Chronic Insomnia and Hormones

Chronic Insomnia and Hormones

Bonnie had always been able to enjoy a good nights sleep in the past. No matter how stressed she might be, she could count on laying her head on her pillow, falling asleep and waking up the next morning refreshed and rejuvenated. However, when she reached her mid 40’s, her periods started changing and she began experiencing sleep problems. First, she would just have insomnia the night before starting her period. As her periods became more irregular, she started waking up in the middle of the night around 2 or 3 am and would find herself wide awake and unable to go back to sleep. With so little sleep, she would be exhausted the next morning. 

Over-the-counter sleep aids would make her feel sluggish the following day. By the afternoon and early evening, she would be crashing. She came to see me on maximal doses of prescription sleep medicine and still was sleeping poorly.

Bonnie suffered from a very common sleep disorder that occurs at the time of perimenopause or menopause. It’s caused by declining levels of estrogen and/or progesterone. It is characterized by wakefulness in the middle of the night and can be very debilitating when it continues long-term. The typical patient with this type of insomnia often becomes addicted to prescription sleeping pills. Bonnie’s insomnia totally resolved after her estrogen and progesterone levels were normalized.

While menopause occurs in all women, insomnia does not uniformly affect all women and
therefore, women may not recognize that this is a low estrogen symptom. Furthermore, if the
insomnia has gone on for many years, other secondary conditions such as depression, anxiety,
chronic fatigue, fibromyalgia, sleep apnea and obesity may also develop.
 Patients are often
prescribed prescription medications such as antidepressants, Xanax, and Adderal for these
conditions! Antidepressants can lead to weight gain and Xanax and Adderal are addictive!
Doesn’t it make more sense to correct the underlying hormone imbalance that’s causing these
symptoms?

It’s important to emphasize that insomnia can result from endocrine problems in both men and
women. Disorders of thyroid hormone, testosterone, cortisol, and growth hormone can all
cause sleep disorders. Detecting a subtle endocrine imbalance may sometimes be difficult
requiring the expertise of an endocrinologist.
 
Sleep is a mysterious bodily process that is
absolutely essential to good health. We should not have to rely on a drug to make us sleep! We
do not have to be “taught” how to sleep. Every member of the animal kingdom has an
obligatory need for sleep. If humans go much more than 18 hours without sleep, they start
experiencing “microsleep” where they “zone out” from a few seconds to minutes. In fact, many
accidents occur when people are sleep-deprived – such as the infamous Exxon Valdez disaster
and the Chernobyl nuclear accident. Falling asleep while driving is responsible for at least
100,000 crashes, 40,000 injuries, and 1550 deaths per year.
 
People can also develop insomnia
from poor lifestyle choices. Overzealous Americans intent on squeezing more work, more fun,
more family time and more sheer activity into their lives often short-change their sleep.

What are ways to promote a good night’s sleep?

Try going to bed at the same time each night
and getting up at the same time. The body likes a regular schedule. Sleep in a cool, dark room –
use nightshades, white noise or a sleep mask if necessary. Avoid spicy food or caffeine-
containing foods in the evening. Finish eating at least 3 hours before bedtime. Many individuals
find that heavy intake of sugar or alcohol at dinner leads to restless sleep. Start winding down in
the evening. Do not engage in heavy exercise late at night. Don’t watch the 10 o’clock news or
read grisly books which cause mental over-stimulation. Individuals who can’t function without a
large dose of coffee in the morning are usually sleep-deprived.

Just how much sleep is enough sleep?

Individuals who consistently get less than seven or eight
hours of sleep per night are often sleep-deprived. Interestingly, people who need MORE than
eight hours of sleep may also have a sleep disorder. They need more than eight hours of sleep
because the sleep they are getting is poor quality sleep. People do not have less need for sleep
with aging. It’s just that sleep disorders are so common in older people that many think this is
“normal.” Most sleeping pills “knock you out” but do not promote normal sleep architecture.

If you are experiencing persistent insomnia, consider seeing an endocrinologist, a physician who
specializes in hormone disorders. Establishing hormone balance can lead to normal, refreshing
sleep which is the body’s own way of healing a myriad of health problems.

Joan’s Ordeal: What Drives a Physician?

When I was first starting my medical practice, menopausal problems were not taken very seriously. Hot flashes and premenstrual syndrome (PMS) were the source of a lot of jokes. Well, it isn’t funny when you feel awful and your life is falling apart. I can’t tell you how many times I’ve had women apologize for “wasting my time” with their complaints or tell me, “Thank you for listening to me.” I would always assure them that hearing their symptoms is essential for my finding the correct solution for their problem.

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Symptoms of Menopause: Spinning Out of Control

Dr. Johnson describes symptoms of menopause

A very few lucky women sail through menopause with minimal symptoms. They have usually been very healthy prior to menopause. However, they are the exception. Most women will have at least some symptoms. These can range from a mild sensation of feeling warm, to a beet red face and drenching sweats that leave the sufferer with wet hair and clothes soaked in sweat. As you can imagine, this can be especially disconcerting to a woman who’s in the middle of a business meeting.

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Solutions Not Suppression

Solutions Not Suppression

 

I’m a naturally curious person which greatly affects how I evaluate a patient. I see signs and symptoms as the language of the body. This is how your body tells you and me there is a problem. Symptoms represent a reactive compensation of the body to an underlying process. Once I understand the process that caused the symptoms, I’m in a better position to formulate a plan to correct the problem.

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Healing Begins By Knowing That It Is Possible

The Golden Gate Bridge, Bridge of Hope

Giving patients hope is an important aspect of the doctor-patient relationship that contributes to good outcomes. Early on in my career as a new Endocrinologist, I saw Alice, a 35-year-old woman with Type 1 diabetes and mild diabetic kidney damage. I started her on a protein restricted diet and medication to slow the progression of diabetic kidney disease. Eager to not be missing any other new therapy that might be helpful, I referred her to a kidney specialist. Alice came back to see me two weeks later, and burst into tears as soon as I entered the exam room. Alarmed at her distress, I asked what had happened. Through her tears, she sobbed,

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A Prayer For The Women of The World

A Prayer for the Women of the World

 

I quietly stand in awe as I realize the

presence of God in everything.

The longer that I am in medical

practice the more I see the miracle

of the human body.

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MARINA JOHNSON
M.D., F.A.C.E.
MEDICAL DIRECTOR

BOARD CERTIFIED
IN ENDOCRINOLOGY
& METABOLISM AND
INTERNAL MEDICINE

10670 N Central Expressway
Suite 510
Dallas, Texas 75231-2111

214.574.4376 office
214.574.4377 fax

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