Sleep Disturbance: Male Menopause Symptoms

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.

Sleep Apnea

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.

Medical disorders

·         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.

Mental disorders

·         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.

Medications

·         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.

Sources and Additional Information:

http://www.nlm.nih.gov/medlineplus/sleepdisorders.html

http://www.insomniacs.co.uk/menandsleep.html

http://www.emedicinehealth.com/sleep_disorders_and_aging/article_em.htm

http://www.bodylogicmd.com/for-men/sleep-apnea

http://insomniarevealed.com/insomania/

Fatigue in Men during Andropause

One of the symptoms of male menopause most prominently described by patients is their perception of suffering from fatigue.

Fatigue in Men

Fatigue in men is usually described as a total lack of energy, both physical and emotional. It is perceived as feeling of struggling to get through the next activity or the cumulative activities of the day. The energy of youth becomes a distant memory. Fatigue is usually a combination of depression, a decrease in metabolism and adrenal fatigue as a result of excess stress– all are caused by hormone decline, primarily testosterone, thyroid and cortisol. There are other contributing factors such as trouble sleeping, weight gain, loss of muscle – all have a cause based in hormonal decline.

Men often experience a waning capability for work or every day activities and overall reduced efficiency and sense of achievement.

What Causes Fatigue in Men?

Testosterone plays an important role in energy production. During andropause, diminished testosterone levels are a major cause behind insomnia or sleep apnea, both of which contribute to fatigue in men. In addition to diminished testosterone, interruption of sleep in men can be caused by symptoms such as night sweats, depression, irritability, weight gain and stress.

Night sweats in men with fatigue add to insomnia and fatigue because they make it difficult to get a good night’s rest. Having to get up in the middle of the night over a period of time can lead to sleep deprivation and ultimately fatigue. Irritability and depression, two very frequent symptoms of andropause can be very draining emotionally, causing feelings of weariness and exhaustion.

Additional weight gain and loss of muscle mass can leave men feeling sluggish and tired. Stress and high cortisol can leave men feeling overwhelmed and frustrated which clearly affects energy levels. Eating the wrong foods can also leave little energy for the body. While exercise itself is tiring, men with fatigue often feel an energy boost after a workout. Not enough exercise can make fatigue in men worse.

Procrastination becomes a bigger player — “I don’t feel like doing it, maybe tomorrow”. Depression becomes a particularly important issue in its negative effect on physical activity and exercise. The motivation to get out and DO IT is just not there. There is a cause and effect relationship between depression and physical activity/exercise – (more depression = less activity and less activity = more depression).

Dr. Alan Mintz, from the Cenegenics Medical Institute in Los Vegas, explains that this symptom can "include loss of strength (if left untreated, this can lead to gradual muscle atrophy); loss of energy (getting tired early in the evening, falling asleep in front of the TV); stiffness and aching of muscles and joints." Most experts agree that chronic fatigue is a primary symptom of having diminished sex hormone levels.

What to Do?

All andropause symptoms are kind of linked together and can be traced to the hormonal imbalance. We will review the medical, alternative, and lifestyle related ways to form a successful resisting shield, helping to slow down the gradual changes in our body and mind. In relation to fatigue in particular, you need to give yourself more rest and treat your physical and emotional well-being with great respect. Keep yourself focused on your essential tasks, but give yourself enough sleep to get recharged. Spent some time exclusively for yourself – not for your spouse, your kids, friends, or parents. You deserve it!

Listen watchfully for your body and act promptly when problem signs appear, but do not be a slave of your body. Move, go out, and enjoy your life!

Misdiagnosis

While fatigue is one of the markers of the normal andropause, you should be aware that there is a medical condition, which might have a similar appearance, but might not be associated with particular age. It is Chronic Fatigue Syndrome (CFS).

Chronic Fatigue Syndrome (CFS) is an illness of unknown origin whose primary symptom is of extreme fatigue and flu-like symptoms.

Yes, in spite of the rapid development of the medical science, researchers still are not quite sure what causes chronic fatigue syndrome. There are some who favor viral causes from several different possible viruses including herpes simplex, the virus that commonly causes cold sores. Epstein-Barr, the virus that causes mononucleosis is another possible cause.

There are others who think that CFS is an autoimmune disorder, as seen in lupus, or allergic individuals, or rheumatoid arthritis, where the immune system ramps up into high gear to fight invading organisms and winds up attacking itself instead!

Still other researchers feel CFS may be caused by other physical conditions, such as mercury dental fillings, low thyroid, low blood sugar, insomnia, or even a nutritional deficiency! Whatever the various possible causes, there seems to be an association between CFS and stress which may trigger the condition.

