Doctor, I can’t sleep

Doctor, I can’t sleep

Date: 5 Nov 2017

Written by: Dr David Woodhouse

I just can’t get a good night’s sleep. I stay up as late as I can so that I’m sleepy but when I get into bed I just lie there, tossing and turning for what seems like hours getting hotter all the time. Finally, I drift off to wake up with my legs twitching and my partner nudging me because I’m snoring. I get up because my bladder is bursting.

Start again with less bedclothes to reduce the heat. I stare at the ceiling in the dark with a thousand things going through my mind. I seem to drift off but the twitching, nudging and sweating are repeated. Over and over till finally I sleep. But it’s 5.30am and the garbage truck has started clanking its way down the street. Alright, I’m awake. I give up and get up. It’s going to be a lousy day.

Sound familiar?

Poor sleep is the second commonest symptom of the perimenopause and menopause just behind hot flushes and the above scenario is being repeated nightly all over Australia and the rest of the world when the sun disappears. There is nothing new in this. Chasing sleep with the aid of sleeping potions and various concoctions have been long recorded in history and in the modern era a couple of hours of artificially induced slumber are available at the flick of a prescription pad, occasionally at the cost of some pretty horrible side effects.

During the long menopausal process (which usually starts in your early to mid-forties) egg production (ovulation) becomes irregular. The hormone progesterone is produced only when you ovulate so progesterone levels progressively fall causing symptoms such as over-heating, irritability, mood swings, poor concentration and forgetfulness. But the low levels also can cause problems with your sleep cycle resulting in problems falling asleep or frequent waking during the night. Normally, progesterone crosses into the brain and acts on receptors in the brain slowing it to normal speed. No progesterone means a brain which in simplest terms is overactive. Hence the irritability, anxiety and inability to concentrate for long enough to set down short term memory…. someone tells you something and five minutes later it’s gone.

The “irritable” brain also has trouble entering into and staying in the normal sleep cycle. Result -you just can’t get a good night’s sleep and you feel awful. In these situations, the problem can be solved or alleviated by replacing the missing progesterone. But it has to be pure progesterone, that is a bioidentical. The artificial progestins just don’t have that effect on the brain. Progesterone is a beautiful hormone with only one side effect – it makes you sleepy. This is the reason why we advise you only take it about 30-60 minutes before retiring to sleep. This is important to remember if you are a shift worker. Don’t take it and then go to work. Your sleep is important to you for normal functioning and important to us as part of the overall management of your menopausal process. Make sure you talk it over with us and have a good night’s sleep.