1. Think about short-term HRT.
Surprised? Hormone replacement therapy (HRT) has largely fallen out of favor among women and their doctors, and for good reason. Long-term research studies have found it can increase your risk of blood clots, breast cancer, and gallbladder disease.
Still, the fact is that perimenopausal women who use HRT sleep better. Whether it’s because it reduces hot flashes or has some other effect isn’t known.
How do you weigh the risks and benefits? “The risks and benefits of any treatment need to be individualized to your particular body—not just what the research says or professional scientific associations prescribe,” says Dr. Becky Wang-Cheng, a medical director at Kettering Medical Center and author of Menopause.
If breast cancer runs in your family but hot flashes are preventing you from getting enough sleep to do your job, a super-low dose of hormones might be helpful despite the research. And we’re not talking about long-term or daily use. “Sometimes just one pill a week is enough to keep symptoms in check,” says Wang-Cheng.
Dr. JoAnn Manson, the Harvard researcher who pioneered much of the research that uncovered the dangers of HRT and author of Hot Flashes, Hormones and Your Health, agrees that HRT should still be an option for some women.
Most women do not need hormone therapy to get through the hormonal transition into menopause, says Manson. Menopause is natural, and we need to guard against the over-medicalization of our lives. “However, for about one in every five women, menopausal symptoms are severe enough to disrupt sleep and quality of life,” she adds. “Hormone therapy still has an important role to play for such women.”
2. Reinforce your sleep schedule
Like other kinds of insomnia, the sleeplessness of perimenopause can be overcome by sticking to the cycles of sleeping and waking that you have previously established with your biological clock. This helps your body override some of the conflicting messages it may be getting from wayward hormones activated by perimenopause.
It’s important that you keep your sleeping and waking schedules pretty steady—no Sunday sleep-ins, for example—if you want to be able to count on good, restorative sleep during this uneasy stage of life. And good, restorative sleep is the best gift you can give yourself at this time.
If you don’t already have a firm sleeping schedule, now is certainly the time to develop one. It isn’t hard to do, and the benefits will serve you for the rest of your life.
3. Consider an alternative treatment.
Women who are reluctant to use estrogen may want to talk with their doctors about the antidepressant Effexor, says Wang-Cheng. It decreases the hot flashes that can disrupt sleep and is even prescribed by doctors for breast cancer patients who are undergoing active therapy.
“It’s not as good as estrogen,” adds the physician, “but it reduces hot flashes by 40 to 60 percent and will make you drowsy.”
4. Work with a therapist.
Eight or 10 weeks with a certified cognitive behavioral therapist will frequently give you a handful of sleep strategies custom-tailored to your particular issues during this life stage. If you’re regularly waking up in the middle of the night and can’t get back to sleep, however, you might find it more helpful to contact a psychiatrist to talk over old struggles that may be troubling you.
5. Take a sleep break.
After those nights when your reproductive hormones and the hormones that control your sleep/wake cycle really can’t work together, try to get back some of the sleep you’ve lost by 4:00 p.m. Not all of it—that’s not practical for most of us. Just take the edge off your drowsiness and you’ll be surprised at how effectively your brain cells will start firing again. If you drive to work, go out to the car at lunch, put down the backseat, and snooze for 10 minutes. Or just put your head down on your desk for 5.
6. Wick away the problem.
If hot flushes are your particular sleep disrupter, buy long johns, or gym shorts and T-shirts made from fabrics that athletes use to wick away moisture. Then wear them as pj’s. They won’t stop a hot flash, but they’ll keep it from turning into a majorly disruptive night sweat in which you have to get up and change clothes.
7. Chill in bed.
Chillow is a pillow with a cooling water insert that lowers your body temperature. It won’t stop hot flashes, but it can reduce their intensity and their ability to disrupt your sleep.
8. Drop your temp.
Lower the temperature of your bedroom before you climb into bed, says Wang-Cheng. Lower temperatures signal your body that it’s time to sleep, and they make hot flashes less disruptive. If your bed partner objects, just tell him to bundle up.
A hot bath also helps you lower your body’s temperature. Yeah, your temperature goes up while you’re in the bath, but your body’s response to the heat will be to drop your temperature.
As long as perimenopausal dryness hasn’t resulted in painful intercourse, enjoy a quickie, suggests Wang-Cheng. Some 44 percent of perimenopausal women say they don’t have time for sex. But the Big O is still one of the most sleep-inducing agents around. Just don’t forget to protect yourself against an unanticipated side effect that could appear nine months later. Now that would really trash your sleep!
9. Tone it down.
Toning down a jumpy sympathetic nervous system will encourage a balanced sleep/wake cycle in perimenopausal women. Think about tai chi, meditation, prayer, biofeedback, yoga—any activity that allows you to cultivate a peaceful center and a sense of balance.
10. Talk to a sleep doc.
If you suspect you have a sleep disorder involving breathing difficulties, restless legs or narcolepsy, ask your primary-care physician for a referral to a sleep center for testing, diagnosis, and treatment.
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