As published in the ANNALS OF INTERNAL MEDICINE in 1988, the Centers for Disease Control has developed a case definition for Chronic Fatigue Syndrome which includes:

I. New onset of persistent or relapsing fatigue, with at least 50% reduction of activity level for at least 6 months.

II. Exclusion of other conditions through History, Physical examination and Laboratory Examination.

III. 6 of the following 11 symptoms:

1. Mild fever
2. Sore throat
3. Painful lymph nodes
4. Muscle weakness
5. Muscle pain
6. Prolonged fatigue after exercise
7. Headaches
8. Joint pain
9. Neuropsychologic complaints
10. Sleep disturbance
11. Acute onset of symptoms

And 2 of 3 signs on physical examination:

1. Low grade fever
2. Throat inflammation
3. Palpable or tender lymph nodes

IV. OR 8 of the 11 symptoms without physical signs.

While societal expectations are indeed changing, it has long been perceived that the male has unique and different responsibilities, within the family, than does the female member. For many, a male may base his self-worth on his ability to perform, to succeed and to provide for the family. Being afflicted with CFS, the male cannot meet such self-imposed and societal expectations. In many cases, it is not uncommon for the individual to attempt to push or fight to keep himself functioning at his pre-illness level. The goal of such behaviors may be to escape from the feelings of being a failure and of "letting others down."

However, pushing oneself beyond the physical limits will typically result in a relapse of the condition thus only placing the individual deeper and deeper into the hole of recovery and a never ending vicious cycle begins.

Staring at an illness which impedes or blocks the ability to perform at even a minimal degree of the pre-illness capacity makes this task even more difficult. It is essential that all individuals with CFS, and especially males, must confront their own expectations of themselves. The individual must question if such are truly realistic and accept their individual strengths and limitations. Having such an illness does not render the male "less masculine" or lower his value to the family or society. It is imperative that each individual must develop the mindset of setting realistic goals within the individual's PRESENT abilities and to stick with such regardless of the pressure which might be received.

Males have far too often attributed self-worth with their income potential or employment position. As the illness encompasses the individual's life, the capacity to be gainfully employed and to use the energy to "climb the corporate ladder" becomes an even greater and burdensome task. Many will see themselves gradually falling behind their peers up the ladder of success. They may hear of others successes which further deepens the undercurrent of their own present shortcomings. Furthermore, as they are unable to perform the tasks within the workforce, the likelihood of receiving supplemental income through disability can become even more possible.

Dating back to the Stone Age, males were taught to hunt, feed and protect the family from all outside predators. However, what if the "predator" is an illness from within which renders the protector unable to perform those duties? Males are often taught, at a very young age, that others will have certain expectations from and for them, roles to perform and they are to never relinquish such regardless. The family may be forced to make dramatic changes. Often times, males feel powerless to stop the negative changes, let alone view themselves as the cause of such. The "demons" in their own head may begin to surface as well as fearing others perceptions as the effects of the illness begins to take its toll. "Old lessons" must be rewritten or discarded. New lessons of each individual pulling a "fair share" must emerge. Change need not necessarily be negative. One must remember that no matter what happens, others will continue to think whatever they are going to think. Facing and confronting others expectations is a task which everyone, with or without CFS, must undertake.

As with the females affected by CFS, many individuals can experience some change in weight as they no longer possess the energy to engage in physical activities or exercise. The loss of their physique is often times extremely difficult to face. Many such individuals may fear rejection by their loved one due to their perceived "non-attractiveness." In such cases, open communication with the loved one is often recommended.

For the most part, in spite of recent movements, the societal view that males should not express or verbalize their fears and feelings continues to exist. It is almost as if many males fear becoming "weak" to express their feelings, fears and disappointments. It is well known that fewer males tend to seek counseling or attend area support groups. Hopefully, as our society continues to change, males will allow themselves this avenue of assistance. It is only through the verbalization of the fears and feelings that any individual can face and overcome them. Without such, the feelings and fears tend to grow and grow within their own being.

An individual's ability to be "productive" in life has far too long been correlated with self-worth. The basis for this standard of "productivity" is generally based upon the individual's pre-illness capacity or level of functioning. For all individuals getting older in years, this is an unrealistic standard as we all lose abilities with age. Such is especially true for those afflicted with CFS. When the individual attempts to continue judging their life by this unrealistic standard, secondary depression will develop.

