The Senior Scene

Peri- and post-menopausal women don’t often complain about poor sleep, says menopause specialist Terry Silvestrin.

“They don’t complain because they’ve come to expect it,” she says.

But that’s just the kind of stoic resignation Silvestrin says puts women’s health and well-being at risk.

“Sleep disruption can be one of the most disturbing symptoms of menopause,” Silvestrin says.

Women suffering from disrupted sleep find it more difficult to focus at work or at home.

“It gets to be a vicious cycle,” Silvestrin says. “As it keeps going, it affects your work, your personal relationships, your sexuality. It can affect moods and it can become a safety factor when women are driving while very groggy in the morning.”

So what’s a woman to do? It starts with identifying the factors contributing to sleep disruption. One of the classic menopausal symptoms that affects sleep is the “hot flash,” or night sweats.

“You can’t control a night sweat, but what you can do is change the environment to be more restful,” Silvestrin says. “Wear less to bed so you’re not going to get as overheated. Get a personal fan and direct it on you so it’s not disturbing your partner.”

If it’s safe, open a window, she advises. And when you do get hot, uncover your head and feet, even though those aren’t the only parts of your body that get overheated. “If your head and feet are uncovered, you’re going to cool off the fastest,” Silvestrin says.

Cooling pillows and mattresses also help, but sometimes it’s not enough.

“I literally have women tell me, ‘I jump out of bed, fling the back door open and walk outside, and I’m naked,’” she says.

If night sweats and temperature-related sleep disturbances are that persistent, Silvestrin suggests considering hormone replacement therapy. And if you’re skeptical, she urges women to talk to their doctors and learn more about hormone replacement before dismissing it out of hand.

“Menopausal hormone therapy can play a real relieving role,” she says. “You don’t have to be scared of hormone therapy any more.”

Absent specific risk factors, hormone replacement can be an effective tool for many women, at least for a time. “You may need it now, you may not need it in a year,” Silvestri says. “Nothing is forever.”

Aside from temperature spikes, the menopausal years also seem to see an increase in general anxiety for women, who are often still caring for children in the home while also facing the responsibility of their own aging parents and increased work responsibilities.

“What women are doing far too often is simply too much,” Silvestrin says. “There’s an inability of the mind to shut off.”

Silvestrin recommends keeping a set sleep schedule, turning off electronics at least an hour before bedtime, and making sure alarm clocks aren’t easily viewed. Seeing the minutes tick by can make sleep even more elusive. Drink plenty of water and avoid caffeinated beverages after dinner. And definitely don’t have that heavy discussion with your spouse just before bedtime.

Over-the-counter medication can help, too, Silvestrin says. Melatonin is an herbal sleep aid that helps some women. Benadryl can also help, but you have to take it well before bedtime or you’ll wake up groggy. Silvestrin says these medications aren’t habit forming.

For those with the most serious sleep problems, prescription sleep aids are available, but should be used only once or twice a week, Silvestrin advises. She also advises taking them only when you have an especially important event the next day, and acknowledges that it’s easy to fall into a habit of using them nightly.

“They have dependent, addictive potential,” she says. “If you’re not sleeping, you’re not thinking well and you’re also not safe.”

For some women with anxiety, panic attacks or OCD (obsessive-compulsive disorder) symptoms, antidepressants can provide the sleep relief they need. The key is talking frankly and honestly with your health care provider, Silvestrin says.

Finally, Silvestrin says more women should probably get sleep study referrals for sleep issues during menopause, to determine if there are other issues at play.

“We can find out if other factors affecting sleep beyond menopause disruptions are hindering a good night’s rest, such as lack of oxygen,” she says.

Regardless of what’s keeping you up at night, you don’t need to suffer in groggy silence. “Quality of life is the bottom line, from my perspective,” Silvestrin says.

 

Terry Silvestrin, who wrote this article,

is a nurse practitioner and certified menopause clinician with MultiCare Health System, a not-for-profit healthcare organization.

It’s that time of year when people with Medicare review their health insurance choices and enroll in a Medicare Advantage or prescription drug plan for the coming year.

People typically have a lot of questions as they research their Medicare options, which primarily include Original Medicare, Medicare Advantage and Medicare Supplement plans, before finding the plan that best fits their needs. Here are some of the most commonly asked questions Humana licensed health insurance agents get from consumers:

When is the annual enrollment period to choose a Medicare plan for 2019?

The period takes place from Oct. 15 through Dec. 7, 2018, for coverage that takes effect Jan. 1, 2019.

Do I have to re-enroll in Medicare every year?

You don’t need to sign up for Original Medicare each year. However, you should review your Medicare Advantage or prescription drug plan coverage annually, since Medicare plans and personal circumstances can change every year. If you take no action during the annual enrollment period, you’ll typically automatically be re-enrolled in your same medical or prescription plan for 2019.

Does Medicare include coverage for my prescription drugs?

Original Medicare does not cover most prescription drugs. Many Medicare Advantage plans include prescription drug coverage, or you can sign up for a Part D Prescription Drug Plan separately. A licensed agent can look up your medications and tell you what the cost of each drug would be on a plan.

How are health insurers able to offer Medicare Advantage plans with no monthly premium?

Private insurers keep premiums low through programs like disease and chronic-care management, which help people better manage health conditions and, in turn, reduce healthcare costs. Keep in mind that you still need to pay your Medicare Part B premium, which covers medical services and preventive care. You might want to use the additional premium dollars you save for out-of-pocket medical costs, such as co-pays.

How do I find out if my doctors, hospitals and specialists are in my Medicare Advantage provider network?

Most Medicare Advantage plans offer easy-to-use online tools to help you find doctors and hospitals that are in the plan’s network. A licensed agent can also help you look up hospitals and doctors to see if they’re accepting a plan and taking new patients.

If I select a Medicare plan for the coming year, and then find I don’t like it, can I drop it and choose another plan?

The plan you select by Dec. 7 will be your Medicare plan for all of 2019, with few exceptions, so it’s wise to research your options carefully. If you sign up for a Medicare Advantage plan for 2019 and then find it’s not the right fit, between Jan. 1 and March 31, there will be an open enrollment period during which you can switch from a Medicare Advantage or a Medicare Advantage-Prescription Drug Plan to another Medicare Advantage plan with or without prescription drug coverage, or choose Original Medicare with or without a standalone prescription drug plan. Full information on 2019 Medicare health and prescription drug plans is available on www.medicare.gov. You can also call 1-800-MEDICARE (1-800-633-4227) (or TTY: 1-877-486-2048) 24 hours a day, seven days a week.

 

Catherine Field, who wrote this article, is a regional president of Humana, a Medicare, healthcare and prescription drug plan organization.