I wonder what would be the result if you took a poll of women over 45 to find out how many of them suffer from insomnia? Most of the women who come to me with menopausal symptoms would include insomnia on the list. But if you take a closer look at it, insomnia has many faces.

There are those who simply cannot get to sleep in the first place, plus those who wake during the night, sometimes several times. Then there are those who wake but cannot get back to sleep.

Sometimes the night sweat is what wakes a woman up, sometimes she just awakens and then experiences a hot flush. Some women have so much sweating they have to change their night clothes, or even the sheets. Life is a real misery but relief is at hand if they are suitable for oestrogen replacement. However, I use only natural oestrogen, not the synthetic variety.

The problem with insomnia is that it can stem from other sources, for which oestrogen is no help at all. Those who cannot fall asleep, no matter how exhausted, are usually quite stressed and their stress levels may or may not be related to their menopause. Giving those women sleeping tablets without addressing the main cause of their stress is pointless and will not help in the long term.

Those who wake and cannot get back to sleep are another category. Usually when we sleep we process the day’s events or week’s events and we find ways to file away the experiences for the future.

Sometimes the experiences themselves contain elements that we find hard to deal with and our unconscious, rather than processing them, wakes us up. Occasionally we hear of women waking, like children, with night terrors, or waking with some worry dominating their thoughts. Using sleeping tablets in these circumstances is not advisable as you are trying to force the unconscious back to sleep without dealing with the issues.

For many women in mid life, they come to realise that they have put up with, or settled for, a less than pefect life that has parts missing that they really need. None of us has a perfect life but we mostly are happy with what we have. If the Self has so far avoided telling you there are significant issues, then it is in mid life that these will surface, so that you have time to reappraise your life and decide what you need to change. This is why so many women get unsettled in midlife and start to re-invent themselves, with or without their current partner!

Because of my faith in our own body and soul’s ability to heal, I try not to intervene with medication if it’s not needed. Meditation, re-evaluating our lives and patterns, being grateful for what we do have may settle the anxious or depressed soul. But sometimes the currents run deep and are not immediately accessible via meditation or discussion. Sometimes the “stress chemistry” of the brain is so erratic and intrusive that long-standing patterns have to be altered and medication is needed.  Natural hormone balance can help with general moodiness and progesterone can be slightly sedating in many women. But progesterone alone is not sufficient to combat insomnia caused by sub clinical depression or overt anxiety.

My policy on medication for insomnia with anxiety or depression is primarily “Do no harm”, which largely rules out sleeping tablets as they are universally habit-forming, or worse, addictive. Getting patients off tablets in the benzodiazepine family (which includes almost all sleepers and sedatives) is a huge chore and takes months, if not years, to accomplish.

If there is a clinical depression present, it will often be disclosed by simple questionnaires giving a score, e.g. Beck questionnaire. Then an assessment of the presence and severity of the depression can be made and treated accordingly.

In the field of general psychiatry, acute and chronic depression form a significant part of practice. But usually in general family medical practice depression can be much milder and still disrupt the life of the patient, even if only via insomnia.

Low dose anti-depressants are useful in these patients as they are not addictive, do not accumulate in the blood, and contribute to changing the brain chemistry while giving a reasonable sleep. I tend to use the smallest dose that will relax the patient enough to let them sleep and that is often just a child’s dose used in an adult.

But if it is the hormones, then that can be managed. If there are less symptoms than would allow a diagnosis of frank anxiety or frank depression, it may be that there is simply the mental fragility that sometimes accompanies menopause. Any hormonally based upset is different in quality from other forms of emotional upset. The reason is that there is nothing fundamentally wrong with the woman, she is just roaring around with her hormones and her sensory system in overload!

Calming everyone else down is next to impossible unless she cracks a major crisis so they will all stop and listen! So the only other option for her is to calm herself down instead. I have extensive experience in using the imagination to create a safe place in the mind as a retreat from the world. Another option is to create, with the imagination, a bullet-proof shield to use in the immediate moment to protect against ‘bad vibes’ around you.

Have you ever been the subject of a curse or a spell?? I have, and until I took steps to deal with it, it was a very harrowing experience. There IS evil in the world and we need to take precautions so that we and our family and friends are protected from it. There are a number of books on the subject but as with most things, you have to avoid the charlatans. I recommend having a quiet word to the Universe as you stand in front of the bookshop shelves to make a choice, so that your choice is guided by the divine. (This worked a treat for me when I was studying law!)

Also it’s a good idea to “send in the troops” before you start delving into that area, i.e. ask for help and protection and you will get it. Even if you don’t believe in angels, they will still help!! So if you can’t sleep, practise being calm, breathing calmly, and if you have to resort to medication, make sure it is not just sleepers!