I hear this almost daily from new patients: “I used to sleep like a log. And now I can’t fall asleep; I can’t stay asleep if I do fall asleep; and I’m exhausted in the morning. What has happened to me?”
I know this firsthand. I was one of those heavy sleepers who didn’t wake up even during a major thunderstorm. Then I hit 40 and had trouble falling asleep because my mind wouldn’t shut off, and I would obsess over the day’s events or obsess about tomorrow.
When I finally did fall asleep, I would wake up suddenly, my heart racing. Yet nothing had happened to awaken me. I’d finally fall asleep again, but an hour or so later, there I was again: wide awake, heart pounding.
“What is going on?” I wondered. Work was stressful, but I didn’t really have any other reasons to cause these frequent and upsetting awakenings. I didn’t smoke or drink alcohol, I exercised regularly, and I was healthy.
The only changes I had noticed were lighter and irregular periods, and extremely bad PMS. I didn’t really think those were connected to the sleep problems. I didn’t want to take sleeping pills, so I just tried to get through it. But I was exhausted and grumpy.
I began paying attention to when these awakening episodes and fragmented sleep nights were worse. Sure enough, it was right before my period started or during the second half of my cycle.
Turns out, the “hormone doctor” herself was having a hormone problem. When I checked day one and day 20 hormone blood tests, I was missing the right amount of the key ovarian hormone that regulates sleep: estradiol.
My level was very low for both cycle phases, and this correlated with the time of my most disrupted sleep.
All my other hormones were fine, and I was still making plenty of progesterone. My doctor and I found a simple solution: I started using a Climara patch at those times of my cycle to bring my own estradiol back to the optimal range. It worked like a charm. Within two weeks, I was back to my normal restful sleep and felt great.
Why is Estradiol Important?
Sometimes called E2, 17-beta estradiol is our primary active estrogen before menopause. E2 works on brain pathways to help regulate the balance of many chemical messengers (neurotransmitters) serotonin, norepinephrine, acetylcholine, dopamine.
Estradiol and these chemical messengers work together on brain receptors in the limbic system to help regulate our sleep, mood, pain, appetite, thirst, sex drive, heart rate, blood pressure, and even our body’s heat regulatory center.
When estradiol is falling or low, it triggers a fall in serotonin and a burst of norepinephrine, the “flight or flight” chemical. Norepinephrine hits the “sleep center” and jolts you awake. It also causes the feeling that your brain is “wired,” and you can’t fall back asleep.
The drop in estradiol hits the heart rate regulatory center and sets off rapid, pounding heartbeat that you may “hear” whizzing in your ears. So while it is happening in your brain, it is not “all in your head” – you aren’t imagining this.
Other hormone imbalances can also cause fragmented sleep: excess thyroid hormone, excess testosterone, excess DHEA, and low levels of vitamin D. Low ferritin, a measure of iron stores, can cause restless legs and fragmented sleep, worse in women who also have low estradiol or excess levels of the androgens. Our ovarian hormones play a critical role in sleep regulation and often are an overlooked cause of insomnia in women.
Get Better Sleep
If you’re experiencing symptoms like mine, I recommend these five action steps:
1. Keep a journal to see where in your menstrual cycle your sleep is affected the most.
2. Eliminate “sleep disruptors” such as cigarette smoking, alcohol use in the evenings, drinking beverages with caffeine late in the day, and too much light coming into the bedroom.
3. Before you take a sleeping pill (and then risk getting hooked), read the free booklet on medical tests posted on my Web site and ask your doctor to check these hormones.
4. If your estradiol is low at the times you are having severe insomnia, then talk with your doctor about trying an FDA-approved estradiol option (patch, gel, lotion, spray, or pill) to boost your hormones to healthy ranges, instead of using heavy-duty “mood stabilizers.”
5. Read my book, It's My Ovaries Stupid! I describe other ways to balance your hormones and improve your sleep.
If you aren’t sleeping well, it can lead to other serious health problems like depression, high blood pressure, memory loss, weight gain, or diabetes.
Sleeping pills just mask the underlying problem that can lead to other problems. Check out what is causing the problem, get answers, and get on the road to hormone health.
For more information about Dr. Vliet, visit www.herplace.com.
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