Correlation Between Menopause &Insomnia

8/3/2019 Correlation Between Menopause &Insomnia

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THE CORRELATION BETWEEN INSOMNIA AND MENOPAUSE

AZMAN HAKIM BIN HASSANUDDIN

030.08.270

UNIVERSITAS TRISAKTI

TAHUN 2011

ENGLISH III

TRISAKTI UNIVERSITY

FACULTY OF MEDICINE


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PREFACE

Assalamualaikum Wr Wb

I would like to take this chance, first of all, to thank God for all the blessing throughout

this work and generally my entire life, for the richness and all the opportunity for me to learn and

to become a better person. This paper would not be materialized if it was not for the endless

support from my family and friend, and from the lecturers whom I mostly respect for all the

teachings and knowledge I acquired.

This paper entitled The correlation between insomnia and menopause which I have

chosen for completing my coursework assignment in English III, Faculty of Medicine, Trisakti

University.

I also would love to apologize if there is mistakes and wrongs in this paper, whether

technically or human error, or in elaborating or in choosing my sources as well. Thank you again

to evaluating lecturer and people who have helped me tremendously in the process of completing

this paper, and for you interest which I greatly appreciate.

Wassalamualaikum Wr Wb

Jakarta,January 2012


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CONTENTS

Preface ............................................................................................................................... 2

Contents ............................................................................................................................. 3

Abstract .............................................................................................................................. 4

Chapter I: Introduction ........................................................................................................ 5

Chapter II: Menopause & Insomnia..................................................................................... 6

Chapter III: Findings............................................................................................................ 8

Chapter IV: Discussion........................................................................................................ 14

Chapter V: Conclusion......................................................................................................... 16

Chapter VI: References........................................................................................................ 17


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ABSTRACT

Often Insomnia may be due to menopause. Unfortunately a main symptom of menopause

is insomnia. The important dilemma are the triggers of insomnia and relationship between

insomnia and menopause. Quite a lot of women find they practically never used to have

problems getting to sleep until they reached menopause. Menopause itself is simply the name

given to the cessation of a female's reproductive process and occurs naturally when females

attain middle age. It can have devastating effects on a woman's hormones which are inclined to

fluctuate wildly, which leads to many of the unpleasant symptoms, among them sleep issues.

Symptoms of menopausal insomnia include difficulty falling asleep, frequent waking and waking

up too early and being unable to get back to sleep. The anxiety and worry connected with

menopause may sometimes appear without good reason. Both stress and anxiety can be helped

by exercising daily, especially in the morning which is when we set up our circadian rhythms to

promote restful sleep that night.In dealing with insomnia during menopause , the symptoms

generally can be reduced by improving sleeping patterns by using homeopathic remedies for

menopause, or natural herbal remedies. Besides, the good nutrition and exercise with trying to

keep stress to a minimum can come out with a good result. If insomnia is still lasting after trying

everything suggested , then the sleep aid may be a last resort.

Keyword: Insomnia, Menopause


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CHAPTER I

INTRODUCTION

Insomnia is a common complaint during peri/menopause. This insomnia often takes the

form of an inability to sleep through the night. Women often wake up in the wee hours of the

morning and have great difficulty getting back to sleep. Sometimes these awakenings

immediately precede a night sweat or at least a warm period where one wants to throw off the

covers. Some times a woman will wake up with heart pounding and in an anxiety state for no

apparent reason. Very vivid dreams may wake up other women. Other times there doesn't seem

to be any reason at all why one awakes at two and three and four a.m. unable to fall back to sleep

for 20 or 40 minutes or even longer. It is possible that these awakenings are due to the body's

inability to maintain a consistent temperature due to hormone fluctuations. Even if a hot flush

isn't apparent to the woman, it may be that the body temperature has risen to the point where

continued sleep is impossible. It will then take a period of time before body temperature falls

again making getting back to sleep difficult.


