Sleep disorders represent one of the most annoying and potentially debilitating symptoms of Andropause. Long-term persistent lack of adequate sleep can disrupt daytime activity, affect job performance and general lifestyle, and trigger multiple health related physical and emotional problems in turn. Fortunately, most common cases of sleep disorders are preventable and treatable through lifestyle and diet changes, medications, and hormone replacement therapy as last resort.
Male and Female Differences in terms of Sleep
Differences in sleep patterns between men and women are found throughout the ages, and it is confirmed that men are more likely to suffer from sleep disturbances such as snoring and sleep apnea amongst others, than women are.
The traditional picture of the male sleeping anywhere or falling asleep on the sofa may not be just a joke. Recent research has shown that men may in fact sleep better alone. When men and women were tested for cognitive ability and levels of stress after sleeping together, the men fared worse than the women. The men appeared to be more disturbed when sharing a bed than the women, while the women enjoyed a better night's sleep.
Another major difference between men and women is related to the fact that men frequently fall asleep immediately after the intercourse, while women may stay awake for long. That created many jokes and multiple family conflicts, while women were accusing men in lack of feelings. However, it was scientifically proven that there are many reasons for men to fall asleep straight after sex, and that is nothing to do with attitude to the partners.
One supposition is that men have sex at night and the combination of daytime exhaustion and muscular tension followed by deep relaxation induces sleep. Another is that prior, and during ejaculation, men hold their breath for a short period and readjustment causes changes in breathing that create deep relaxation, encouraging sleep.
Whatever the reason, it appears that sex is a good prelude to falling asleep for men and not the best time for conversation. Women may feel more stimulated after sex and find it harder falling asleep. An awareness of the affects of sex on both partners will help maintain harmony in the bedroom.
According to researchers from the Penn State University lack of sleep can be fatal for men. Surprisingly, women were not significantly affected by lack of sleep. Researchers studied for more than a decade 2,000 men and women, examining their sleep patterns in a sleep laboratory. They found out that men who slept for only 5-6 hours a night had five times higher risk of dying from medical complications. In comparison to those who slept 6 hours or more.
Sleep Stages and Aging
Normal sleep has different stages that cycle throughout the night. Sleep specialists classify these as rapid eye movement (REM) sleep and non-REM sleep.
- REM sleep is the stage in which muscles relax most completely. Dreaming occurs during REM sleep.
- Non-REM sleep is subdivided into 4 stages. Stages 1 and 2 constitute light sleep; stages 3 and 4 are called deep sleep. Deeper sleep generally is more refreshing.
Sleep changes with age. Older people are less efficient sleepers and have different patterns of sleep than younger people.
· The duration of REM sleep decreases somewhat with aging.
· The duration of stage 1 sleep increases, as does the number of shifts into stage 1 sleep. Stages 3 and 4 decrease markedly with age in most people, especially men. In people aged 90 years or more, stages 3 and 4 may disappear completely.
Common Sleep Disorders
Men at Andropause are experiencing significant sleep disturbance patterns, making it hard to impossible to sleep properly through the night. The most common sleep disorders include:
- Insomnia: Inability to fall asleep and/or waking up frequently on a regular basis.
- Sleep apnea: Cessation of breathing during sleep (often accompanied by snoring).
- Night sweats: Nocturnal hot flashes (sudden sensation of intense heat, perspiration, flushing) that disrupt sleep.
- Restless Leg Syndrome (RLS): Irresistible urge to move the legs during rest, often experienced as an itching or spasmodic sensation. This is a neurological condition that is rarer than the other symptoms.
- Narcolepsy: Daytime "sleep attacks".
- Other: Other sleep related problems include nightmares, night terrors, sleepwalking, sleep talking, head banging, wetting the bed and grinding your teeth. Such sleep problems are called parasomnias.
The menopausal causes of sleep apnea and insomnia in men often vary significantly from the causes of insomnia in women. The low testosterone associated with andropause largely contributes to sleep apnea in men, leading to insomnia or sleeplessness. Sleep apnea is the interruption of or difficulty breathing during sleep. It is a sleep disturbance where a short period of oxygen deprivation to the brain means numerous awakenings during the night. This means that sufferers may be getting less REM sleep. REM (Rapid Eye Movement) sleep is the light sleep where dreaming occurs. Sleep apnea affects approximately 9% of adult males and is more common in obese males. The inhibited breathing and loud snoring common of sleep apnea tends to disrupt sleep many times throughout the night.
