Menopause A to Z.pdf - Medwords.com.au

MENOPAUSE A to Z
particularly in poorer countries. These poor women constantly dribble urine through their vagina.
Rarer causes include severe allergy reactions affecting the genitals, psychiatric disorders (eg. severe depression)
and birth abnormalities of the bladder structure.
X-rays of the bladder and kidneys, and cystoscopy (looking into the bladder through a thin tube) can be used to
investigate the cause of the incontinence. Incontinence is not a disease but a symptom, and the responsible disease
needs to be diagnosed before any treatment can start, although medications such as propiverine, trospium or
tolterodine may be useful in some patients.
INSOMNIA
Insomnia is an inability to sleep, either a difficulty in getting to sleep, waking repeatedly or for prolonged periods, or
early morning waking (EMW) after initially falling asleep. Sleep is as essential for the normal functioning of the human
body as food and drink. Doctors do not completely understand why we need sleep, but they do understand what
happens when we are asleep.
There are two main types of sleep - deep sleep and REM sleep. REM stands for rapid eye movements, and several
times a night, the level of sleep lightens, and while the eyelids remain closed, the eyes themselves move around
rapidly. It is during this stage of sleep that dreams occur, and it is the more valuable form of sleep. If a volunteer is
observed, and woken every time s/he starts REM sleep, s/he will remain tired and irritable, and obtain little benefit from
the sleep. REM sleep does not start until an hour or so after first falling asleep, and long periods of deep sleep occur
between each episode.
Unfortunately, many sleeping tablets induce deep sleep, but tend to prevent REM sleep, so that people using them
do not benefit from their sleep as much as those who sleep naturally. This is one of the reasons that doctors are
reluctant to use them until all other avenues have been explored.
The amount of sleep needed varies dramatically from one person to another. Some require only three or four hours
a day; most require seven or eight hours; others may need ten hours. As we age, our sleep needs change too. An
infant requires 16 or more hours of sleep a day; in middle age, eight hours is normal; but the elderly need only five or
six hours sleep.
The problem here is that older people may have less to occupy their days, and so look forward to the escape of
eight hours sleep every night, but find they cannot obtain it because their bodies do not require that much. This is
further exacerbated by the low activity levels of many elderly people, and any midday naps they take. As a result, some
elderly people seek help in obtaining extra sleep from their doctors by means of sleeping pills. This is not true
insomnia, merely a desire for extra sleep, above what is biologically necessary.
There are, of course, those who genuinely cannot get to sleep for a variety of reasons, and 15% of the population
fall into this category.
Specific causes of insomnia include stress and anxiety (including post-traumatic stress disorder), pain, depression
(particularly early morning waking), menopause and its associated hormonal fluctuations, snoring, the restless legs
syndrome and Cushing syndrome (over production in the body of, or excessive medication with, cortisone).
Numerous drugs, both illegal and prescribed, may cause sleeplessness. Examples include alcohol, caffeine,
marijuana, cocaine, slimming pills and pseudoephedrine (Sudafed) for runny noses.
There are many things other than medication that can be done to ease the problem.
The simple steps that anyone can use to aid sleep include:-
- Bed is for sleep and sex only, not for watching television or reading.
- Go to bed when you feel tired, not when the clock tells you to.
Do not lie down or nap during the day.
- Do not have a clock in the bedroom.
- Avoid exercise immediately before bed. Take time to wind down before going to bed.
- Avoid drinks containing caffeine such as tea, coffee or cola. Caffeine is a stimulant.
- Do not smoke before going to bed.
- Relax by having a long warm bath and/or a warm milk drink before going to bed.
- Lose weight if you are obese. A slight weight loss can significantly improve sleep.
- Avoid eating a full meal immediately before bedtime. Give your food a couple of hours to settle.
- If you cannot sleep once in bed, get up and read a book or watch television for half an hour before
returning to bed. Never lie in bed tossing and turning.
- Learn to relax by attending specific relaxation classes, which your doctor may recommend. Follow
up by listening to relaxation tapes.
- Try counting backwards slowly from 100.
- Have a radio on all night tuned to a news/information station playing very quietly so that you can just
understand the voice, and listen intently to what is being said when trying to go to sleep and when
awake during the night.
- Instead of counting sheep or worrying about your problems, focus your mind on a pleasant incident
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