Wide Awake at Midlife

What keeps us awake? The list is long. Stress. Anxiety. Flickering screens. Demanding workdays that overflow into the nighttime hours. Worries about teenage kids or elderly parents. Noise. Hormones.

Insomnia might rear its ugly head as the inability to fall asleep, stay asleep or fall back to sleep if you wake during the night.

“We see it across the age span,” said physician Dawn Flickema, MD, Avera Medical Group Integrative Medicine. “Most often it’s a product of our busy lifestyles.”

Being “too busy” can lead to a racing mind. If you imagine your brain as a computer, and it’s busy sending emails, making lunches and folding laundry until bedtime – you can see why it can overwhelm you.

“Like a computer, you have to shut down to restart,” Flickema said. Good rest can be your reset, she added.

Why Insomnia Happens at Middle Age

Numerous factors can make those precious ZZZZs even more elusive at midlife, including hormone imbalance at perimenopause and menopause and those unwelcome hot flashes.

“Rather than being the underlying cause of sleeplessness, it might be that one factor that makes everything else too much to handle,” Flickema said. You can ask your clinician about treatments that can help ease menopause symptoms.

Your body’s metabolism can cause difficulty sleeping. Eating a lot of carbs late in the evening or drinking alcohol can cause a glucose drop that stimulates your body to wake up.

Sometimes, the reason for lost sleep isn’t all in your head – it’s all in your bladder – when you have to get up to “go” multiple times during the night.

“This happens more as we get older for several reasons. Women who have had babies can experience greater weakness in their pelvic floor,” said Flickema said. Or, if you have varicose veins you might have fluid gather around your ankles. It can move to your kidneys when you lie down.

Many women cope by not drinking any water after supper. “But then you dehydrate yourself, and by morning you are well behind on fluids,” Flickema added. “There are changes you can make to your daily routine, but cutting water isn’t among them.”

Instead, she advises women to do Kegel exercises to strengthen the pelvic floor. They can also try to retrain the bladder by waiting longer before going. When you do urinate, empty your bladder completely. There are also medications that can help.

If the problem is still not resolved, women can be referred to Avera Medical Group Urogynecology for specialty care.

A Sleep Disorder May Be to Blame

Sleep apnea is common sleep disorder men and women experience. People with the condition will experience stoppage of breathing due to airway blockages. “You unknowingly wake yourself up to breathe,” Flickema said.

Snoring and gasping is a sign of this disorder which causes your oxygen levels to drop. “If you have apnea, you’re not getting that good REM sleep that your body needs,” Flickema said.

People who have apnea and are referred for sleep studies may have ongoing treatment that includes use of a CPAP.

If sleep problems persist, see your doctor. While a prescription sleeping pill is a last resort, sometimes it’s needed to get you back on track.

All-Day Tips for Better Sleep at Night

Flickema said there’s good news: simple daily routine changes can improve quality and quantity of your sleep.

“Non-pharmaceutical interventions such as exercise, mindfulness, bedtime mind-body exercise and good nutrition can balance hormones and improve sleep,” she added. Other helpful ideas include:

• Expose yourself to natural daylight to regulate your sleep/wake cycle.
• Eat a healthy, balanced diet that emphasizes fruits and vegetables, protein and complex carbohydrates.
• Avoid foods that are high in carbs and sugar at night.
• Limit caffeine, especially in the evening.
• Find ways to quiet your mind before bed, for example, meditation or light reading.

If you learn to practice mindfulness during the day, then you can use those strategies to calm your mind down when trying to go to sleep. More tips might include:

• Avoid screen time in the evening. The blue flickering light of any device can “trick” our body to stay awake.
• Turn down the thermostat – the best sleeping temperature is 68 degrees.
• Go to bed and get up at the same time every day. Sleeping in on Saturdays or taking long naps won’t help your cause.
• Go to bed when you’re naturally tired – 10 to 10:30 p.m. for most people. If you miss that window, you might get a second wind that makes it even harder to fall asleep.
• Don’t depend on alcohol to put you to sleep. While it initially makes you feel sleepy, it can cause you to wake during the night.

Supplements, in small doses, can also help. Chamomile tea, l-theanine or 3-milligram doses of melatonin are effective choices for many. “Poor sleep has a multitude of bad effects on your body and spirit,” Flickema added. “But you can improve it.”

Need more help? Start by talking to your family doctor; you can also see integrative medicine experts who can guide you through changes.