An insomniacs guide to falling asleep: a women’s addition.

My cast is finally off and I feel absolutely amazing to be free of it! It was removed this Thursday, just in time for my boyfriends sisters wedding (very much enjoyed wearing a dress and two pairs of shoes).  I’ve been making some serious progress in my recovery over the last few days. From my first VERY uneasy steps out of a cast to my now, almost comical, hobble, I am very happy that I can finally start getting my independence back.  The satisfaction of scrubbing away all of the (heaps of) dead skin and moisturizing was almost indescribable. I am also really enjoying being able to carry things from room to room- 2 months of not being able to carry things with my hands has certainly made me realize how amazing it is to have two functioning legs!

Here’s some picture of me climbing before my cast came off!

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While insomnia, a condition that involves a difficulty in falling and/or staying asleep, is an increasingly common burden, females are taking the biggest toll. In an American survey, 27% of the female participants suffered with insomnia verses the 19% of males. In fact, women are 41% more likely to experience insomnia than males, and even more so during menopause, when over 50% of women reporting significant insomnia symptoms. Sleep loss is a major hit to our overall health and wellbeing, directly contributing to a lower blood sugar control, weight gain, memory impairment, whole body inflammation, increased appetite, anxiety and a higher risk for chronic disease. While sleep is influenced by a number of factors, such as light and melatonin, diet, and stress, it’s becoming increasingly clear that sex hormones can play a significant role in our ability to fall asleep.

As many of you know, melatonin is an important sleep hormone that is produced later in the day by our pineal gland to make us sleepy at night. Dysregulation of this sleep hormone is thought to be a common cause of insomnia, brought on by brighter lights, higher activity levels and more stress close to bedtime. Due to an age related degradation of the pineal gland, melatonin is also significantly lower in elderly individuals, contributing to insomnia in old age. As a result, melatonin supplements are promising for managing insomnia in individuals with a dysregulation of melatonin, especially in elderly individuals. Furthermore, they have a high safety profile and do not have the addictive potential or hangovers seen in pharmacological agents. Unfortunately for many of us women, insomnia can also be brought on by the hormonal changes throughout our lifetime, making its treatment far from straight forward. For example, lower estrogen during menopause, nighttime elevations in luteinizing hormone pulses in postmenopausal women and low estradiol levels across the menstrual cycle are all associated with less sleep. With the complexity of insomnia in women aside, what can you do to get better night’s sleep?

1) Adjust your bedtime routine!

Often the first step doctors take (or should take) while treating insomnia is taking a look at your bedtime routines. Strategies to manage insomnia are complex but typically begin with establishing a sleep and sex only rule for the bedroom, only going to bed when tired, leaving if unable to fall asleep within 20 minutes and keeping a set wake-up time. This strategy is effective at promoting an association with the bed and sleep. If you tend to exercise, eat heavy meals, drink coffee or smoke close to bedtime, think about moving those activities earlier in the day to avoid arousal or discomfort when you try to sleep. Since light stimulation is associated with melatonin production, avoiding bright lights (e.g. TV, cellphones, and computers) close to bedtime, and even dimming your house lights if possible, can be an effective way at promoting sleep. As someone who has struggled with insomnia first hand, I know all about the worry and expectations for sleep that comes with it close to bedtime. This worrying and frustration only makes things worse so try to be positive about whether you sleep or not, which I know, is a very difficult task. Reading can be an effective way at turning off your brain enough to stop thinking about not sleeping. Finally, finding a relaxation method can be a useful step for getting sleepy and keeping positive. Good options for this final step can include progressive muscle relaxation, deep breathing techniques and meditation.

2) Take a look at your diet!

Healthy diets with regular meals, fewer refined carbohydrates and saturated fats, and more fruits (growing studies on tart cherries and kiwifruit), vegetables, nuts, and legumes have been demonstrated to promote a good night’s sleep. These diets provide adequate magnesium, calcium, tryptophan and B vitamins, which have all been seen to improve sleep by enhancing the production of both serotonin and melatonin. If you’re vegetarian and not taking a B12 supplement, seriously consider taking one since it is typically missing from plant-based diets (primarily found in animal products) and is associated with sleep loss if missing (as well as a slew of other health issues). A low level of blood tryptophan has been shown to be another important factor for insomnia and is influenced by a number of factors. For example, carbohydrates help your brain use tryptophan. As a result, a lack of tryptophan use in the brain can be a problem in people who are eating a carbohydrate restricted diet. Tryptophan rich foods include sesame seeds, lentils, beans, sunflower seeds and miso. Consuming these foods with complex carbohydrates, especially when having bedtime snacks, is a good way to promote sleep.

