THE CORRELATION BETWEEN INSOMNIA AND MENOPAUSE

AZMAN HAKIM BIN HASSANUDDIN 030.08.270 UNIVERSITAS TRISAKTI TAHUN 2011 ENGLISH III

TRISAKTI UNIVERSITY FACULTY OF MEDICINE

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

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

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

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.

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.

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.

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.

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

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

She has lost the capacity to reproduce by menopause and insomnia only aggravates her reduced feelings.

Her hormone levels, health problems, her lifestyle and all the stress that she goes through are responsible 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 Natural anti-depressant & calms anxiety Prevents cyclical migraines Promotes normal sleep patterns Facilitates thyroid hormone function Helps normalize blood sugar levels Helps restores normal libido Normalizes zinc and copper levels

Increased risk of breast cancer Restrains bone loss Reduces vascular tone (dilates blood vessels) Triggers autoimmune diseases Creates progesterone receptors Relieves hot flashes Prevents vaginal dryness & mucosal atrophy Increases risk of gall bladder disease Improves sleep disorders Improves health of urinary tract Relieves night sweats

Restores proper cell oxygen levels 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) deficiency symptoms include insomnia. Calcium is a natural sedative that releases the sleep-inducing amino acid cause severe calcium

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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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 / Depression One 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 Cramping Leg 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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Menopause fatigue is not just a result of lack of estrogen or progesterone but is a result of many factors linked to menopausal symptoms. Symptoms like night sweats and insomnia take a toll on body and result in a sometimes chronic lack of sleep. This then translates itself into fatigue during the day. Once menopausal women start feeling fatigued, this increases stress and anxiety levels which in turn help to cause insomnia which leads to fatigue. Menopause and insomnia thus go hand in hand in giving the woman a difficult time.There are some ways that woman can ease out her insomnia problems during menopause:

When the woman crosses forty years of age, she can start using black cohosh, flaxseed oil, antidepressants and breathing exercises to relieve her of her sleep disturbances.

Sometimes the woman goes for hormone replacement therapy also. Sometimes it is seen that the insomnia is due to reduced levels of estrogen.At such times, the woman cold go for a replacement of the estrogen hormones thus solving her problems.

These days everyone is going for natural treatment.Many natural treatments aid in the cure of insomnia. A good balanced diet, lot of rest and relaxation contributes to altering the sleep pattern and give the woman a good sleep.

It has been observed that foods rich in typtophan are good for curing the problem of insomnia.

The woman has to learn to be relaxed. Unnecessary worry about the problem is not going to help. A healthy lifestyles with minimal worry is the ideal solution.

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Exercise is a way that oxygen is pumped into the body.The more the oxygen level in the 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.

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

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

y y y y y

It is also a good idea to not drink alcohol before going to bed. Not watching television in bed ensures that you dont lose sleep. The temperature can be kept five degrees cooler than the normal. It is advisable to abstain from exercising five hours before bedtime. 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 sleepinducing 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 In Postmenopausal Women, SLEEP, December, 2007. Associated Professional Sleep Societies, LLC, 21 Jan. 2008. (pg 8) 2. S.K. Kabra, Rakesh Lodha ,V. Seth. Vasomotor Symptoms and Cardiovascular Events in Postmenopausal Women. The North American Menopause Society; 2011;18 (pg 10) 3. Ashok Rattan,Awdhesh Kalia,Nishat Ahmad. MenopauseWhat's It all about?. J Midwifery Womens Health;2010;55 (pg. 10-13) 4. Kathleen J.W.Wilson.Anatomy and physiology.Gonadal Hormones.Edinburgh;Churchill;2000. (pg. 6-7) 5. Lauralee Sherwood.Human Physiology:from cells to systems.Reproduction Systems.Virginia;Betricia I;2001. (pg. 6-7) 6. Northrup, Christiane. The Wisdom of Menopause: Creating Physical and Emotional Health 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 for Women 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, effects and evidence-based treatment options. J Reprod Med 50:155, 2005

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