Insomnia

Insomnia

Finding Your Way
to Dreamland

You toss. You turn. You roll over on your stomach, twist around to your back, slide a half-turn onto your side.

Nothing feels right. Nothing feels relaxed. The sheets are too wrinkled, the blanket's too rumpled, the pillow's too soft, and your body's so wired that you just know you're never going to get to sleep tonight.

You're in the grips of insomnia, a problem that haunts women twice as often as it does men. It may keep us awake for a night or two as we struggle with temporary problems at work or at home. Or it may hang around for several weeks as we work our way through a family crisis or begin a corporate transition. In severe cases, it may be a constant companion due to some ongoing problem such as depression or arthritis. At some point in her life, experts say, virtually every woman will experience some degree of insomnia.

But insomnia isn't just a hard time getting to sleep at night. It can also get you up much too early in the morning. And either way, the result is a woman too exhausted to cope with the demands of life.

The Cycle of Sleeplessness

Doctors know that the quality of your slumber--how long you sleep, and how deeply--varies at different points in your menstrual cycle. For some women, insomnia is a regular, recurring problem once a month, just before they menstruate. Insomnia is also the number one complaint of women who experience premenstrual syndrome, doctors say, and a major nuisance for postmenopausal women--although hormone replacement therapy can make it go away.

Because estrogen influences the production of brain chemicals that keep you alert and progesterone makes you sleepy, doctors believe that hormonal fluctuations can cause a transient insomnia, which comes and goes with the ebb and flow of your hormones, says Suzanne Trupin, M.D., head of the Department of Obstetrics and Gynecology at the University of Illinois College of Medicine at Urbana-Champaign and an expert on the effects that hormones have on women's bodies.

But no one's sure of the hows, whens and whys of so-called cyclic insomnia because women have generally been excluded from sleep studies. One reason? Because sleep researchers were worried that women's hormones would distort the studies, says Mary Klink, M.D., medical director of the Sleep Disorders Program at Meriter Hospital in Madison, Wisconsin.

A Plan to Get Some Z-Z-Zs

Because there's little hard data on women and insomnia, doctors had to combine information from the few available studies that included women with their own observations to help their sleepless patients. Here are strategies Dr. Trupin has developed to give women who have hormone-related insomnia a good night's sleep.

Keep a sleep diary. The first step is to see what is causing your insomnia, says Dr. Trupin. Keep a notebook beside your bed and jot down what time you went to bed, the number of times you awakened during the night, the number of times you got up, the first and last day of your period, any menstrual symptoms or difficulties, whether you were sleepy the next day and whether you experienced any particularly stressful events.

Keep the diary for three months, then go back over it and try to detect any patterns, says Dr. Trupin.

If you find that you have insomnia on the same day of your menstrual cycle every month, you can be fairly certain that it's caused by fluctuating hormones, says Dr. Trupin. And although you can't usually keep your hormones from zipping up and down, you can fight insomnia by taking the following measures.

Prepare a mineral nightcap. Your mother was on the right track when she used to suggest that drinking a glass of milk would help you sleep, says Dr. Trupin. She just had the wrong beverage. Although the calcium in milk will help you nod off by slowing nervous system messages, other substances in milk may actually keep you awake.

Instead of a glass of milk, have a glass of water and a couple of Tums or any other 500-milligram tablet form of calcium carbonate, says Dr. Trupin.

Keep the magnesium coming. Magnesium has a calming effect that helps prevent insomnia, says Dr. Trupin: "It tends to smooth out people who are angry and moody." You can get it throughout the day by eating such magnesium-rich foods as soybeans, almonds, black-eyed peas and lima beans. Or, if you don't have a history of kidney problems, you can take a magnesium supplement. The Daily Value for magnesium is 400 milligrams a day, although Dr. Trupin suggests you take 500 milligrams.

Take B₆. Since vitamin B₆ helps the brain release more serotonin, a chemical messenger that has a calming effect upon the body, adding B₆ to your nighttime regimen may help, says Dr. Trupin. But be sure to take it only under your doctor's supervision--too much B₆ can cause nerve damage. "Up to 100 milligrams of B₆ a day is safe for most people; 1 gram is not safe," she says.