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CHAPTER II

Menopause

Menopause is defined as the state of an absence of menstrual periods or the time in a

woman's life when the function of the ovaries ceases. The ovary (female gonad), is one of a

pair of reproductive glands in women . The menopausal transition starts with

varying menstrual cycle length and ends with the final menstrual period. Perimenopause

means "the time around menopause" and is often used to refer to the menopausal transitional

period. It is not officially a medical term, but is sometimes used to explain certain aspects of

the menopause transition in lay terms. Postmenopause is the entire period of time that comes

after the last menstrual period. The process of menopause does not occur overnight, but rather

is a gradual process. This so-called perimenopausal transition period is a different experience

for each woman. The average age of menopause onset is 51 years old, but menopause may

occur as early as the 30s or as late as the 60s There is no reliable lab test to predict when a

woman will experience menopause. The age at which a woman starts having menstrual

periods is not related to the age of menopause onset. Symptoms of menopause can include

abnormal vaginal bleeding, hot flashes, vaginal and urinary symptoms, and mood changes.

Complications that women may develop in the postmenopausal period include osteoporosis

and heart disease.


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Insomnia

Insomnia, from the Latin "in"(not) and "somnus" (sleep), is a condition characterized by

difficulty falling asleep and remaining asleep. It includes a broad spectrum of sleep disorders,

from lack of quantity of sleep to lack of quality of sleep. Insomnia is often separated into three

types. Transient insomnia occurs when symptoms last from a few days to a few weeks. Acute or

short-term insomnia is when symptoms last for several weeks. Chronic insomnia is characterized

by insomnia that lasts for months and years. There are two types of insomnia: secondary and

primary. Secondary insomnia is the most common type. Secondary means that the insomnia is a

symptom or a side-effect of some other problem. Primary insomnia is not a side-effect of another

problem, and it generally persists for 1 month or longer.

Insomnia that lasts for more than 1 month and is present at least 3 nights a week is called

chronic insomnia. Insomnia that lasts for less than 1 month is called short-term or acute

insomnia. Chronic insomnia is a serious problem that can affect mood, safety, and performance

at work or school. If insomnia continues for a few weeks, see the doctor. Secondary insomnia

often goes away or improves without treatment if the cause can be eliminated. Lifestyle changes,

cognitive-behavioral therapy, and sleep medicines can be used to treat insomnia.


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CHAPTER III

FINDINGS

Insomnia was defined as occurring three times a week or more in the previous month.

Studies reveal that an estimated 15 to 17 % of women undergoing menopause also suffer from

insomnia. Rates of insomnia were higher in women, seen in 19% vs 12% of men. Other groups

with a high risk for insomnia were those who are obese (18%), those living under the poverty

level (23%), and those who are abusing alcohol (18%), smoking cigarettes (22%), meopausal

(30%). Divorced respondents also had a higher rate of insomnia, at 20%, than those who are

married (14%) or single (15%).Subjects were categorized into three groups, premenopause,

perimenopause, and postmenopause. In Indonesia, the estimated number of people that are

suffering of menopause insomnia is 28 million,out of 238 millions of Indonesia citizens.The

overall prevalence of insomnia in older age Indonesian women was 11.7 %. The most common

symptom of insomnia was difficulty maintaining sleep (9.7%), followed by difficulty initiating

sleep (7.9%), and early morning awakening (7.5%).. The major finding is that insomnia is

significantly associated with the menopausal transition.

Hormones are chemicals that are released by a cell or a gland in the body.This sends out

messages that affect the cells in the other parts. Thus hormones are chemical messengers that

transmit a signal from one cell to another cell. The hormones have a characterestic of fluctuation.

y They fluctuate in a womans body during menopause.These body flushes, hot sweatsproduced by hormonal fluctuations cause a relation between menopause and insomnia.


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y A woman has a lot of mood swings and behavioural changes because of menopause andhormonal changes.

y She has lost the capacity to reproduce by menopause and insomnia only aggravates herreduced feelings.

y Her hormone levels, health problems, her lifestyle and all the stress that she goes through areresponsible for her sleep.

Thus insomnia is related to the menopausal symptoms and is affected by its

manifestation.

