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January 18, 2002

Table of Contents

T Introduction
T Alternative Approaches

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Topic Centers
  • Alternative Medicine
  • Sleep Disorders
  • Women's Health

  • Library
  • Drug Lookup

  • Articles
  • Menopause and Sex: Good News and Bad
  • Menopause: What Type Is Your 'Change of Life'?
  • Hot (News) Flash: Different Ethnic Group, Different Menopause Symptoms

  • Article Level: Advanced

    Sleep Soundly Through Menopause

    Alternative Approaches
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    Several studies found black cohosh safely reduces night sweats and weariness, with no side effects.
    Acupuncture shows real promise of providing nonhormonal relief from hot flashes and sleep problems. In a recent Yale study, participants had nearly 50% less sleep disturbance. It takes at least two or three treatments to see results, says Susan M. Cohn, a lead investigator. A few HMOs, including Oxford, now cover acupuncture. (The American Academy of Medical Acupuncture, at 800-521-2262, makes referrals.)

    A single, evening dose of nonaddictive melatonin (1 milligram) significantly increased actual sleep time and sleep efficiency in a British study, with no hangover effect. Lavender oil, a proven mild sedative, promotes drowsiness and relaxation. The old folk remedy can even be used in an "herbal pillow."


    Behavioral Changes

    Anything that induces relaxation should encourage sleep. Learning to meditate--best done for 20-40 minutes, in late afternoon--trains people to sleep better. Experts advise using a Worry Book to jot down any concerns that interfere with falling asleep. Whether family issue or work problem, it won't look half as bad in daylight. Try to think of a solution or approach, and reduce your number of anxieties.

    A Cognitive Behavioral Training Program in Canada taught participants to:


    • Leave their bedrooms if not asleep within 20 minutes.
    • Get up at the same time every day.
    • Use their beds only for sleep or sex.

    Naps, only before 3 PM, had to be an hour or less. After only eight sessions, patients reported a 55% reduction in sleep difficulties.

    Choose absorbent cotton sheets and bedclothes and keep the bedroom cool, suggests Joyce Walsleben. "Have an extra T-shirt or nightgown nearby so you don't have to find one if you wake up drenched. Turn your clock around: You'll hear the alarm, but not seeing the time avoids that panic of knowing you're awake at 3 AM. Simply tell yourself to go back to sleep," urges the director of NYU's Sleep Disorders Center.

    Start to quiet down 2-3 hours before bedtime. Take a shower or bath; avoid radio or TV, which may be too stimulating. Stay up until sleepy. At night, try drinking herbal tea or milk--its L-tryptophan helps some people sleep. Avoid caffeine and nicotine, which are stimulants, and alcohol, which makes it hard to stay asleep.

    Prescription Drugs

    Medication provides a sense of control while one learns better rest habits, if all else fails. Pick the night to use a prescription drug, says Walsleben, suggesting short-acting sleeping pills like Sonata (generic name zaleplon) or Ambien (generic name zolpidem tartrate). A sedative and hypnotic, Sonata should not be taken for more than 10 consecutive days. It has no hangover effect.

    Both Megace (generic name megestrol acetate--a synthetic progestogen) and clonidine (brand names Catapres, Duraclon; originally used for high blood pressure) decrease the incidence of hot flashes and may help women stay asleep. Cenestin, a synthetic estrogen that reduces hot flashes, was recently approved by the FDA for short-term use.

    The same chemicals in the brain regulate sleep and mood. A deficiency in serotonin, which brings poor sleep, may also cause depression or hunger. Some new medications, like Prozac (generic name fluoxetine) and Zoloft (generic name Sertraline), increase serotonin levels, which could help with sleep. Take them daily, in the morning.

    How Soy Can Help

    Can phytoestrogens--the natural plant compounds whose structures are similar to that of estrogen--produce estrogen-like effects in menopausal women? In current research, isoflavones in soy protein are considered the most promising phytoestrogens.

    Sleep is a research area being pursued in studies at Winston-Salem's Wake-Forest University Baptist Medical Center. "People tell us they're sleeping better with soy," notes study leader Dr. Greg Burke. Investigators found women who added 20-34 grams of soy protein to their diets experienced less intense night sweats. Results were best if women consumed soy protein twice a day.

    "We believe soy may offer many benefits of estrogen replacement therapy. It has a mild effect on number and severity of hot flashes--though nowhere near the same magnitude as HRT," says Burke. "We're investigating phytoestrogens because we think they may have different properties and risk-to-benefit ratios than traditional HRT."

    Burke cautions people not to think of soy as a drug, but as part of a healthy diet. Besides eating fruits and vegetables, add at least one serving of soy a day, he advises. "Find a form that you can easily tolerate: soy milk, tofu, soy burger, or soy protein in a shake, and use it regularly." He doesn't recommend isoflavone pills due to lack of data about their benefit.

    In Asia, where soybeans are a staple of the diet, women report fewer hot flashes during menopause. They typically consume at least 30-50 milligrams of isoflavones each day--the amount found in half a cup of soy milk or tofu or one-quarter cup of roasted soy nuts.

    Four of soy's most active isoflavones are also found in red clover. Promensil, a red clover-based supplement, has 40 milligrams of plant estrogen per tablet.

    Reviewer: Beth Israel Deaconess Medical Center. Reviewed for medical accuracy by physicians at Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School. BIDMC does not endorse any products or services advertised on this Web site.

    Source: Medscape Health
    Copyright: © 2000 Medscape, Inc.
    Posted On Site: Feb. 2000
    Publication Date: Feb. 2000

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    Many of these articles appear on the publication's website, which are often password-protected or members-only. For your convenience, I've gathered them on my own website.