For women with insomnia, being awake when the rest
of the world is asleep is pure misery and frustration. Sleep is part of your basic
biological rhythm — a process that will naturally reset itself when you address
any underlying physical and psychological issues that need attention.
Chronic insomnia also has its own set of unpleasant physical symptoms and is a genuine
concern for many women. Sleeplessness has serious effects on your health because
- disturbs metabolism
- disrupts cognitive and neurotransmitter function
- undermines immunity
- imbalances adrenal function
- upsets overall hormonal balance
Conventional practitioners often turn to sleep medications, like Ambien, to treat
insomnia. But a better first step is to look for clues that can uncover the
root source of your insomnia. Then you can restore healthy sleeping patterns
naturally and permanently.
Your natural sleep-wake cycle — the circadian rhythm
Your circadian rhythm is a 24-hour cycle linked to the rising and setting of the
sun. Deep in your brain, a tiny, powerful cluster of nerve cells called the suprachiasmatic
nucleus (SCN) works 24/7 as an internal clock. It programs key activities like cell
regeneration, detoxification, brain activity patterns, and production of hormones
that regulate during the sleep-wake cycle.
When it gets dark, your SCN begins to lower body temperature and sends signals to
release melatonin, the hormone that makes you sleepy. But at night, exposure to
light— both natural and artificial — counters that natural slow-down process by
raising body temperature, tamping down melatonin and releasing “wake-up” hormones
like cortisol. Your internal pathways are so sensitive to light and darkness that
it’s easy for them to be thrown off. Even switching on the light for a few seconds
can shift your circadian cycle by more than 40 minutes.
Fortunately, your circadian rhythm can reset itself — but only up to a point. When
you have a newborn baby, work the night shift, or travel across time zones, your
inner clock will be able to adjust to the change temporarily. While this allows
you to function, it is not a long-term solution (think jet lag).
For most sleepless women, ongoing physiological and/or lifestyle imbalances are
responsible for upsetting their inner clocks, including:
- hormonal imbalance
- certain dietary changes
- daily lifestyle habits
Circadian disturbance results in daytime
fatigue and nighttime insomnia, often establishing an ongoing cycle that
becomes hard to correct if not addressed quickly.
Do sleeping pills work?
The use of sleeping pills in America has more than doubled since 2000, and there
are plenty of side effects to go along with the increase. People using Ambien have
been found sleep-walking, bingeing on food, and even driving during the night with
no memory of it the next morning.
Sleep aids are meant to treat temporary — not chronic — conditions. Most pharmacologic
sleep aids, or hypnotics, are habit-forming. Sleeping pills may worsen
chronic insomnia by further disturbing your natural sleep mechanisms.
Short-term use can help a chronic insomniac function, but sleeping pills won’t resolve
Instead, recent evidence shows that natural and behavioral approaches, like cognitive behavioral therapy
and relaxation techniques, are more effective at treating long-term insomnia.
What is chronic insomnia and what causes it?
Waking up and staying alert during the night is a lonely and discouraging experience.
But when it happens night after night, it can generate anxiety and a sense of desperation
that can carry over into your daylight hours. Trouble sleeping every night for more
than a few weeks is considered chronic insomnia, which can be broken down into two
types: primary and secondary.
- Primary insomnia is a relatively short-term problem likely brought
on by conditions that interfere with sleep, like worry and stress, uncomfortable
sleep environment, alcohol consumption, smoking or drinking coffee too close to
bedtime. Primary insomnia doesn’t seem to have significant physical or psychological
causes at its root.
- Secondary insomnia is harder to trace because it occurs alongside,
or as a result of, a medical or psychological problem that upsets sleeping patterns.
It can be caused by medications, environmental factors, or physical issues such
as perimenopause, hormonal imbalance, hot flashes, nocturnal leg or foot cramps,
fibromyalgia, chronic pain,
arthritis, breathing problems (sleep apnea, nasal polyps, nasal changes), insulin
resistance, gastrointestinal disorders, mineral deficiencies, and urinary incontinence.
Secondary insomnia can quickly become as bad as the condition that’s causing it.
Finding effective relief is possible when you target both the primary health concern
and the insomnia it’s causing.
