Articles

Insomnia and Your Hormones

By Brock Smith, R.Ph.

Why can't I sleep like I used too? Is it my bed, my age, stress, heredity, hormones or is it something else? What are possible causes and treatments? The following article will discuss common causes and treatment options for insomnia.

History:
What is Insomnia? Definition: Prolonged and usually abnormal inability to obtain adequate sleep. Insomnia is characterized by difficulty falling or staying asleep and waking too early in the morning. Approximately 60 million Americans each year suffer from insomnia.

Is insomnia a symptom of a physical or psychological condition? It may be a combination of the two. Sleep is essential to good health. Just how much sleep do we need? If you consistently get less than 7-8 hours of sleep per night you are probably sleep deprived. If you get more than 8 hours and still are tired in the morning you may also have a sleep disorder from getting poor quality sleep.

Causes:
There are a myriad of causes for insomnia. Insomnia can be primary or secondary—primary insomnia means the inability to sleep is not caused by other health conditions; while secondary insomnia means other health conditions interfere with sleep.

Sleeping problems can run in families, about 35% of persons with insomnia have a family history of it, with the mother being most affected. Overall 10-18% of the general population may suffer from insomnia.

Brain chemicals at abnormal levels have been observed in some people with insomnia. Low levels of melatonin, the hormone secreted by the pineal gland, have been observed in chronic insomnia. The stress hormone cortisol in high levels (stressful situations) over a prolonged period have been shown to reduce REM sleep. Reduced levels of growth hormone also contribute to insomnia. Thyroid disorder, anxiety, depression and bipolar disorder, medications, illegal drugs and alcohol may also be factors. Poor lifestyle factors also increase chances of insomnia.

Declining levels of estrogen and progesterone during perimenopause and menopause may cause many women to experience insomnia at times of fluctuations in gonadal hormones, such as the late-luteal phase of the menstrual cycle, during pregnancy and the postpartum period, and in the menopausal transition. Among the challenges is that, while there has been an assumption that sleep disruption is caused by the levels (or changes in levels) of the gonadal hormones, primarily estrogen and progesterone, the relationship between symptoms and hormone levels cannot be established. Sleep disorders become more common in women as they progress past menopause and can become debilitating if suffered long-term. Women have more trouble falling asleep and staying asleep. When they do sleep, it has been documented that they spend less time in rapid eye movement (REM) sleep and, therefore, when they wake up, they report that they feel less rested.
One basis for this assumption is that progesterone may have a sedative/hypnotic-like effect and women tend to have symptoms when progesterone levels fall.
Estrogen replacement therapy appears to bring sleep patterns closer to normal and improve sleep quality in a group of postmenopausal women, according to a report in the February issue of the American Journal of Obstetrics and Gynecology.
Treatments:
Non-drug:

• Regular sleep times
  
• Comfortable bed, quiet room, cooler temperature
  
• Regular exercise, but not closer than 4 hours before bedtime
  
• Avoid caffeine, large meals, alcohol and tobacco
  
• Relaxation techniques
  
• Avoid naps during the day
  

OTC:

• Melatonin - Melatonin is a hormone made by a part of the brain called the pineal ("pin-ee-all") gland. Melatonin may help our bodies know when it's time to go to sleep and when it's time to wake up. Melatonin deficiency may cause sleep disorders, immune deficiency conditions, and depression. Melatonin has been found to alleviate sleep disorders and boost the immune system.

• Sleep Naturally® - a dietary supplement to encourage sleep containing: magnesium, melatonin, vitamin B complex, and 5-HTP. This product can be found at Bellevue Pharmacy by visiting www.bellevuerx.com/pharmacy/sleep_disorders/74.asp
  

• Antihistamines

• Tryptophan: L-Tryptophan is an essential amino acid, meaning the human body does not produce it naturally, but is required for the body's healthy functioning. L-Tryptophan is present in a wide range of foods including beans, nuts, milk, and poultry. L-Tryptophan is a precursor to 5-hydroxytrytophan (5-HTP) (which is a precursor to serotonin) and is sold as a sleep aid and mood enhancer.
  

• SSRI (Prozac, Paxil, Effexor)
  
• Sedative/hypnotics (Valium, Ambien, trazodone)
  
• Hormones: (estrogen, progesterone, melatonin)
  

Unfortunately, there is a surprising lack of clinical research regarding insomnia and gonadal hormone changes. It is important to carefully assess symptoms of insomnia and hormonal fluctuation to rule out other factors. For instance, if insomnia is generated by behavioral factors then it should be treated accordingly.

References:

1. Krystal, Andrew D. "Gonadal Hormone-related insomnia in Women", 2004. Medscape.

2. The Institute of Endocrinology and Preventive Medicine
   http://www.drmarinajohnson.com/Articles/ChronicInsomnia/tabid/196/Default.aspx

3. University of Maryland Medical Center Archives http://www.umm.edu//patiented/articles/what_insomnia_000027_1.htm