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SLEEP MEDICINE

Tolle Causum: Treat the Cause

Achieving restorative sleep is the chief goal for anyone experiencing insomnia.  This is because the cumulative effects of losing every precious minute of shut-eye leads to chronic sleep dysregulation, increased risks of chronic disease, daytime fatigue and declining cognitive health.  Sleep deprivation is a known independent risk factor for motor vehicle accidents, and chronic sleep loss can shave a decade or more off of one's lifespan.   


Sleep loss is also a known risk factor for weight gain, insulin resistance, cardiovascular diseases and neurobehavioral disorders, and these same conditions worsen during menopause. This means that sleep loss fans the flames of chronic disease development.    Regaining restorative sleep is an essential first step towards healing myriad ailments.  Addressing the root cause of insomnia makes the therapeutic response more sustainable and effective. 


In menopausal women, disruptions in neuroendocrine circuitry and decreases in estrogen and progesterone contribute to insomnia.  Lowered estradiol and increased follicle stimulating hormone (FSH) have been associated with increased night sweats. The quantity of night sweats has been used with predicitve accuracy in waking epsiodes in polysomnographic sleep studies (PMID: 2614224)1.


Growth hormone deficiency, estrogen decline and progesterone insufficiency are commonly overlooked causes of poor sleep.  Obstructive sleep apnea, periodic limb movement disorder & restless leg syndrome are other forms of sleep disorders  which may be impacted by ovarian hormonal changes.    Insomnia is actually one of the most common concerns for perimenopausal women, and women in this group are more likely to deny themselves sufficient sleep than postmenopausal women. This sets the stage for increased risk of daytime cognitive errors.  Falling estradiol levels has been associated with difficulty falling and remaining asleep, whereas elevated levels of follicle stimulating hormone  (FSH is a neuroendocrine hormone which communicates to the ovaries as a request for estradiol production) have been associated with  poor sleep maintenance (Kravitz et al 2012. PMID 21961720 ).      Increased FSH, estradiol fluctuation and lower levels of inhibin B have also been correlated with sleep difficulty issues (Freeman et al, 2007, PMID: 17666595).


Holistic and integrative treatments are started after a clinical review of symptoms has been performed. Those with greatest risk of sleep apnea are referred to sleep medicine physicians for a polysomnography test.  

Female Insomnia

Women transitioning into menopause often experience:  

  • Poor sleep quality
  • Lack of restorative sleep
  • Insufficient sleep
  • Increased nocturnal awakenings
  • Hypoxic events / apnea (often unbeknownst to them)