For all, and especially males, afflicted with Chronic Fatigue Syndrome, the following suggestions should be considered:

1. Do not attempt to push yourself beyond your present physical capacities. Accept and work within your present realm of abilities.
2. Set immediate, realistic and obtainable short-term goals which can be achieved on a daily basis.
3. Talk, talk, talk. Express your feelings and fears -- not for the purpose of having others refute your beliefs, but rather to assist you in seeing yourself in a more realistic perspective.
4. Attend area support group meetings. Attend or develop a support group specifically designed to address the unique issues directly related to males afflicted with CFS.
5. Throw out "old lessons" of roles which a male should or must meet in order to be of any value. Write "new lessons" for your individual life.
6. Realize that change does not necessarily produce negative results or consequences. Look for the gains which can be achieved by and through the changes.
7. Accept that you may not be as powerless as you feel or fear. While you may not have power over your own physical abilities now, or how others may perceive you, you always have absolute power and control over how you view yourself.

Lifestyle Tips to Boost your Energy

Getting back to our first suggestion, do not try to push over the limits or self-medicate with one of these energy boosters, available on the open market. Listen your body and help it to recognize the health troubles early, when they can be managed the most efficient and painless way.

Still, there are several suggestions for the lifestyle changes, which may help to fight your testosterone deficiency, which is coming with the aging, no matter what.

1. Develop strategies to combat sedentary living. One of the main reasons that older people feel weak is that they slip into a sedentary lifestyle or allow themselves to be trapped by boredom. But there are some easily applied antidotes to these enemies of high-energy living. With inadequate physical activity, muscles begin to lose strength, and they tend to feel weaker and weaker. Exercise is one of the best available strategies to counter this decline in muscle strength and endurance. Many times, extra exercise is exactly what is needed. You can embark at any age on a program to build up your muscles and increase your aerobic lung capacity. The more exercise you do, the more likely you are to increase the energy and enthusiasm in your life.

2. Learn creative ways to combat boredom. Another common cause of weakness and fatigue in older people is boredom. Many of the people who have these complaints are retired, and lack a regular daily schedule or activities to keep them interested and involved in life. As a result, they begin to feel useless and may start suffering from depression. A chronic sense of weakness or fatigue is a natural consequence of this process. Compulsory and unwilling retirement is one of the greatest geriatric threats to our society. For many people, stopping work sets the stage for diminishing brain stimulation and loss of muscle strength. The best cure for such people is to have a part-time job of some sort. You should work a few hours each day, just to keep your mind and body active. If you do this your feelings of fatigue will disappear.

3. Get more sunlight. Yes, we need sunlight. Often retired people do not go outside for days at a time. Open the blinds and let the light in, even if it is raining! There is a benefit to daylight in your life every day. Go outside for a short walk each day if you possibly can. Sunlight gives us vitamin D which is good for our eyesight and our skin responds by darkening just a little to protect us. Do not overexpose yourself to sunlight, however. Skin cancer is not what you have dreamt on.

4. Drink enough water daily. Are you drinking enough water? It's easy to become partly dehydrated and this state will influence your energy levels. Feeling thirsty can sometimes be mistaken for food hunger or tiredness. Take a big drink of water and see if you feel better. If you pay attention, you might find that you brighten right up.

5. Eat healthier. Food is a huge part of our life support system. Do you find yourself craving sweets? Sugar can give you a rush but leave you feeling tired. Any type of fruit is better for you. Try hard to stay away from sweetened cereals and then try honey instead of sugar. Eating the right combinations of foods makes a difference in your energy too. Your body needs fiber. We used to call it "roughage" and it is found in fruits and vegetables. Some doctors recommend five servings of fruits and vegetables every day for older people.

6. Have enough sleep. Are you sleeping well? Need naps? You can get sleep deprived pretty quickly and you might need to learn some tricks for going to sleep and staying that way. A little exercise during the day, cutting back on sugars and alcohol at bedtime, and a well-balanced food plan can really help your sleep. Even if you need to get up in the night to go to the bathroom, you will go back to sleep more quickly if you are taking care of your body.

7. Learn to relax. There are many techniques, especially with complementary and natural therapies that can help you to relax and revitalize your energy. Developing personal relationships with friends and relatives can be helpful. Also, making time for gratifying activities and having fun is a great way to get over tiredness.

8. Listen your body clock. Some people get a burst of energy first thing in the morning. They're often called morning larks. Night owls are people who are at their best at the end of the day. These individual differences in daily energy patterns are determined genetically and can be tough to change. Instead, become aware of your own circadian rhythms. Then schedule demanding activities when your energy levels are typically at their peak.

9. Talk about it. There’s some evidence that talking therapies such as counseling or cognitive behavioral therapy (CBT) might substantially help to fight fatigue. See your therapist who will help you to shape strategy to combat your fatigue.

Sources and Additional Information:

http://www.renewman.com/fatigue-in-men/

http://www.bodylogicmd.com/for-men/fatigue

http://www.selfgrowth.com/articles/chronic_fatigue_syndrome_in_men

http://www.prohealth.com/library/showarticle.cfm?libid=8114

http://webspace.webring.com/people/fc/cfsdays/cfs-men.htm