If you’ve read our last few blogs, then you know what insomnia is and why it typically occurs in midlife women more. While Google can be exceptionally helpful for finding recipes and which show to binge next, it’s not the best place to go for insomnia treatments (or diagnoses for that matter!). Fear not, we’re breaking down science-backed treatments you can take to improve insomnia during perimenopause. From hormone therapy to medication and herbs to supplements, here’s a helpful guide to understanding what insomnia treatment may work best for you. 

Can hormone therapy improve insomnia?

Since our levels of hormones fluctuate during perimenopause, we should just take more, right? Well, this really depends on your symptoms and if you are a candidate for hormone therapy. Decreased levels of estrogen can lead to hot flashes, which is a big reason why perimenopausal women have insomnia. Studies show low dose estrogen or progesterone (alone and when combined) improves sleep quality in women who experience hot flashes. If you’re interested in being a candidate for hormone therapy, speak with your doctor as side effects such as blood clots, stroke, cancers of the endometrium, or breast may occur.¹

What medications can be prescribed for insomnia?

Sleeping pills work by slowing down your brain waves which helps you feel calm, relaxed, and sleepy. If hormone therapy is not an option for you, or you want non-hormonal treatment for insomnia in perimenopause the following is a list of the commonly used FDA-approved drugs for insomnia followed by their corresponding generic name.

• Ambien (Zolpidem)
• Belsomra (Suvorexant)
• Lunesta (Eszopiclone)
• Restoril (Temazepam)
• Rozerem (Ramelteon)
• Silenor (Doxepin)
• Sonata (Zaleplon)
• Benadryl (Diphenhydramine) * 
• Unisom (Doxylamine) *

*Found over the counter.

As with all medicated drugs, you should be aware of their potential side effects. “Z-drugs” (zolpidem, eszopiclone, and zaleplon) are associated with complex sleep behaviors such as sleepwalking, sleep driving, or sleep cooking (yes, cooking unconsciously is a thing and can be very dangerous!).

Studies that measured sleep quality in menopausal women taking zolpidem, eszopiclone, and ramelteon reported an improvement in sleep quality — however, it’s crucial you talk to your doctor about dosage. According to the FDA, these drugs have a history of leading to accidental overdose and other life threatening side effects in insomniac patients. Your doctor can help you safely decide which medication is best for you. ²

Can antidepressants improve insomnia?

Depression and insomnia is a classic game of which came first, the chicken or the egg? Insomnia is one of the many symptoms of depression and yet, insomnia can also lead to states of depression. 

If you have depression and insomnia, it’ll be most beneficial to seek treatment for both conditions as one can easily trigger the other. Antidepressants are commonly used for depression and there are many to choose from. Perimenopausal women with both depression and insomnia were found to have a better mood, sleep quality, fewer hot flashes, and higher quality of life scores after taking Lexapro (Escitalopram). Celexa (Citalopram) is another antidepressant that has been shown to improve insomnia symptoms for women in perimenopause. ¹

Can herbal and nutritional supplements improve insomnia?

Two supplements that can help improve sleep during perimenopause are isoflavones and valerian root. Isoflavones are also known as phytoestrogens as they are similar in structure to estrogen. One study found that women who take isoflavones reported a three fold improvement of hot flashes and insomnia as compared to taking vitamin D and calcium supplements. Soybeans have the highest level of isoflavones. Herbs, such as red clover and alfalfa, also have high levels of isoflavones. 

Valerian root works to improve sleepiness by interacting with the GABA system in our brain. This is the same system that the “z-drugs” workout, but without the complex sleep behaviors as side effects. In one study, 100 perimenopausal women who had chronic insomnia took valerian root twice a day and were found to have better quality sleep. Valerian root is commonly used 60 minutes before bedtime. It can be taken in tablet form, liquid extract, or as a powder to make into a tea. Beware it has a very pungent odor, which can be off putting for some   ^1,3

Navigating life during perimenopause can be complicated, especially when you are exhausted. Keep fighting and know there is light at the end of the tunnel, and most importantly, good treatments do exist! Talk to your doctor to see which option is best for you. 

For more information on how to get the best sleep of your life during perimenopause contact Dr. Val at www.sleephoria.health, 1:1 sleep coaching is available.

References:

1. Attarian, H., Hachul, H., Guttuso, T., & Phillips, B. (2015). Treatment of chronic insomnia disorder in menopause: Evaluation of literature. Menopause, 22(6), 674–684. https://doi.org/10.1097/GME.0000000000000348
2. FDA (2019, April 30).Taking Z-drugs for Insomnia? Know the Risks https://www.fda.gov/consumers/consumer-updates/taking-z-drugs-insomnia-know-risks
3. Christiansen, S. (2021, September 8) What are Isoflavones? For menopausal symptoms, preventive health, and more. https://www.verywellhealth.com/isoflavones-benefits-side-effects-dosage-and-interactions-4687017.