Insomnia in men resulting from low testosterone and sleep apnea can lead to several other problems including fatigue, reduced insulin sensitivity, low human growth hormone levels and high cortisol levels. Cortisol, the stress hormone, will increase with prolonged insomnia because of the stress on the body. Constant high levels of cortisol can create a hormone pattern that further reduces testosterone production. It can also lead to adrenal fatigue which often worsens the fatigue and insomnia.
Human growth hormone is naturally made during the first 90 minutes of sleep. Therefore, if your sleep is disrupted, your growth hormone production is reduced. This can lead to lower levels of testosterone and reduced lean muscle mass. Sleep is also very important for proper insulin sensitivity and glucose control. If sleep is disrupted, the body stops utilizing insulin as effectively and the body begins to need more and more insulin to control blood sugar. This leads to weight gain and a pre-diabetic state that, if not well managed, can lead to diabetes. Research has also discovered a connection between sleep apnea and erectile dysfunction.
Alcohol and smoking affect sleep and should be limited. Caffeine, large meals and heavy exercise are best avoided before bedtime. Anxiety and stress are part of life but by learning how to relax some of the physical and emotional damage can be avoided. Lack of sleep may be inevitable at certain times but by being sensitive to the body's need for sleep and catching up on any sleep with daytime naps and extra sleep at weekends, sleep can become a cooperative partner through life's challenges.
Obstructive Sleep Apnea vs. Central Sleep Apnea
Obstructive Sleep Apnea (OSA) is caused by obstructed breathing, either due to too much tissue as seen in obesity or decreased muscle tone which may be seen with low testosterone. This inhibits the air flow in the mouth and nose which causes snoring and decreased ability for adequate oxygenation during sleep. As a result, men often wake up numerous times during the night and rarely achieve deep sleep.
Central Sleep Apnea (CSA) is a central nervous system disorder in which the brain signal for breathing is delayed. CSA if often caused by injury or disease affecting the brain stem. Most cases of sleep apnea caused by low testosterone is obstructive sleep apnea.
Other Causes of Sleep Disorders
While hormonal deficiency is a common source of sleep disturbance during male menopause, there are other multiple causes, which may contribute, trigger, or escalate the sleep related problems. Let’s review them briefly.
· Physical pain is one of the most common reasons for poor sleep in aging people.
· Heart failure often causes breathing problems that can disturb sleep.
· Rapid heartbeat and palpitations can interrupt sleep.
· Other breathing problems that can disturb sleep include heart disease, certain neurological problems, and emphysema.
· A frequent need to urinate and other urinary problems may cause frequent awakenings.
· Persons with Parkinson disease may experience frequent urination, difficulty turning in bed, and difficulty getting out of bed. These problems may impair sleep.
· Gastroesophageal reflux disease (GERD) causes discomfort that can interfere with sleep.
· Constipation can cause discomfort that can disturb sleep.
· Allergies, sinus problems, nasal congestion, and similar problems can disrupt sleep.
· Itchy skin conditions often cause sleep problems.
· Depression disrupts sleep in all ages, and this condition is especially common in older people. Many people with depression have trouble falling asleep at night or wake in the night and are unable to go back to sleep.
· Dementia, especially Alzheimer disease, increases the length of stage 1 sleep and decreases stage 3, stage 4, and REM sleep. Dementia is linked to more episodes of sleep disruption and awakening, nocturnal wandering, and daytime napping.
· Bipolar disorders, psychosis, and anxiety can result in difficulty falling asleep and/or staying asleep.
· Sedative antidepressants and sedative antipsychotics can cause daytime drowsiness. Sleeping during the day interferes with nighttime sleep.
· Beta-blocker medications can cause difficulty falling asleep, an increased number of awakenings, and vivid dreams.
· Prolonged sleeping medication use may cause daytime drug withdrawal effects or daytime drowsiness.
· Theophylline and caffeine are stimulant drugs. These drugs increase wakefulness and decrease total sleep time. Caffeine's effect can last as long as 8-14 hours and may be more pronounced in older patients. Over-the-counter pain relievers, cold or allergy remedies, appetite suppressants, and tonics may contain caffeine.
· The stimulant nicotine affects sleep like caffeine. Smokers have more sleep disturbances than nonsmokers. Smokers also have difficulty falling asleep and decreased sleep duration. Even a nicotine patch can disrupt sleep.
Lifestyle and social factors
· Many older people are less active, and their bodies are not as ready for sleep at the end of the day.
· Alcohol can disrupt sleep.
· Daytime sleeping or lying on the bed to read or watch television can interfere with nighttime sleep.
· Sadness and bereavement can interfere with sleep.
· Everyday stress can make sleep more difficult.
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