How hormonal imbalance is connected to insomnia
Secondary insomnia can be one of the first signs of perimenopause, a time when many
women wake up throughout the night — or are unable to fall asleep at all. Due to
issues with temperature regulation and the fact that we’re getting older, perimenopause
is a time when we typically spend less time in deep sleep. Both factors make you
more sensitive to disturbances — even a minor increase in body temperature can wake
you up. Another interfering factor is nighttime hot flashes, which are also usually
accompanied by an adrenaline response, effectively putting your whole body on alert.
Temperature changes, hot flashes and night sweats can become maddeningly frequent
during perimenopause and menopause, due to shifting hormones. Changing levels of
estrogen may also be influencing both how much of the sleep hormone melatonin you
produce and how your body responds to it. Impaired regulation of two major hormones,
cortisol and/or insulin, are additional causes of nocturnal waking. Stress-related
high cortisol disrupts normal sleep patterns.
The physical effects of insomnia
Feeling exhausted is an obvious consequence of insomnia, but inadequate sleep causes
even worse problems because sleep is a restorative process for your body. When you’re
asleep, your body detoxifies, repairs, builds muscle, and recharges your brain.
During sleep your immune system is finally free to deal with any unfinished work
from the day.
Lack of sleep upsets metabolism — studies link it to both obesity and type 2 diabetes.
Long-term sleep loss can trigger or worsen insulin resistance, disrupt appetite,
increase inflammation, and lead to a rise in the hunger hormone ghrelin and a restriction
of leptin, the “I’m-full,” hormone. In one study, obese people got almost two hours
less sleep than people with average body mass — so even a moderate increase in sleep
may help heal your metabolism.
Chronic stress, poor diet, too much
caffeine, and insulin resistance all cause the adrenal glands to pump out
extra cortisol. High cortisol levels keep us awake and alert, and interfere with
the production of DHEA, an important building block of sex hormones. Inadequate
DHEA contributes to fatigue, reduced muscle mass, bone loss, aching joints, decreased
sex drive, impaired immune function and depression.
Without the right amount of sleep, there is no way you can keep up with life’s demands,
maintain stable moods, or balance your hormones, even if you think you’re doing
okay on a few hours of sleep a night. Your body wants to sleep, and it will when
it gets what it needs.
Find the source of your insomnia
What you do during the day has dramatic effects on your ability to sleep at night.
Keep track of your sleeping conditions, also known as “sleep hygiene,” along with
other factors that may be contributing to your insomnia:
- Foods you eat and when you eat them
- Caffeine, nicotine and alcohol consumption
- Medications, vitamins, minerals and supplements, and when you take them
- Stress and anxiety levels
- Exercise routines
- Menstrual cycle patterns
- Bedtime schedule
- Sleep environment, including temperature, light, noise, bed and bedding
Simply observing your behaviors and writing them down can reveal patterns that will
help you find out exactly what’s keeping you awake.
Get back to sleep — the Women's Health Network approach
At Women's Health Network, we believe you can resolve your insomnia naturally by
creating the conditions for better sleep. Here’s what we recommend:
- Tell your body it’s time to sleep at night. Establish a bedtime
routine to send an internal message to your body and mind that it’s time to let
go of the day and prepare for sleep. Experiment with some of these time-tested options:
a relaxing bath before bedtime, meditation, reading, tidying up your bedroom, a
cup of chamomile tea, aromatherapy (try lavender), and gentle stretching exercises
- Inventory your sleep hygiene. Set a firm bedtime, allotting an
hour to wind down before you even try to go to sleep. Dim the lights, turn off the
TV, cell phone and computer, and make your bedroom as comfortable as possible. Choose
calming colors and keep the room completely dark when it’s time to sleep, or wear
a sleep mask. Block out any outside noise with earplugs. Keep your bedroom temperature
on the cool side to help you stay asleep — 60-68 degrees is a good range. Key steps:
eat your last meal at least four hours before bed, avoid caffeine after noon, and
don’t have sugar, coffee, cigarettes and alcohol near bedtime.
- Engage in physical activity during the day. Exercise helps relax
your body and prepare it for sleep but don’t do it close to bedtime.
- Empty your brain of disturbing thoughts. Jot down your current
concerns on paper in the evening to help prevent anxious ruminations and circular
thinking if you wake during the night.
