Here's some potentially good news for the millions of women who are coping with insomnia as a consequence of menopause: a recent study indicates that the herbal supplement valerian is an effective treatment for women with post-menopausal insomnia.
Researchers at the University of Tehran examined the effects of valerian on post-menopausal women suffering from insomnia. One hundred women between the ages of 50-60 participated in the study. All the women had reported problems with insomnia. The women were divided into two groups: the first group was given a twice-daily dose of valerian for two weeks and the second group received a placebo. The women who received valerian experienced a significant improvement in the quality of their sleep, compared to those in the placebo group. Researchers reported that 30 percent of women who took valerian for the two-week study period saw a positive change in their sleep quality, compared with 4 percent of women in the placebo group.
Valerian, a flowering plant that is native to both Europe and Asia and is now also grown in North America, has long been used medicinally, particularly for sleep—the ancient Greeks wrote about its power in treating sleeplessness. It is the plant's root that is cultivated and processed for use in supplements, which have been popular and widely available for decades. There has been no significant research into the long-term effects of valerian use, which is a significant omission-as with any medicinal sleep aid, "herbal" or not, we need an understanding of its effects on the body over the long term, both in terms of its safety and its effectiveness. The short-term side effects of valerian, however, we know to be relatively mild, consisting of headaches and stomach upset.
Women face challenges to sleep throughout their lives, but menopause often brings with it particularly difficult obstacles to sleep. According to the National Sleep Foundation, 61 percent of post-menopausal women report experiencing some degree of insomnia. What happens during menopause that wreaks such havoc with sleep? There are several factors:
- Hormone shifts. Starting in peri-menopause, the hormones estrogen and progesterone begin to fluctuate, and these short-term shifts can be disruptive to sleep. Over the course of menopause, the body's levels of estrogen and progesterone decrease. Both estrogen and progesterone have effects on sleep, and the new, decreased, post-menopausal levels of these critical hormones can make sleep more difficult.
- Physical symptoms. Menopause brings about a number of physical symptoms that can be very uncomfortable and also challenging to sleep. Hot flashes in particular can pose frequent interruptions to a woman's nightly sleep, leaving her feeling fatigued and sleep deprived. Over time, interrupted sleep can take on a life of it's own—insomnia and disrupted sleep can persist even after the hot flashes have disappeared.
- Mood changes. The process of menopause has not only significant physical changes, but also emotional ones. Some women will experience depression, anxiety and other mood disorders in greater frequency during menopause. These mood-related shifts can be a cause of sleep deficiency—they can also be a consequence of insufficient sleep.
- Lack of sleep during and after menopause can be disruptive to a woman's overall physical health, and also to her general sense of well being and quality of life. One recent survey indicated that 76 percent of women who experienced insomnia related to menopause reported a moderate to significant impact on their quality of life. More than one-third—34 percent—said their intimate lives were affected.
Women and their physicians are not talking about sleep problems nearly as much as they need to be. A recent survey revealed that 62 percent of women who participated had not spoken with their doctors about their problem sleeping. If that's not bad enough, here's an even more distressing piece of data: of the women who did talk with their doctors about their struggles with sleep, 90 percent reported having to initiate the topic themselves. We can—and must—do better than this, both as patients and physicians.
Valerian may be a promising option for post-menopausal women experiencing insomnia, but I do encourage my patients to try making adjustments to their regular habits and choices as a first step before pursuing any sleep aid-and make no mistake, even herbal remedies are chemicals in the body. Here are some options to consider:
- Exercise, especially early in the day. Physical activity is a mood booster for the rest of the day, and exercise in the morning, especially in sunlight, can help strengthen our circadian clocks, which weaken as we age.
- Limit caffeine. Start by cutting yourself off from caffeine to later than 2 p.m. Your morning cup of coffee may still be okay, but if you continue to have trouble sleeping, it may be time to consider pulling that no-caffeine deadline back even earlier.
- Mind-body exercise. Yoga, tai chi-these disciplines work to strengthen both the physical and the mental self, and there are indications they provide benefits for sleep.
- Talk to your doctor. This one is a must, for everyone. Make sleep a part of your regular conversation with your doctor. Don't wait for the topic to come up on it's own—initiate the conversation. And always consult your physician before adding a chemical sleep aid—even an herbal one—to your regimen.
Michael J. Breus, PhD
The Sleep DoctorTM
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