Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Dear Dr. Pat,

I realize that I haven’t slept well since my first child was born twenty-three years ago. Both children are living on their own now and I have no reason to be worry about them the way I did when I was a new mother. However, I still have trouble falling asleep and sleeping soundly. The slightest noise wakes me up and I live in an apartment in the city that never sleeps. I need coffee in the afternoon at 2 p.m. and again at 4 p.m.  in order to focus on my work as a librarian.

I get home about 6 p.m. most nights  and my husband is usually there before me, prepping food for dinner. We make a nice dinner most nights, share a bottle of wine over the course of food preparation and dinner and enjoy a pleasant evening. We are both passionate foodies and look forward to our evening meals. We have also gained about thirty pounds over the last three years and keep postponing exercise, except for walking the dog.

The first thing on my mind when I get into bed is “how bad am I going to feel in the morning?” I generally fall asleep in about thirty minutes after reading the breaking news on my phone. But then I wake up about four hours later and struggle with worry about the world and my own anxiety about exhaustion for the next day. I am fifty years old now and I thought  I would eventually return to the good sleep pattern I had in my 20s when the children moved out. However, with menopause looming, I don’t think a decent night’s sleep is in my future.  I don’t want to take sleeping pills because I feel drugged the next day. Melatonin made me feel the same way. I do sleep very late on the weekends to make up for my lost sleep during the weekdays and feel quite good on Saturday and Sunday.  What can I do to make a difference in my poor sleep and exhaustion during the day.

Melanie

Dear Melanie,

Insomnia is a condition where difficulty sleeping at night disrupts the ability to perform during the day, causing impaired cognitive function, fatigue, mood disorders, and poor performance at work.  Insomnia is more common in women of all age groups. About 10 to 13% of adults meet the criteria for insomnia but 30 to 40% of adults have some form of disturbed sleep during the year. In fact, over half of Americans suffer from sleep problems in any given year. Issues include trouble falling asleep, waking too often, not sleeping long enough, and having a poor quality of sleep. Fortunately, there are a number of steps you can take to help improve your sleep.

1. See your healthcare team first. It’s important to ensure that you do not have a medical condition that is contributing to your sleep difficulties.  These conditions include disorders that we commonly think of as being related to sleep, such as obstructive sleep apnea and restless leg syndrome, but other medical conditions can affect sleep as well, such as thyroid, heart, and kidney problems. Questions about sleep and daytime energy and wakefulness should be part of all wellness visits to a health practitioner.  A few selected questions will direct further evaluation and treatment for a sleep disorder that has an impact on a patient’s ability to function.

2. Skip the afternoon coffee break. Caffeine begins acting within fifteen minutes of your first cup and lasts for hours in the system; six hours after you finish that cup, half the caffeine you consumed is still active. Caffeine works in the brain by blocking the action of one of the key molecules that are involved with sleep. Thus it is best to avoid caffeine in the late afternoon and evening.  Even if you think caffeine doesn’t affect your sleep, it’s worth going without—studies have shown that people tend to underestimate the impact of caffeine on their sleep. Something to note is that “decaffeinated” is not the same as being completely caffeine-free. Decaf coffee still actually contains caffeine, although in fairly small amounts. Instead of decaf coffee, you may try switching to herbal tea, which is caffeine free.

3. Eat your smallest meal at night during the week. Late-night eating is a recognized factor in poor sleep.  Eat your lightest meal of the day in the evening, unless it is a special occasion.

4. Avoid all alcohol. Until you have improved your sleep disorder, skip the alcohol. It allows many patients to fall asleep more easily, but increases arousal for the rest of the night. Alcohol also reduces REM sleep, which is necessary to a healthy sleep cycle.

5. Create a calming ritual. With our children, we create bedtime rituals—the evening snack, the bath, the bedtime story—but as adults we tend to go-go-go until we realize how late it is, and then we want to be able to fall asleep at the drop of a hat. Take the time to wind down, whether that calls for herbal tea, a hot shower, or half an hour with a good book. Avoid things—like the evening news or an intense movie—that are likely to get your adrenaline flowing.

6. Use the bedroom only for sleep and romance. Tell colleagues, friends, and family not to email or call after 10 p.m.  Reading a pleasant book may help some people wind down but think about giving up television viewing in bed. Reading a pleasant book may help some people wind down. Studies show that the blue light from our many devices interferes with sleep and random texts and unnecessary alerts wake even the soundest sleeper.  Put them outside the bedroom door.