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Altered sex hormone levels, higher body temp affects sleep quality in postmenopausal women

December 03, 2007

WESTCHESTER, Ill. - In an examination of potential relationships between objective sleep measures, nocturnal sex hormone levels, and the nocturnal course of body temperature of older postmenopausal women, a study published in the December 1 issue of the journal SLEEP finds that altered levels of both sex hormones and gonadotropins may contribute to sleep disturbance in older postmenopausal women and confirm the results of previous studies indicating that higher body temperature is associated with poorer sleep quality.

The study, authored by Patricia J. Murphy, PhD, of Weill Cornell Medical School in White Plains, NY, focused on 10 women between 57 and 71 years of age, who were at least five years past menopause.

According to the results, lower estradiol (E2) and higher luteinizing hormone (LH) levels were significantly correlated with indices of poor sleep quality, with relationships between LH and quality of sleep being stronger than those for E2.

In addition, significant increases from basal LH levels occurred more frequently after sleep onset than prior to sleep onset, and 30 of 32 of these LH pulses occurred prior to long awakenings from sleep.

Further, higher body temperature prior to and during sleep was significantly correlated with poorer sleep efficiency and higher LH levels.

"Few studies have measured gonadal hormones in women who are more than a couple of years postmenopause, and almost no studies have investigated, beyond menopause, whether endogenous levels of these hormones influence sleep," said Dr. Murphy. "Yet, perimenopausal and postmenopausal women share many of the same features of sleep disturbance, such as awakening in the early morning hours and an inability to return to sleep. Furthermore, several studies have shown that hot flashes and other vasomotor symptoms that influence sleep continue years beyond menopause in up to 40 percent of postmenopausal women. Thus, the sleep difficulties that emerge at menopause often do not abate and may become compounded by age-associated disruption of circadian and homeostatic processes that regulate sleep."

The hormonal and physical changes that occur during and after menopause can affect a woman's sleep. Sleep disturbances are more common, and sleep quality can decline. Insomnia related to menopause often occurs.

Obstructive sleep apnea (OSA) is much more common in postmenopausal women. This increase may be due in part to menopause-related weight gain. But it also appears to be hormone related. Estrogen seems to help protect women against OSA.

Fibromyalgia often develops due to menopause. Eighty percent of people with fibromyalgia are women. It peaks between the ages of 50 and 70 years. Widespread pain related to fibromyalgia can make it hard to sleep well. Restless legs syndrome and sleep related leg cramps are more common as women age. But this increase is not linked directly to menopause.

Experts suggest that most women need about seven to eight hours of sleep each night.

The following tips are provided by the American Academy of Sleep Medicine (AASM) to help women get the most out of their sleep:

* Make your bedroom a comfortable and safe place. Reduce noises and extreme temperatures that might disturb you.
* Use light and comfortable bed linens and garments.
* Go to bed only when you are sleepy and use the bed only for sleeping and sex.
* Begin rituals to help you relax at bedtime, such as taking a soothing bath or enjoying a light snack.
* Go to bed and get up at the same time every day, including weekends and holidays.
* If you need to take a nap, keep it to less than one hour and take it before 3 p.m.
* Only drink caffeine in the morning, and avoid alcohol and cigarettes late in the day.
* Stay away from fatty, spicy foods that are likely to upset your stomach or cause heartburn.
* Set aside time during the day to get all of your worries out of your system.
* Increase vitamin E in your diet, or take a vitamin E supplement.
* Hormone replacement therapy may help you sleep better by relieving severe hot flashes related to menopause. Ask your doctor for advice about this kind of treatment.
* Only use sleeping pills when supervised by a doctor.
* Talk to your doctor or a sleep specialist if you have an ongoing problem related to your sleep.

Those who believe they have a sleep disorder should consult with their primary care physician or a sleep specialist.

American Academy of Sleep Medicine