Sleep in menopause. Understand what's keeping you awake and what can help

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Table of contents:

Chapter 1. Before we treat insomnia, let’s understand why it appeared in you specifically

Chapter 2. What is normal sleep — and why do we sleep at all?

Chapter 3. What is considered normal sleep? 

Chapter 4. Why don’t we sleep the same way throughout the night?

Chapter 5. Why do we need to know about sleep stages?

Chapter 6. Why do we wake up in the middle of the night?

Chapter 7. What helps improve sleep?

Chapter 8. Why the harder you try to fall asleep, the longer it takes

Chapter 9. How to retrain the brain to sleep

Chapter 10. Why doesn’t sleep recover in 3 days?

Chapter 11. When insomnia needs to be treated with medication and when it’s better not to start with pills

Chapter 12. Why the doctor first asks questions and only then prescribes medication

Chapter 13. Melatonin. Why doesn’t it help everyone?

Chapter 14. How to take melatonin correctly

Chapter 15. Sleeping pills. Is it true that they cause dependence?

Chapter 16. What sleeping pills exist today?

Chapter 17. Which medications are prescribed for insomnia and what to expect from them

Chapter 18. How to quit sleeping pills correctly

Chapter 19. Can psychologists cure insomnia?

Chapter 20. Why the bed should be associated only with sleep?

Chapter 21. Why our thoughts can prevent us from sleeping

Chapter 22. How to assess your own sleep

Chapter 23. Apple Watch, Oura Ring, Samsung Galaxy Watch and other gadgets. Can they be trusted?

Chapter 24. Which metrics on Apple Watch, Oura Ring, Samsung Galaxy Watch and other gadgets are worth paying attention to?

Chapter 25. When the watch starts interfering with sleep. What is orthosomnia?

Chapter 26. The sleep diary. Why do we need it if we already have a watch or a ring?

Chapter 27. When is it time to see a doctor?

Chapter 28. What examinations are needed and which doctor should you see?

Chapter 29. What do we know today about the treatment of insomnia?

Instead of a conclusion

Before we treat insomnia, let’s understand why it appeared in you specifically

Most books about insomnia start with an advice.

I want to start this one with a question.

Why do two 45-year-old women who both complain of poor sleep need completely different treatment?

You might ask:

“How is that possible, Nataly? The complaints are the same, the age is the same — so the treatment should be the same too.”

But it’s not that simple.

When a woman comes into my office and says, “Doctor, I sleep poorly,” those words tell me almost nothing. From that single phrase it is impossible to understand what is actually happening — and therefore impossible to choose the right treatment.

So I always ask the next question:

“What exactly do you mean when you say ‘I sleep poorly’?”

Does it take you a long time to fall asleep?

Do you wake up several times during the night?

Do you wake up too early in the morning and cannot get back to sleep?

Do you sleep eight hours but still wake up feeling unrefreshed?

Or does your husband wake you because you snore or stop breathing in your sleep?

These are completely different situations. And the reasons behind them are different too.

Until the doctor gets answers to these questions, the complaint of “sleep problems” is only a starting point. It tells us that a problem exists, but it tells us nothing about why it has appeared.

This, I believe, is where one of the most common mistakes made. We rush to look for treatment and almost never stop to ask ourselves:

What exactly are we trying to treat right now?

Open the internet and you will find dozens of recommendations.

Take magnesium.

Take melatonin.

Don’t use your phone before bed — or at least turn on night mode.

Buy a weighted blanket.

Try meditation.

If one thing doesn’t help, try the next.

If magnesium citrate didn’t work, switch to glycinate.

If melatonin didn’t help, change the dose or buy a different brand.

We carefully, step by step, go through ready-made solutions, hoping that one of them will finally work. Sometimes it does. But not because we found the real cause of the sleep problem — simply because we accidentally hit upon it.

The main question remains unanswered the whole time:

Why did your sleep become disturbed?

What changed in your body or in your life?

What mechanism is behind this complaint?

Only after answering these questions can we talk about treatment that will actually suit you.

There is another reason of why I decided to write this book.

 Over the years of practice I have realized a simple fact: even the most experienced doctor does not live with you. He does not know how many times you woke up last night. He does not know what was happening the week before the insomnia started.

Maybe you had a very stressful time at work or constant arguments with your husband. Maybe your child is applying to university or has a new boyfriend.

The doctor does not know that after a glass of wine you almost always wake up around three in the morning. And the most interesting part is that most of the time you don’t know it either — because you have never looked for that connection before.

He does not know that after an evening walk you fall asleep easier. And it is very good if you have already noticed this about yourself. This part of your life is known only to you — once you started paying attention to it.

That is why a good doctor asks questions, and a good patient helps find the answers.

I desire that after reading this book you begin to understand your own body better. Not so that you can diagnose yourself or start treatment without a doctor, but so that you notice patterns.

- When did the sleep problem first appear?

- What changed shortly before that?

- After which events does it get worse?

- What, on the contrary, helps you sleep better and feel better?

These observations can become the missing pieces that help your doctor make the correct diagnosis — and therefore choose the correct treatment.

This book will not replace a consultation with a doctor.

But I sincerely hope that after reading it you will come to the appointment differently. Not simply with the complain “Doctor, I sleep poorly,” but with an understanding of how exactly your sleep has been disturbed, when it started, what preceded it, and what you have already noticed.

Believe me, for a doctor this is enormous help.

Now imagine you are driving a car. Suddenly a warning light comes on the dashboard. The first thing we do is look at what exactly happened.

If it is the low-fuel light, we understand: it is time to look for a petrol station.

We do not cover the light with a plaster and pretend nothing has happened.

The light itself is not the problem. It is giving us important information.

But sometimes the Check Engine light comes on. And that is a completely different situation. We understand that a fault has appeared in one of the car’s systems. Which one exactly — we do not yet know. But we do not start filling the tank with petrol in the hope that the light will go out. We go to a service centre because we want to find out the source of the problem.

The same happens with sleep disturbance. Sometimes the cause turns out to be very simple. For example, for several days in a row you went to bed late, drank coffee in the evening, or simply had not been getting enough sleep for a long time. In that case it is enough to remove the cause, restore a proper routine, and sleep will recover.

But sometimes it is different.

There is more to this than meets the eye. A more careful search might be needed — possibly additional examinations and a consultation with a specialist.

In both cases, sleep disturbance is first and foremost information. That very same warning light on the dashboard. A body signal that needs to be understood correctly.

That is why we will not begin this book with treatment.

We will begin with something else.

We will try to learn how to read the signals that our body is sending us.

Because the better we understand these signals, the easier it is to find the real cause of the problem. And the higher the probability that the treatment will actually help.