It’s two o’clock in the morning, and you are deciding whether to toss for awhile more, get up and do a sudoku puzzle, put on the shopping channel, or just scream and get it over with. You have insomnia, and it started when you entered the menopausal years.
There are many women struggling with the same frustration, but that isn’t much comfort when all you want is just a few more minutes of sleep before that alarm goes off. And once your mind is engaged, there are so many worries and responsibilities to choose from that it can be impossible to get back to sleep.
Chronic insomnia can really affect your quality of life. Daytime sleepiness and fatigue will make every task harder and can begin to erode your mood. Let’s say that you have tried hot baths before bed, can’t seem to get the knack of progressive relaxation, and have cut back on caffeine. If you are caught in a pattern of habitual wakefulness it may be time to consider medications to turn your sleep cycle around.
Check in with your medical provider if you have been having sleepless nights more than a couple of times a week. He or she has several options of medication that might pull you out of that pattern and restore your energy and mood. Be sure to discuss what you think might be causing the sleeplessness, since it may be possible to treat the underlying problem rather than the insomnia alone, and solve both problems at once. Depression, anxiety, pain, restless leg syndrome, night sweats and sleep apnea are all conditions that will rob you of your sleep, and that can be treated in ways that help you get back to a restorative sleep routine.
Here are some of the choices you might consider:
Over-the-counter sleep aids
Usually these are some sort of antihistamine, sometimes combined with a pain medication. Because you don’t need a prescription, they are readily available, inexpensive and are pretty effective at helping you get to sleep. They tend to give you a “sleep hangover” though, and that can make you feel groggy into your morning, or interfere with motor tasks like driving. But if you take them early in the evening and can sleep for a full 8 or 9 hours, they may be a good choice for you.
The group of medications called “benzodiazepines” are often prescribed for anxiety and for sleep. These drugs, like Valium, Xanax, Ativan and others, are quite effective in calming you and helping you sleep. There are newer, shorter acting benzodiazepines like Restoril and ProSom that are effective for treating temporary insomnia, and don’t have as many side effects. Be aware that all of the benzodiazepine medications can create a dependence, and some cause memory and other cognitive problems during the day. These medications tend to become less effective over time, so short periods of use are better than long term use.
There are non-benzodiazepines hypnotic medications such as Ambien, Sonata and Lunesta that are proving to be very effective without the side effects of benzodiazepines. Lunesta seems to be quite safe even when used up to 6 months.
Many types of antidepressants, including tricyclic and some of the SSRI antidepressants, are used to treat sleep disturbances. Since these medications also treat depression and anxiety, they can be good choices if you suffer from a mood disorder with insomnia. It’s good to be aware, though, that some antidepressants actually cause insomnia, which can intensify your depression or anxiety. If you are currently on an antidepressant and are also having insomnia, talk to your medical provider to see whether your medication is causing the insomnia, and whether another one might be a better choice.
If your insomnia is due to night sweats or hormone swings causing wakefulness, you might be a good candidate for a course of hormone therapy. Sometimes a small dose of estrogen, or estrogen/progestin therapy can get you through the most dramatic menopause symptoms, and then can be tapered and stopped. But hormones have their own risks, so if your sleep is paying the price of waning estrogen, check with your doctor or other medical provider to discuss the hormone options.