PHYSIOLOGICAL EFFECTS OF ESTROGEN AND PROGESTERONE

Estrogen Effects

Creates proliferative endometrium

Increased body fat and weight gain

Salt and fluid retention

Cyclical migraines

Interferes with thyroid hormone function

Impairs blood sugar control

Increased risk of blood clots

Little or no libido effect

Loss of zinc and retention of copper

Causes endometrial cancer

Progesterone Effects

Maintains secretory endometrium

Helps use fat for energy

Natural diuretic

Naturalanti-depressant & calmsanxiety

Prevents cyclical migraines

Promotesnormalsleeppatterns

Facilitates thyroid hormone function

Helps normalize blood sugar levels

Helps restores normal libido

Normalizes zinc and copper levels


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Increased risk of breast cancer

Restrains bone loss

Reduces vasculartone (dilates blood vessels)

Triggers autoimmune diseases

Createsprogesterone receptors

Relieves hot flashes

Prevents vaginal dryness & mucosal atrophy

Increases risk of gall bladder disease

Improvessleepdisorders

Improves health of urinary tract

Relievesnightsweats

Restoresproper celloxygenlevels

Prevents endometrial cancer

Helps prevent breast cancer1

Decreased risk of prostate cancer

Stimulates new bone formation

Prevents autoimmune diseases

Increases sensitivity of estrogen receptors

Necessary for survival of embryo

Precursor of corticosteroid biosynthesis

Sleepiness,depression

Digestive problems

CAUSES OF MENOPAUSE INSOMNIA

y The lack of ovarian hormones (estrogen and progesterone) cause severe calciumdeficiency symptoms include insomnia.

Calcium is a natural sedative that releases the sleep-inducing amino acid

tryptophan. Calcium is directly related to our cycles of sleep as researchers found that

calcium levels in the body are higher during some of the deepest levels of sleep, such as

the rapid eye movement (REM) phase and the disturbances in sleep, especially the

absence of deep REM sleep or disturbed REM sleep, are related to a calcium deficiency.

Restoration to the normal course of sleep was achieved following the normalization of

the blood calcium level.


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y Night Time Hot Flashes (Night Sweats)Hot flashes are a known side effect of menopause, and may also explain being

continually woken during the night. These can increase body temperature, making

women with menopause feel hot and causing them to throw off bedclothes because the

night sweats

y Stress / DepressionOne part of menopause is focus problems . Stress can cause to have trouble with

focus. At night, that can manifest itself when the women lay in bed.In fact it is a

stressful time for a woman, thus keeping them awake as they find it hard to relax and

simply switch off. The anxiety and worry connected with menopause may sometimes

appear without good reason. They might find themselves thinking about so many things

at once that it's absolutely impossible to rest or sleep especially at night. Depression may

also rear it's ugly head and is a prime cause of early waking.

y Leg CrampingLeg cramping can also become so severe during perimenopause that the woman

awakens and has difficulty going back to sleep. Something else that may be going on

during this time is the fact that a woman's circulatory system may be slowing down

during menopause as well. If the blood is not circulating properly, extremities including

legs, will not be getting enough of the vital oxygen and nutrients that are typically carried

by the blood to them .

y Fatigue


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y Exercise is a way that oxygen is pumped into the body.The more the oxygen level inthe brain,the more active it is and the less chances of developing insomnia. A good

mind, a good body and a good life are factors that can keep the relation between

menopause and insomnia at bay.

y There are certain kinds of tea that help to cure insomina.Teas like peppermint andchamomile are good for soothing the mind and they contain no caffeine.

y Increasing the level of melatonin, the sleep inducer is going to go a long way inpermanently solving the problem.

y It is also a good idea to not drink alcohol before going to bed.y Not watching television in bed ensures that you dont lose sleep.y The temperature can be kept five degrees cooler than the normal.y It is advisable to abstain from exercising five hours before bedtime.y Medications(Antidepressants)

Thus menopause and insomnia are in a neverending chain of incidents.They occur

together and are related to each others functions.The best way to combat menopause and

insomnia is to ensure that the mind,body and soul is kept in proper functional condition.


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CHAPTER IV

DISCUSSION

Menopause is the natural culmination of a womans reproductive cycle. Accompanying

the end of egg production is also the decrease in hormones produces by the ovaries, estrogen and

progesterone. It is the decrease in estrogen and progesterone, or rather the ups and down that

mark a gradual decrease in estrogen and progesterone production, that produce the most

noticeable symptoms of menopause. Different women will experience symptoms of menopause

to different degrees. Some women a minority report no symptoms at all. For others, multiple

symptoms of menopause can be experienced at the same time. The vast majority of women will

experience at least one symptom as they transition into menopause. Most symptoms are related

to changes in estrogen and less so, progesterone. Therefore, the sleep problem among women

during peri/menopause is caused by decreasing or instability of two main hormones which are

estrogen and progesterone in the body.

