Hormones, Sleep, and Insomnia – Q & A
1) Why to women have more insomnia than men?
This is true, but it seems strange since slow wave sleep (the deepest stage of sleep) is less in men.
The answer lies in aging rate differences in the major sleep inducing center (the VLPO). It deteriorates more rapidly in women. Thus, an imbalance develops between the brain’s sleep and wake centers. The alerting centers becoming more dominant. Result—Women have more insomnia.
2) Why does Insomnia flare around the menstrual period?
Estrogen & progesterone have sleep inducing properties. These hormones fluctuate wildly around the menstrual period and is like a teeter totter effect. The rapid decline from elevated levels produce a rebound with resulting insomnia.
3) What does prednisone do to sleep?
Did you ever have poison ivy or asthma and were placed on prednisone. Odds are that you had insomnia. Forget about the annoyance from not breathing or itching- these can be minimal or absent.
Sudden changes in Cortisol or its medication equivalent (prednisone) ramps up the arousal system so you can’t get to sleep or stay asleep. Hello insomnia.
4) What do you do about Insomnia?
There are two treatment paths, and they are not mutually exclusive. You can use combinations. The first is non-pharmacologic (no sleeping meds). The other is pharmacologic (sleeping pills). Both paths are designed to decrease insomnia’s hyperarousal state so you can get to sleep or stay asleep. Both work (but not equally well for every person). Both have their down sides.
a) Non-pharmacologic path (also called Cognitive Behavioral Therapy for Insomnia or CBT-I)
CBT-I usually has a 2-week learning curve before seeing benefit and you often feel worse during that time. But -- if you can tolerate the terrible 2’s—it is like having an extra arrow in your quiver and you do not have to pay for the arrow.
Furthermore, CBT-I lasts longer. Perhaps because the therapy, once learned, remains with you. There is no need to return to the pharmacy for refills.
b) Pharmacologic path (sleeping pill route).
There is no 2-week learning period because everyone knows how to swallow a pill. The problem is that you must pay for the pill.
There is another problem—something that everyone with insomnia worries about. That is “will I become addicted” to this stuff. The answer was provided in a 20-year study by the Food and Drug Administration (FDA). The study looked at two large groups. One was a large population arm. In the other arm, they followed individual patients. The study results were released in 2006.
In the population arm, the FDA was looking to see if after 20 years there were more persons in the population taking sleeping pills. In this arm the FDA found a 1% decrease in the use of sleeping pills.
In the Individual arm resulted in the identification of two personality types – the “drug seeker” and the “therapy seeker”.
The drug seeker type:
This is the type the FDA does not recommend sleeping pills for. These persons are using the medication to supplement their primary drug of abuse (alcohol or drugs). They tend to take the sleeping pill in excessive amounts and at unusual times during the day.
The therapy seeker type
The FDA agrees with providing pills to this group. This group takes their sleeping pill at night when it makes sense for insomnia control. There were no abuse problems more than the control group. Furthermore, they stopped their sleeping medications when no longer needed.
Almost all sleep medicine physicians have some person on a long term sleeping medications. Perhaps it is how your nervous system is put together. Insomnia is a hyperarousal state. You are using the medication to dumb down the hyperarousal state so you can get to sleep or stay asleep.
If you have questions, we encourage you to reach out to a doctor at Iowa Sleep by sending us a question. We can help you identify the reasons you may not be sleeping well and get you on the path to sleeping better each night to wake you ready to take on another day. You can also call (800) 226-6084 to schedule a consult with one of our board-certified sleep physicians.
Written by Steve Zorn, MD, Board-Certified Sleep Physician and Medical Director of Iowa Sleep