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Sleep Disorders

Only sleep normally 1-2 times/month

09/24/2007

Question:

For as long as I`ve been exclusively brestfeeding my daughter (about 18 months now), I`ve always had problems staying asleep at night. However, I just realized that only during the first day of my period can I actually sleep through the night without trouble.

I don`t know if I`m delusional or if my reasoning is an effect of my insomnia, but does this make any sense? Is there really a pattern here? Is it possible for me to get back to sleeping through a night without waiting for "high tide?"

Answer:

Insomnia is a very common. A third of Americans suffer from insomnia at one point during their lives. Fortunately, most of these are short-term and resolve within weeks, rarely requiring prolonged therapy. However, up to 20 million Americans complain of problems with chronic insomnia that may significantly effects their life. Even though your problem seems to be different, I'd like to assure you, that you are not delusional.

It seems that your problem is mainly staying asleep rather than falling asleep, and that you associate this with the time you have been breast feeding. Many hormonal changes occur during pregnancy and the time after delivery. The effects of these changes on sleep are not well understood. What is known is that during breast feeding, levels of a hormone called "Prolactin" peak, and this has been associated with an increase in deep sleep. This, in itself, suggests that breast feeding may not be the root of your sleep problem. More complicated hormonal changes occur during the menstrual cycle. The effects of these changes are variable and have not been studied adequately to draw clear conclusions. In limited reports, subjective sleep quality was found to be lowest around menses, but the timing and composition of sleep remained relatively stable across the menstrual cycle. This is not the case for you.

Your sleep problem is unusual, and could be confounded by more factors than the ones you are describing. These may include one or more of the following; a poor sleep environment (e.g., the bedroom is too noisy, too bright or too warm), learned poor sleep habits (e.g., watching TV), excessive use of stimulants (medications, caffeine, and nicotine), stress or anxiety, some psychiatric conditions (e.g., depression, bipolar disorder), pain, medical conditions that may make it uncomfortable or difficult to breath well when lying down, heartburn, restless legs syndrome (an irresistible need to move the legs when awake at night) and circadian rhythm disturbances (when the body's biologic rhythms are out of synchrony or delayed).

Without knowing more about your case, it is hard to comment on potential causes and treatment options. Some simple strategies you may consider before discussing your problem with your doctor include the following:

1) Try writing down a "worry list" 2 hours before bedtime. This should include things you need to do the next day and serve to "free your mind" of the day's troubles.

2) Establish a relaxing bedtime routine that does not involve listening to music. A warm bath 1-2 hours before bedtime or some light reading may be useful.

3) Avoid caffeine and alcohol 6 hours before bedtime.

4) Daily exercise, particularly earlier in the daytime, may help you rest better at night.

The workup of insomnia usually requires a detailed evaluation by your primary care physician, and may require the help of a Sleep Specialist.

If you would like additional information regarding sleep and sleep disorders, you can obtain it on the American Academy of Sleep Medicine website. This website also contains a list of Sleep Centers across the country so you can locate one near you if need it. Good luck, and sleep well.

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Response by:

Ziad  Shaman, MD Ziad Shaman, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University