Cheryl Martin (Host): Do you want to unravel the mysteries of sleep disruptions during menopause so you can reclaim restful nights? Here with valuable insights and practical tips is Dr. Mokerrum Malik, an OB-GYN at University of Maryland Women's Health. She's also an Assistant Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of Maryland School of Medicine.

Welcome to the Live Greater podcast series, information for a healthier you, from the University of Maryland Medical System. I'm Cheryl Martin. Dr. Malik, so glad you're here to talk about the impact of menopause on a woman's sleep.

Mokerrum Malik, MD: Thank you so much for having me.

Host: So, how does menopause affect sleep patterns and quality?

Mokerrum Malik, MD: That's a really wonderful question. Menopause actually has many associated symptoms with it, including vasomotor symptoms, such as hot flashes and night sweats that we all know about. There's also definite mood disorders, such as anxiety and depression and sleep disturbances. But it's kind of hard to figure out what the sleep disturbances are that are associated with menopause as opposed to just normal aging, because everyone during this time is experiencing these sleep disturbances as well.

Host: So, what would you say are some of the potential causes of the sleep problems during menopause?

Mokerrum Malik, MD: Yeah. Again, it's a multifactorial thing. I think scientists are now trying to discern is that these vasomotor symptoms and the anxiety are the two main conditions that may disrupt sleep in women going through this mid-lifetime period. And I think based off of the recent literature, it seems that the anxiety that patients are exhibiting during this time is the strongest predictor of poor sleep quality.

Host: So, what role does hormone therapy play in managing sleep issues during menopause?

Mokerrum Malik, MD: Right now, hormone replacement therapy is something that's a hot topic. It's something that we're looking at from many different angles. But at the time being, hormone replacement therapy is only being offered for vasomotor symptoms. So if a patient is having hot flashes and night sweats, and that's what's causing her to have sleep disturbances, then I think that hormone replacement therapy is a wonderful treatment option for that patient and can potentially improve her sleep patterns. However, right now, hormone replacement therapy isn't being offered for sleep disturbances by themselves.

Host: And you've talked about some of the sleep disorders. Any others specifically that you want to point out?

Mokerrum Malik, MD: So, there's actually a slew of sleep disturbances that can happen during this transition time period. The biggest one is insomnia, of course, which I'd like to point out that the definition for insomnia is the sleep complaint that occurs at least three times per week for at least three months. And it's associated with distress or impaired daytime personal functioning. And I really want to mention that, because I think more people have this condition than they may think. Other things that may be happening during this time period are sleep disordered breathing, such as obstructive sleep apnea. And other things like restless leg syndrome or a rare disorder called periodic limb movement disorder.

Host: We talked about hormone therapy. So, are there any natural remedies or alternative therapies that can aid in better sleep?

Mokerrum Malik, MD: Yeah. This is something that we're always looking at and we're always trying to figure out. There's not much research out there on alternative therapies, but the biggest thing that can be helpful are like behavioral treatments such as relaxation therapy. And then, there's always some herbal treatments that can be used. We all know that lavender and chamomile are linked with improved sleep patterns and those may be beneficial.

Host: What about lifestyle changes or sleep hygiene practices that can help improve sleep during this stage?

Mokerrum Malik, MD: Yeah, this is number one in helping us to improve our sleep. So, sleep hygiene is it. So, number one, I would say things to do at home would be to try to awake at the same time every morning, increase daytime bright light exposure, exercise regularly and to establish a daily routine. I really encourage patients to journal and that helps us to set aside our worry time and to create a comfortable sleep environment. Other things that we can do is do something relaxing before bedtime, even try like a warm bath and develop like regular pre-sleep rituals and a regular bedtime.

Host: I'm glad you mentioned that because I was going to ask you, you mentioned awake at the same time, but you're saying it's just as important to try to go to bed at the same time.

Mokerrum Malik, MD: That's right. And things to avoid would be like napping in the day or avoiding stimulants right before bedtime, such as alcohol, caffeine and nicotine, and exposure to bright light before bed, which we all do because we're always on our phones. Even things like exercising within three hours of going to bed and eating heavy during this time is not recommended, and to avoid noise and to avoid a too hot or too cold bedroom. And another thing that we all do is watch the clock. Oftentimes patients that are not able to sleep properly, they'll just count down the hours and say, "I only have five hours left. I only have four hours left," and I think that kind of prevents the onset of sleep.

Host: Now, what about strategies for managing night sweats or hot flashes that disrupt sleep?

Mokerrum Malik, MD: Yeah, I think this is every menopausal woman's biggest question. Lifestyle modifications are probably the number one thing, things that we've talked about, like creating a comfortable bedroom environment, wearing comfortable sleep clothing and daily exercise. But then at some point, we may have to encourage women to talk to their doctors about medical management and consider hormone replacement therapy as we mentioned before.

Host: When you talked about alternative therapies or even, and this isn't a therapy, but I've heard some people mention taking melatonin, do you recommend that?

Mokerrum Malik, MD: Melatonin can be helpful. I think it's worth trying for some patients. Some people actually have a reverse effect to melatonin. It could work, it could not, but I think we wouldn't know until we tried.

Host: I'm sure this is a big question. How long do sleep disturbances typically last during the menopausal transition?

Mokerrum Malik, MD: Unfortunately, it can be ongoing. There was a study done in 2015 to kind of evaluate women from the ages of about 40 to 59. And what they found was that these perimenopausal women were less likely to sleep seven hours a night. But postmenopausal women, which were past that menopausal transition, actually had poor sleep quality. So, they said that 27% reported trouble falling asleep and 36% trouble staying asleep. So as you can see, it goes throughout the entire transition and can become problematic as time goes on.

Host: What are the potential long term consequences of untreated sleep problems during menopause?

Mokerrum Malik, MD: Yeah. Sleep is a really well-studied thing, but it's something that we don't know very much about. Troubled sleep can possibly lead to daytime fatigue and dysfunction, but we don't actually know the true effects of poor sleep quality. Recent studies have shown, however, that this eventually can lead to cognitive impairment in older adults. So, it can lead to problems with mental functioning.

Host: So, it's important to take it seriously and get treatment. So, what do you want to be the key takeaways for the woman listening today?

Mokerrum Malik, MD: Sleep is complex and we certainly don't know every single thing that's causing sleep disturbances in women, especially women going through the menopausal transition. I would say that it's important for women to take care of themselves, to take care of their medical conditions that may be underlying and causing further issues and for them to help work on their menopausal symptoms as well with their menopause doctors so that they can help create a better healthy lifestyle. And I think the number one takeaway for me would be that sleep hygiene is incredibly important in order to create a healthier sleep pattern.

Host: Dr. Mokerrum Malik, thank you for sharing some practical tips for managing sleep issues during menopause.

Mokerrum Malik, MD: Thank you again for having me.

Host: You can find more shows just like this one at umms.org/podcast and on YouTube. Thanks for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again. And please share this episode on your social media.