Work out. Everyone who suffers from insomnia should exercise, says Dr. Trupin. Women who do not have physically demanding jobs should exercise vigorously sometime during the day or early evening. The minimum amount of exercise to discourage insomnia? Thirty minutes, three times a week.

Altering Your Chemistry

Here are five natural ways to actually alter your hormonal chemistry to help prevent insomnia and encourage sleep.

Check your estrogen levels. As estrogen levels begin to drop somewhere in the midthirties or forties, insomnia can become a problem, says Dr. Trupin.

If you're in that age range and your sleep diary hasn't revealed other possible causes of insomnia, have your doctor check your follicle-stimulating hormone (FSH) levels. They're one of the first indicators to change as your body prepares itself for menopause.

Eat phytoestrogens. If FSH levels indicate you're premenopausal, then think about adding fruits and vegetables rich in estrogen--called phytoestrogens--to your diet, says Dr. Trupin. Besides curbing your insomnia, these foods--apples, carrots, cherries, green beans, oats, peas, potatoes, soybeans and sprouts--can actually increase your estrogen levels enough to prevent insomnia.

Manage stress. Although most women are aware that everyday stress can cause insomnia, many don't realize that it does so by causing the release of various chemicals in the body that stimulate alertness, says Dr. Trupin.

Stress-management techniques may be effective for chronic insomnia (for stress-management tips, see page 000).

Try a natural relaxer. Women who breastfeed after pregnancy actually modify their hormonal mix to encourage sleepiness, Dr. Trupin says. The effect only lasts until your child graduates to a cup, of course, but it does help alleviate the insomnia that occasionally plagues new mothers.

Treat underlying disease. Various diseases that affect the body's endocrine system--heart disease, depression or diabetes, for example--can also trigger production of "fight or flight" chemicals in the body, says Dr. Trupin. The only way to prevent insomnia is to treat the disease.

How to Chase Insomnia Away

Although many of us may experience cyclic insomnia, there's hardly a woman alive who hasn't had difficulty sleeping at one time or another. Here are three simple strategies to prevent it from happening to you.

Create a comfortable environment. Make your bedroom quiet, cool and dark. Do not use the bedroom for anything but dressing, sleep or sex, suggests Dr. Trupin.

Schedule your sleep. Keep yourself on a sleep schedule. Go to bed at the same time every night, wake up at the same time every morning, and do not take naps, recommends Dr. Trupin.

Let there be light. "Sleep onset time is highly related to light," says Dr. Klink.

The pineal gland produces a hormone called melatonin, which regulates sleep. When melatonin levels go up as it gets dark outside, you get sleepy. When melatonin levels go down as the day dawns, you become more alert.

So how can light prevent insomnia? "If you have trouble falling asleep at night, exposing yourself to light for an hour or so immediately following wake-up time in the morning may reset your biological rhythms," says Dr. Klink. "It may allow you to shift the beginning of your sleep time to earlier in the evening."

These lights are not the ones you have sitting in the living room, however, says Dr. Klink. They're called full-spectrum, high-intensity lights. The special high-intensity bulbs fit into any normal light sockets, and you can get them at most health food stores.

They may be particularly helpful in preventing insomnia among the 22 percent of employed women who work shifts, adds Dr. Klink. Several studies show that exposure to high-intensity lights, which mimic daylight, can shift women's biological rhythms and synchronize them with a work schedule within several days, she says. As a result, people who have to be up late at night, like shift workers, will be less likely to experience insomnia--and to escape the impaired judgment, slowed reflexes and all-around grouchiness that frequently result from it.

The Medical Option

While drugs are never the answer on a long-term basis, they may have a place in treating insomnia in the short term, doctors say. Here's the way doctors suggest you use them.

Avoid over-the-counter sleeping pills. Although OTC medications may help some people who have insomnia, the risks generally outweigh the benefits, according to a joint study by Tufts University School of Medicine in Boston and the University of New Mexico School of Medicine in Albuquerque. One problem is that the sleeping pills may cause daytime grogginess. And some people who take sleeping pills may experience forgetfulness the next day.

Stay away from sleep disrupters. Don't drink caffeine within six hours or alcohol within two hours of bedtime, says Dr. Trupin. Caffeine stimulates alertness chemicals in the brain, and although alcohol might initially make you drowsy, your sleep will be so light that the slightest noise will probably disrupt it.