Section 3: Medical and Behavioral Treatments

While good sleep habits should be a part of any sleep plan, there are treatment options that can help alleviate your sleep struggles: 

Menopause Hormone Therapy – Studies have shown that Hormone Replacement Therapy (estrogen and progesterone) improves sleep quality, enables falling asleep, decreases nighttime wakefulness, and also reduces vasomotor symptoms in postmenopausal women. While this treatment option is effective for some women, your medical history will be an important factor in whether it is a suitable option for you. You should discuss with your doctor whether HRT is an option.

Cognitive Behavioral Therapy for Insomnia (CBT-I) – CBT-I is a structured program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Unlike sleeping pills, CBT-I helps you overcome the underlying causes of your sleep problems.

The therapy is typically conducted over a course of several weeks and includes various components such as:

1. Sleep Education: Understanding the mechanisms of sleep and the factors that can disturb sleep.
2. Sleep Restriction: Limiting the amount of time spent in bed to be closer to the actual time spent sleeping, thereby increasing sleep efficiency.
3. Stimulus Control Therapy: Creating and maintaining a sleep environment that promotes and is associated with healthy sleep.
4. Sleep Schedules: Establish and maintain a consistent bedtime and wake-up time.
5. Sleep Hygiene Training: Teaching habits that promote good sleep, such as limiting caffeine and creating a pre-sleep routine.
6. Cognitive Therapy: Addressing the attitudes and beliefs that hinder sleep. This may include unrealistic sleep expectations or catastrophic thinking about the consequences of sleeplessness.
7. Relaxation Techniques: Methods such as muscle relaxation, deep breathing, and meditation to reduce anxiety and body tension.

CBT-I is considered the gold standard for treating insomnia because it effectively addresses the root causes of insomnia without the side effects associated with medication. Studies show that CBT-I has a profound and lasting effect on reducing insomnia symptoms and improving sleep quality.

Supplements – Some supplements like magnesium and L-theanine (an amino acid found primarily in green and black tea and some mushrooms) have been reported to help with sleep. However, because supplements in the US are not regulated by the Food and Drug Administration (FDA), their safety and efficacy cannot be guaranteed.

Over-the-Counter Sleep Aids – Over-the-counter (OTC) sleep medications, such as antihistamines, are not recommended as sleep aids by experts although they are often advertised as such. While they are easy to access and may offer temporary relief for sleep disturbances, the risks include potential dependency, grogginess, tolerance build-up, and interactions with other medications. Furthermore, some sleep aids may not address underlying causes of sleep issues, making it essential to consult a healthcare provider before prolonged use.

Prescription Medications – Prescription sleep medications can provide significant relief, helping to restore more consistent, restful sleep. These medications are often stronger and more targeted than over-the-counter options, potentially addressing insomnia related to hormonal changes. However, the risks include dependency, potential side effects like daytime drowsiness, dizziness, or cognitive issues, and the possibility of tolerance, where higher doses are needed over time for the same effect. Therefore, long-term use is not recommended.  Long-term use can also mask underlying issues, so it’s crucial for women to work closely with a healthcare provider to find a balanced, safe approach.