- Take a natural
sleep aid. Try melatonin or a supplement with phosphatidylserine and/or
L-theanine 45 minutes before bedtime. Many readers have success with our
Sleep Reset Program that includes tips to help with your sleep hygiene.
- Eat right for sleep. Focus on eating a balanced diet of whole foods,
and make sure you take a high-quality multivitamin/mineral supplement daily to help
ensure adequate amounts of magnesium, calcium, folate and iron. These can help with
leg cramps and more.
- Balance your hormones. Gently rebalance hormone levels, especially
estrogen and progesterone, with
herbal support. This can calm your nerves and help relieve other symptoms
that might be interfering with your sleep. If your symptoms are so intense that
they’re affecting your quality of life, see a healthcare practitioner.
Press the “pause” button — it’s time to rest
Insomnia is a highly treatable condition that doesn’t usually require sleeping pills.
Quieting the conversation between your body and your mind and relieving hormonal
fluctuations can improve your sleep patterns. Give us a call if you need more help.
We’re always ready to listen.
For more information on herbal sleep treatments, read our article
Nature’s sleeping aids.
1 Wikipedia. 2009. Circadian rhythm. URL: http://en.wikipedia.org/wiki/Circadian_rhythm
2 Cromie, W. 1999. Human biological clock set back an hour. Harvard University
Gazette. URL: http://www.news.harvard.edu/gazette/1999/07.15/bioclock24.html
3 Morin, C., et al. 2009. The natural history of insomnia: A population–based
3-year longitudinal study. Arch. Int. Med., 169 (5), 447–453. URL (abstract):
http://www.ncbi.nlm.nih.gov/pubmed/19273774 (accessed 05.15.2009).
4 Ancoli–Israel, S. 2006. The impact and prevalence of chronic insomnia
and other sleep disturbances associated with chronic illness. Am. J. Managed Care,
12 (8), S221–S229. URL: http://www.ajmc.com/supplement/managed-care/2006/2006-05-vol12-n8Suppl/May06-2308pS221-S229
5 Mayo Clinic. 2006. Insomnia: Causes. URL: http://www.mayoclinic.com/health/insomnia/DS00187/DSECTION=3
6 Cagnacci, A., et al. 2000. Different circulatory response to melatonin
in postmenopausal women without and with hormone replacement therapy. J. Pineal
Res., 29 (3), 152–158. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/11034112
Okatani, Y., et al. 2000. Changes in nocturnal melatonin secretion in
perimenopausal women: Correlation with endogenous estrogen concentrations. J. Pineal
Res., 28 (2), 111–188. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/10709973
7 Datta, S., & MacLean, R. 2007. Neurobiological mechanisms for the
regulation of mammalian sleep–wake behavior: Reinterpretation of historical evidence
and inclusion of contemporary cellular and molecular evidence. Neurosci. Biobehav.
Ref., 31 (5), 775–824. URL: http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17445891
8 Spiegel, K., et al. 2005. Sleep loss: A novel risk factor for insulin
resistance and Type 2 diabetes. J. Appl. Physiol., 99 (5), 2008-2019. URL:
http://jap.physiology.org/cgi/content/full/99/5/2008 (accessed 05.15.2009).
Vorona, R., et al. 2005. Overweight and obese patients in a primary
care population report less sleep than patients with a normal body mass index. Arch.
Intern. Med., 165 (1), 25–30. URL: http://archinte.ama-assn.org/cgi/content/full/165/1/25
References regarding use of sleep aids
a Saul, S. 2006. Record sales of sleeping pills are causing worries.
New York Times. URL: http://www.nytimes.com/2006/02/07/business/07sleep.html
b Szabo, L. 2006. Insomnia drugs: A wake-up call? USA Today.
URL: http://www.usatoday.com/news/health/2006-04-23-insomnia-drugs_x.htm (accessed
c Morgenthaler, T., et al. 2006. Practice parameters for the psychological
and behavioral treatment of insomnia: An update. An American Academy of Sleep Medicine
report. Sleep, 29 (11), 1415–1419. URL (abstract): http://www.ncbi.nlm.nih.gov/pubmed/17162987
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