Are you or your patients sleeping well? Mine are not, and I wasn’t either. Do you ask them how they sleep? I never used to ask, and no one asked me. When I was in medical school, we had rigorous instruction in taking detailed medical histories. Sleep quantity and quality were not included.
What changed? Is it the digital age we live in, or is it the pervasive multi-tasking we undertake? The definitive study may never be done. I never anticipated, when I started out in gynecology 28 years ago, that lack of sleep would be one of the first “complaints” my patients would voice. To clarify, as a menopause specialist, I do evaluate women who have night sweats. However, the sleep challenges my patients face are not always related to getting hot and sweaty after the lights go off.
As a gynecologist, I don’t consider myself a sleep expert. My patients often attribute their lack of quality sleep to menopausal changes, and, at times, request that I prescribe hormones to help them sleep. When menopausal changes do not explain their specific sleep concerns, hormones are not the answer. Lack of quality sleep has many causes, and some of them respond well to lifestyle changes. Here are two of my favorite suggestions to help you and your patients get more quality sleep before obtaining prescription sleep medications or consulting a sleep specialist, either of which may be an appropriate in individual cases.
1. Avoid looking at back-lit screens for 60 minutes before bedtime. That means no television, iPad use, laptop use, checking the smartphone, or reading a back-lit e-reader before bed. Reading a book made from trees is ideal, as is listening to music or having a relaxing conversation, if you remember that vanishing social custom.
2. Taper the amount of caffeine you consume. Even if you finish your coffee in the morning, you will benefit. It takes six hours to clear half the amount of caffeine you consume. With super-sized coffee cups, a large cup may contain more than 200 milligrams of caffeine. Here is the math. If you drink three large cups of coffee by 11am, you have consumed 600 milligrams of caffeine. Six hours later, at 5pm, 300mg of caffeine remain in your body. Six hours after that, at 11pm, 150mg remain. At 5am the next morning, 75mg of caffeine remain from the previous morning. This compromises your ability to fall asleep readily, and makes your mind race. It also prevents deep, rapid eye movement (REM) sleep. If your patient offers to stop “cold turkey,” don’t let her. A slow taper prevents caffeine-withdrawal headaches.
Both caregivers and patients alike may benefit from trying one or both of the strategies discussed here: avoiding back-lit screen viewing during the hour before bed, and tapering the amount of caffeine. Sleep medicine has much more to offer if you or your patients still don’t get a good night’s sleep.
Julia Schlam Edelman is an ostetrician-gynecologist and author of Successful Sleep Strategies for Women.
Image credit: Shutterstock.com
