL PROGESTERONE:) can be great for getting you through several restless nights, but you also need to establish and adhere to a going-to-sleep ritual based on good overall sleep habits. This is known in the trade as “good sleep hygiene.”

  First, count backward from your preferred wake-up time to establish a bedtime that gives you sufficient sleep. Keep to this bedtime every day, even on weekends, so that your body clock can stabilize.

  Get out of your regular clothes and into something more comfortable (even your pajamas) up to a half hour before sleep, to give your body the signal that it’s time to start winding down. Do your bathroom rituals at least half an hour before bedtime, too, including brushing your teeth, washing your face, and taking bedtime medications, so you can go straight to bed without reawakening yourself with these tasks.

  ~ BE YOUR OWN EDITOR. Don’t surf the Web or read, watch, or listen to anything that might be disturbing before bedtime (especially the 11:00 p.m. news), because this can activate your sympathetic nervous system, thereby taking the rest-and-rejuvenation functions of the parasympathetic nervous system offline. (When I went to see the movie Titanic with my kids years ago, I couldn’t sleep that night because of visions of freezing, drowning victims.) Also, please get the television out of the bedroom. On an energetic level, even having a television hooked up in your bedroom means that you are only a switch away from all the worries of the world. Spending hours on Facebook into the wee hours is the latest impediment to a good night’s sleep. We’re all eager to hear and see the latest news from our friends and children, but be sure to disconnect an hour or so before bedtime so you can truly relax.

  ~ AVOID EMOTIONALLY STRESSFUL DISCUSSIONS OR POTENTIALLY DIFFICULT PHONE CALLS NEAR BEDTIME. For some, however, an urgent unresolved issue with a loved one will result in a sleepless night. The point here is to know yourself and consciously decide which approach works best for you.

  ~ GET THE GERBIL WHEEL OUT OF YOUR HEAD. One of the most common sleep detractors is the gerbil-wheel-in-the-head syndrome: stewing over worries, things not said, things not done, or things on the docket for tomorrow. When I get into one of these states, I get out of bed, take a couple of herbal tinctures known as Amantilla and Babuna (see Natural Sleep Aids), step into a warm bath, and read a good book. Then, when I am sleepy, I consciously send God’s love into my sleep and into my dreams. After about a half hour I go back to bed, and I don’t look at the clock.

  ~ PUT YOUR WORRIES TO BED. Another way to get rid of the gerbil wheel is to write down everything that is bothering you just before you turn out the light. Then turn your worries over to the higher power of your choice, asking this power to guide you toward solutions to your problems while you sleep. Then imagine that when you wake up the next morning you’ll have a healthier perspective and be inspired to the right action to change your situation for the better.

  ~ IMPROVE YOUR SLEEPING SURFACE. Many people try to get a good night’s sleep using mattresses that have lost their support years before. You spend about one-third of your life asleep. Make sure you support yourself well when doing so. I recommend a new mattress at least every ten years. Every five would be far better!

  Prescription Sleep Medications: Caution

  Use prescription sleep medication sparingly. Many health care practitioners prescribe sleep medications such as Lunesta and Ambien very freely. (Ambien was the seventeenth most commonly prescribed drug in 2008.) Other sleep medications are of the benzodiazepine class of drugs, such as diazepam (Valium), lorazepam (Ativan), and temazepam (Restoril). All of these drugs work in conjunction with the GABA receptors in the brain to produce a calming effect. All are habit-forming and lose their effectiveness over time as the brain builds up tolerance, so you need more and more to get the same effect. I’ve seen many older women who were prescribed Valium for anxiety and insomnia during their perimenopausal years and who were still addicted to it thirty years later. These drugs have their place, but don’t use them for longer than seven to ten consecutive days. (They’re particularly good on overnight flights for those who can’t sleep on airplanes.)

  Other medications that can initially help sleep problems include the antidepressants known as selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), venlafaxine (Effexor), and sertraline (Zoloft). Like the benzodiazepines, these can also lose their effectiveness over time.

  Over-the-counter sleep remedies such as diphenhydramine (Sominex or Benadryl) interfere with the production of the brain chemical acetylcholine, which is very important for memory. Over time, the use of these drugs can cause serious memory problems and confusion.

