The New York Times just ran an article on the benefits of estrogen and the controversial issues surrounding better control of menopause symptoms vs. future cancer risks. I wrote a lengthy reply to comment on the Well Bog, but evidently, I’ve been blacklisted! None of my comments are showing up on any the the Well Blogs. I decided to place it here instead:
I frequently see young men with hot flashes, night sweats, moods swings, insomnia, and irritability. No, they’re not going through menopause—but they’re slowly gaining weight, experiencing a relative change in their involuntary nervous system. The involuntary nervous system is what controls, temperature, sweating, blood pressure, heart rate, digestion, etc.
Women with smaller jaws and dental crowding are more likely to suffer the effects of menopause due to smaller upper airways.
Progesterone is a powerful upper airway muscle dilator—it actually tenses your tongue muscle. As progesterone slowly drops in a woman’s early 40s, the tongue can fall back easier in deep sleep due to muscle relaxation. This leads to more frequent obstructions and arousals. Studies have shown that women wake up from breathing pauses, and not from night sweats (the same reason as waking up to go the the bathroom). As you slowly gain weight, the fat cells in your throat begin to narrow your already narrow airway even further, preventing you from getting deep sleep.
Here are 10 tips for menopausal women to improve your sleep:
1. Most women with these issues naturally prefer to sleep on their sides or stomach. However, if you do sleep on your back, switch to your side.
2. Don’t eat or snack within 3-4 hours of bedtime. Excess stomach juices can be suctioned up into your throat, waking you up more frequently.
3. Avoid alcohol within 3-4 hours of bedtime. Alcohol relaxes your muscles.
4. Over-optimize your nasal breathing. Try nasal saline irrigation before bedtime, and try nasal dilator strips (Breathe Rite), especially if you have flimsy nostrils. Nasal congestion aggravates tongue collapse downstream.
5. Practice yoga, tai chi, meditation, or any other discipline that promotes relaxation.
6. Sing. Exhalation is activated by your parasympathetic nervous system. The more time you spend breathing out, the longer you’re stimulating the relaxing half of your involuntary nervous system. You can also play a wind instrument, hum, or whistle.
7. If you snore, or if one of your parents snore, get checked for sleep apnea. Even if you don’t snore or are thin, you can still stop breathing often. Gaining even a few pounds can uncover sleep apnea.
8. Oral appliances that advance the lower jaw forward can help some women. There are a variety of inexpensive over-the-counter devices (usually for snoring), as well as more formal appliances made by dentists.
9. Working with your doctor, consider over-the-counter bio-identical progesterone creams.
10. If you must sleep on your back (due to pain, discomfort or other reasons), use a contour pillow or a roll-type husk-filled pillow. These pillows tilt your head back slightly, which can open up the space behind the tongue.
If you have some time, perhaps you could relay this valuable information to Tara Parker-Pope in the New York Times Well Blogs in response to her post on estrogen. Thanks.
Dr. Park, Would you not say, except for number 9., those are also good tips for men to improve their sleep?
Absolutely! This list applies to anyone with sleep-breathing issues.
My mother used estrogen for few years at the age of 60’s due to menopause and later few years she started to snore event she is not over weight and one morning she woke up and had severe headache and admitted into hospital with MRI scan resultant in aneurysm in the brains. Surgeon did a good job by removing the aneurysm but later next day she had severe headache again, followed by MRi scan again with immediate sent to remove the second aneurysm. She is fine and hormone changes and snore is not funny anymore. God bless!
Well I did get your article into their blog http://well.blogs.nytimes.com/2010/12/13/a-second-look-at-estrogens-benefits/comment-page-1/?apage=2#comments
Thanks, Roger :)
I am perimenopausal (still cycling) and was recommended to take oral progesterone just during my luteal cycle which is sometimes only 10 days long. when I got to 100 mg I realized it was really helping me, and then I would crash about 36 hrs after my last dose after I got my period. my symptoms were unbearable so I decided to take the progesterone every day. I have had no side effects at that dose and without cycling it, and I feel a lot better. it is clear to me that my symptoms from UARS got worse as I hit perimenopause and my progesterone level started decreasing. so my advice would be: don’t rule out using progesterone even if you are not menopausal yet, and don’t worry about cycling it if it makes a big difference. and I am talking about natural progesterone which as far as I can tell is perfectly safe. synthetic progestins are a different story, are drugs with side effects and probably dangerous. read “Sex Lies and Menopause” for more detailed info and find a doc who understands natural hormones.