Sleep eludes many women

There is a lack of research on menopause-related insomnia, a researcher says.
KNIGHT RIDDER NEWSPAPERS
PHILADELPHIA -- Like Winston Churchill, Napoleon Bonaparte, Thomas Edison, Marilyn Monroe, Benjamin Franklin and Vincent van Gogh before her, award-winning documentary filmmaker Janet Goldwater has trouble sleeping.
Unlike those other chronic insomniacs, Goldwater, 52, of Philadelphia, was a sound sleeper until she reached a certain age.
"As somebody who has always enjoyed sleep, it's frustrating to have to spend a lot of time strategizing about why I can't sleep now," she said. "Is it my food? Is it too much exercise? Is it too little exercise? Is it that glass of wine? Is it that I didn't have a drink? Is it the thread count of my sheets?"
Common complaint
Insomnia, which may be the most common and confounding minor torment known to humans, is even more so among women in the years surrounding that menopausal milestone, their last menstrual period, when the ovaries sign off.
Surveys have found that frequent insomnia is reported by 30 percent to 60 percent of U.S. women ages 45 to 55 -- as many as 12 million women, a sleep-starved sisterhood as big as Pennsylvania's entire population. Only hot flashes are a more common menopause-related complaint.
Of course, women of all ages are more likely than men to report what experts call "sleep disturbance," a catchall term that includes insomnia. Besides dealing with 3 a.m. feedings, bed-wettings, nightmares and other child-induced sleep interruptions, women's hormonal cycles can make them feel as if they're in hibernation one week, on speed the next.
Fluctuating hormones, particularly estrogen and human growth hormone, also are involved in menopausal insomnia, although the science is as sketchy as a dream. Some women can't fall asleep; others can't stay asleep; still others can't get refreshing sleep.
Need for research
"In light of the large number of women suffering from menopause-associated sleep disturbances, there is a surprising lack of [medical] literature on the diagnosis, treatment and pathophysiology of sleep difficulties in women in the peri- and postmenopausal periods," said Andrew D. Krystal, a sleep researcher at Duke University Medical Center.
Sleeping more lightly and for shorter periods is a normal part of aging, so some reluctant night owls actually may be getting sufficient sleep. Still, people who don't get enough are more susceptible to illness, accidents and plain old grumpiness.
Fortunately, menopausal insomniacs, like doctors on call, tend to have a lot of stamina.
"It's a mystery to me how I can accomplish the same amount of stuff with no sleep," said Goldwater, a publications consultant at Temple University Law School who recently traveled to Costa Rica and Nicaragua with colleague Barbara Attie to work on a documentary about a child rape victim.
Hormone therapy
Like many women, she quit hormone therapy after findings of a landmark federal study were announced in 2002, saying that long-term use increases the risk of heart attacks, strokes, blood clots and breast cancer. Also, like many women, she tried a popular sleeping pill but didn't like the side effects.
"I felt drugged, and when I stopped taking it after a few weeks, the rebound was horrible. I couldn't sleep at all," she said.
So now, when Goldwater has a long spell of not sleeping well, she pops a Tylenol PM and dozes, and avoids driving long distances.
The key thing, insomniacs agree, is to relax and stop fretting as the wee hours tick by. They also agree this is usually impossible.
"I am getting really tired -- pardon the pun -- of ... reviewing all my life events and how I could have: (a) avoided them altogether or (b) congratulating myself on how brilliant I was," said Corinne Edmonson, 67, of Oakland, Calif.
Edmonson had relentless insomnia even when she was on hormones. Since she quit the therapy, it has gotten worse.
Edmonson, who used to manage a large HMO outpatient clinic, occasionally was so fatigued that she would put her head on her desk and take a power nap.
Since retiring last year, she rarely naps. She'd rather be traveling, running her small bed-and-breakfast, volunteering at a tourism booth, going to the gym or playing with her grandchildren.
"Now, the insomnia is not such a catastrophe," she said. "I just turn on the light and read. I'm reducing the tower of books I've always wanted to read."