NEWSWELLNESS

Not sleeping? You are not alone!

Midlife sleep disruptions are  common and can be very bothersome. This can be waking early, waking multiple times and not having a deep restful sleep among other forms.
Yes shifting hormones can impact sleep. Often the first line of therapy is to alleviate night sweats if that is medically appropriate.
For many that is the cure,  but for those that are still not sleeping, or those who are not having night sweats or cannot or wish not to take hormone therapy there are some options:
    • Cooling Your Environment: Keeping the bedroom temperature cool is ideal
    • Fixing Your Wake Time: Waking up at the exact same time every day builds a reliable circadian rhythm.
    • Cutting Late Stimulants: Stopping all alcohol and caffeine consumption at least four to six hours before bed eliminates artificial sleep fragmentation.
    • Dimming the Lights: Blocking blue light from phone and computer screens for 60 to 90 minutes before bedtime triggers natural melatonin production.
    • Relaxation techniques like meditation, a bath or shower,  or reading can be helpful

Medications
While I am not a fan of sedating medications, I do often consider a newer class of prescription medications called Dual Orexin Receptor Antagonists (DORAs).
    • Turning Off Wakefulness: Traditional sleeping pills sedate the brain, but DORAs work by blocking orexin—the chemical chemical responsible for keeping you awake.
    • Preserving Sleep Quality: By turning down the brain’s wake signals rather than forcing heavy sedation, DORAs help maintain a more naturalistic sleep structure, including vital REM stages.
    • Limiting Dependence: DORAs in Canada have shown that they carry a much lower risk of physical dependency or morning grogginess compared to older sedatives.

There is also a newer medication that is coming to Canada that will manage hot flashes and has good sleep data. This will be discussed in a future blog. It is not to be used as a first line agent for sleep but for those wanting non hormonal therapy for hot flashes/ night sweats it is going to be a great option.

I do not recommend using progesterone for sleep. It is a welcome side effect for those using hormone therapy but not without risk. Progesterone is actually responsible for increasing breast density which is a risk factor for breast cancer. The risk increases with increased dose and length of use.  It also makes you sleep by sedation vs. managing your wake cycle so grogginess and a less restful slee is more likely.

I urge you to speak to your provider about your options .

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