Lower estrogen levels, seen in both in women going through menopause or struggling with amenorrhea (lack of menses), are also associated with lower tryptophan levels and sleep loss. Because of this fact, estrogen supplementation has been demonstrated to be effective at elevating tryptophan levels and improving sleep in these individuals. Since there are a few concerns with hormone replacement, specifically higher risks for heart disease, food sources of phytoestrogens can be a safer alternative, with growing research demonstrating their efficacy. Phytoestrogens, non-steroidal plant derived compounds that have estrogenic activity, are mostly put into three main classes: isoflavones (in legumes, particularly in soy), lignans (rich in high fiber foods, especially flax) or coumestans (e.g. alfalfa, clover sprouts, pinto beans, split peas). Although research is limited, these food items have been shown to have some clinical effectiveness, especially isoflavones. Increasing these food items, especially in women with low estrogen levels, can be another safe way to improve sleep.

3) Address your mental health!

Stress is seen to activate the sympathetic nervous system and is a major contributor to a hyper-arousal around bedtime, resulting in a racing mind that’s hard to shut off at bed time. Furthermore, women tend to experience higher levels of anxiety disorders (1 in 4 women) which frequently results in depression, also more common in women. About 60% of women who experience depression complain about sleep loss. What makes matters worse is that sleep loss alone increases the likelihood of developing a major depressive disorder by fourfold, creating a vicious and frustrating cycle. Making lifestyle changes that promote mental health can have a significant and positive impact on your ability to sleep and can include things such as meditation and positive thinking. Simply practising compassion, smiling more frequently, helping other people and avoiding negative thoughts can do wonder for your mental health. Exercise is another important and effective part of enhancing both mental wellbeing and our overall health. New to exercise and don’t know where to start? Working exercise into your routine doesn’t have to be a huge ordeal and can include simply taking walks during your breaks of using the stairs when possible. Finding a fun activity can be an excellent way to get those good endorphins going; community colleges offer a wide selection of fitness classes that can be a great way to get active. Maybe join a recreational sports league or find a new hobby (rock climbing anyone?). Finding something that you enjoy is a good way to motivate you to stick with it.

Clearly insomnia is a very complex issue, especially for us women. Hopefully this information will help set you on your way to a better night’s sleep!

Bedell S, Nachtigall M, Naftolin F. (2014) The pros and cons of plant estrogens for menopause. Journal of Steroid Biochemistry & Molecular Biology 139:225– 236.

Fernstrom J. (2012) Effects and Side Effects Associated with the Non-Nutritional Use of Tryptophan by Humans. J. Nutr.142(12):2236S-2244S.

Flores-Ramos M et. Al. (2014) Gonadal hormone levels and platelet tryptophan and serotonin concentrations in perimenopausal women with or without depressive symptoms. Gynecol Endocrinol 30(3): 232–235.

Guidozzi F (2013) Sleep and sleep disorders in menopausal women. Climacteric 16:214–219.

Peuhkuri K et. Al. (2012) Diet promotes sleep duration and quality. Nutr Res 32:309 – 319.

Schwartz M and Mong J (2012) Estradiol modulates recovery of REM sleep in a time-of-day-dependent manner. Am J Physiol Regul Integr Comp Physiol 305: R271–R280.

Siebern A, Suh S, Nowakowski S (2012) Non-Pharmacological Treatment of Insomnia. Neurotherapeutics 9:717–727.

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5 comments on “An insomniacs guide to falling asleep: a women’s addition.

  1. brixpoul says:

    Hi Jennifer,
    So cool photos of you climbing with the cast, I had a fall rock climbing last week and snapped my ankle out of the joint and all I can think of is getting a secong operation tomorrow to put some pins in place, get out and start slowly on that wall again!
    I really don’t want to lose to much strenght and fitness during this forced break!
    Any tips for staying fit while on crutches?
    Cheers, Poul

    • Hey Poul!

      First off- sorry to hear about your injury! I kept on top rope climbing as soon as I was able (after 2 full weeks off while I was in the soft cast) which did a lot to keep me in shape. I started doing more upper body workouts (more pullups, campus board (spotted), hang board, rings, etc.) and began lead climbing after a week of top roping. Now I probably did a lot that I probably shouldn’t have so be sure to ask your doctor about continuing climbing. Also- Since I was missing my foot while climbing, I was forced to campus most moves; I noticed some serious gains in my upper body power and grip strength. My best piece of advice is to stay positive (very hard at times, I know) and see all the silver linings. For me, I was forced to work on my weaknesses which I think will result in me climbing much harder this coming season :).

      Wishing you a speedy recovery!
      Jen

      • brixpoul says:

        Hey Jen,

        Thanks a lot for your reply, it helps with my optimism to hear from others that it is possible to get thought this without losing too much fitness and strength, maybe even improve some of my weaknesses :-)

        I’m already working on upper body, fingers and using a hand bike for fitness and tomorrow I should get the external fixator unscrewed from my bones and then it’s a hard cast for up to 4 weeks.

        Have a wonderful day
        Cheers, Poul

  2. MissFit says:

    Awesome as always – love the inclusion of the blood tryptophan i had no idea those foods had it; we are so used to hearing about Thanksgiving turkey and tryptophan!

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