The lack of these hormones will lead to many problems at any part of the body system.

A diminished level of estrogen has a direct effect on the hypothalamus, the part of the brain

responsible for controlling appetite, sleep cycles, sex hormones, and body temperature.The drop

in estrogen confuses the hypothalamus which is sometimes referred to as the body's "thermostat"

and makes it read "too hot." The brain responds to this report by broadcasting an all-out alert to

the heart, blood vessels, and nervous system. The message is transmitted by the nervous system's

chemical messenger, epinephrine, and related compounds: norepinephrine, prostaglandin,

serotonin and is delivered instantly. The heart pumps faster, the blood vessels in the skin dilate

to circulate more blood to radiate off the heat, and sweat glands release sweat to cool off even

more. This produces the red, flushed look to the face and other parts of body.


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Besides, Stress can cause to have trouble with focus where at night, that can manifest

itself when the women lay in bed. Leg cramping can also become so severe during

perimenopause that the woman awakens and has difficulty going back to sleep as woman's

circulatory system may be slowing down during menopause as well. Symptoms like night sweats

and insomnia take a toll on body and result in a sometimes chronic lack of sleep which translates

itself into fatigue during the day.

Calcium act as food for our bones, but its also a natural sedative that releases the sleep-

inducing amino acid tryptophan. Calcium is directly related to our cycles of sleep , less well

absorbed and the urinary losses are greater when the output of estrogen decreases and the urethra

itself has estrogen receptors and without the hormone it can atrophy in the same way as the

vagina .The calcium-deficiency symptoms as nervousness, irritability, sleeplessness, headaches,

and depression are common (at menopause). The greater the total production of estrogen and

progesterone ,the more greater total calcium in the blood as bone formation are stimulated by

the hormone.So, it will cause people become sleepy since there is high calcium level in the brain

blood.


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CHAPTER V

CONCLUSION

Insomnia complaints are common among perimenopausal and postmenopausal women.

Hormonal and physiologic changes; medical, psychiatric, and sleep disorders; and lifestyle

factors contribute to the high prevalence of sleep problems in this population. Underlying

disorders that may contribute to insomnia should be identified and treated. Advances in

behavioral therapies, as well as superior safety and tolerability of the newer hypnotic agents,

have resulted in improvements in the management of "menopausal insomnia." Recognizing and

appropriately treating sleep disorders represent an opportunity not only for improving the quality

of life of women, but also an opportunity to prevent the development of mood and medical

disorders later in life.


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REFERENCES

1. Murphy, P, Altered Sex Hormone Levels, Higher Body Temp Affects Sleep Quality InPostmenopausal Women, SLEEP, December, 2007. Associated Professional Sleep

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2. S.K. Kabra, Rakesh Lodha ,V. Seth. Vasomotor Symptoms and Cardiovascular Events inPostmenopausal Women. The North American Menopause Society; 2011;18 (pg 10)

3. Ashok Rattan,Awdhesh Kalia,Nishat Ahmad. MenopauseWhat's It all about?. JMidwifery Womens Health;2010;55 (pg. 10-13)

4. Kathleen J.W.Wilson.Anatomy and physiology.GonadalHormones.Edinburgh;Churchill;2000. (pg. 6-7)

5. Lauralee Sherwood.Human Physiology:from cells to systems.ReproductionSystems.Virginia;Betricia I;2001. (pg. 6-7)

6. Northrup, Christiane. The Wisdom of Menopause: Creating Physical and EmotionalHealth and Healing During the Change. New York: Bantam Books, 2003. (pg. 8-10)

7. Weed, Susan S. New Menopausal Years. The Wise Womans Way: New Approaches forWomen 30-90. Ashcroft, BC: Ash Tree Press, 2001. (pg. 8-10)

8. Ohayon M. Severe hot flashes are associated with chronic insomnia.Arch Intern Med.2006 June 26;166(12).

9. Bachmann G. Menopausal vasomotor symptoms: a review of causes, effectsand evidence-based treatment options. J Reprod Med 50:155, 2005

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Correlation Between Menopause &Insomnia