  Natural Sleep Aids

  NATURAL PROGESTERONE: Try ¼ tsp (20mg) 2 percent natural progesterone skin cream at bedtime. Natural progesterone binds to the GABA receptors in the brain and has a calming effect. Addiction to its brain effects is very rare but has been reported; I’ve only seen it in one patient in more than twenty years of practice.

  AMANTILLA AND BABUNA: Amantilla and Babuna are natural medicines, originating from the valerian plant (Valeriana officinalis) and the flower of the manzanilla plant (Matricaria recutita, commonly known as chamomile), respectively. In a double-blind, randomized, placebo-controlled multicenter study of these two herbal medicines, patients received 15 drops of each or of both together, administered thirty minutes before sleep. Amantilla was 82.5 percent effective in helping patients sleep, while Babuna was 68.8 percent effective.6 I personally take Babuna (15 drops) thirty minutes before I go to sleep when I’m keyed up or anxious, and then I follow it with Amantilla (15 drops) just before turning off the lights. What I like about these tinctures is that they have no side effects. (See Resources.)

  VALERIAN: Studies comparing valerian with small doses of the benzodiazepines and barbiturates have shown that it is just as effective in inducing sleep and preventing nighttime awakening, but without inducing morning sleepiness.7 Valerian has a very bad taste, so I recommend taking it in capsule form. Dosage is 150–300 mg of a product standardized to 0.8 percent valerenic acid at bedtime.

  MELATONIN: The hormone melatonin is secreted by the brain’s pineal gland in response to cycles of light and darkness. It produces drowsiness. Melatonin is also an antioxidant, and adequate levels help prevent degenerative illness. Our natural melatonin secretion is affected by depression, shift work, seasonal affective disorder, and jet lag, and supplemental melatonin can often help the sleep problems associated with these conditions. The usual dose is 0.5–3.0 mg taken an hour before bedtime. If you are a shift worker, you can maintain a normal sleep pattern by taking melatonin about an hour before going to bed—even if bedtime occurs in the middle of the day. Melatonin also helps reset your biological clock if you have to go on a new sleep/wake cycle.

  5-HTP: Melatonin is made from the precursor molecule 5-HTP (5-hydroxytryptophan), which has also been found to be very effective for treating sleep disorders, as well as PMS and seasonal affective disorder. It is safe and widely available. The starting dose is usually 100 mg three times per day. This can be very gradually increased over several months’ time to a dose of 200 mg three times per day.8 Note: Even natural substances such as valerian and natural progesterone may lose their effectiveness over time, because they bind to the same place in the brain as prescription sleep drugs. It’s best to use them sparingly, and only after you’ve tried other routes to a good night’s sleep.9

  DEPRESSION: AN OPPORTUNITY FOR GROWTH

  Twenty-five percent of women will suffer from at least one major depression in their lifetimes. Millions more suffer from low-level anxiety and mild to moderate depression. Women receive the vast majority of prescriptions for drugs such as E
lavil and Prozac.

  But contrary to popular myth and medical opinion of the past, depression is less common among middle-aged women compared to women of other ages.10 That said, there are still a significant number of women who experience midlife depression or an exacerbation of underlying depression when they enter midlife. Gladys McGarey, M.D., a family physician and friend of mine who has been in practice for over sixty years, told me that before hormone replacement and antidepressant medication, she sometimes saw women who negotiated the change by closing the door and taking to their beds, leaving their families to care for all the details of daily life. Months later, many emerged from the chrysalis of depression rejuvenated and ready to face the second half of their lives. By then, of course, their families’ expectations about their roles and duties had also been transformed.

  Fortunately, there’s now a great deal more that can be done to support women’s bodies through midlife depression. If you are depressed, it is crucial that you take action to get help. Depression can rob you of the pleasure of your achievements or the initiative to make changes for the better. It is also an independent and highly significant risk factor for both coronary artery disease and osteoporosis.11 Remember that depression, sadness, or anger often accompanies the emotional growth spurt that our psyches are undergoing. Just knowing this is sometimes all that is necessary to get you past the dark days. Sometimes outside help in the form of diet, herbs, or even antidepressant medications is needed. Before you can decide what action to take, you need to ask yourself the following questions.