You first must have a good sleep routine. This is imperative. Make sure that the bedroom is used for sleep or sex. It is not a good idea to watch TV or read before you go to sleep. Have a special “routine” that you follow to show your body that you are going to bed. Showering before bed can make you feel nice and warm. Washing your face, brushing your teeth, and putting on pajamas should be the “signal” to your brain that it is time to go to sleep. Keep the room cool and comfortable. Get into bed and shut out the light. Try to think about pleasant thoughts or something nice that you would like to dream about. If you can’t get to sleep, get up and go in another room to watch TV or read. When you get sleepy again, go in and get in bed, shut out the light, and try again.
Some women have a terrible time sleeping, and it is not just the night flushes and hot feet; it is an overwhelming feeling of anxiety that hits you right when you get into bed. You can’t shut your head off no matter how many sheep, butterflies, or pleasant thoughts are imagined.
I frequently offer a low dose of Ambien® for these patients. I think that 10 mg of Ambien® is really too high a dose for most adults. I think that is why people do things in the middle of the night and don’t remember what they did when they are on Ambien®. I usually prescribe the 5 mg dose and have my patients cut them in half. A dose of 2.5 mg of Ambien® will shut your head off and help you sleep through the night flushes. A low dose of Xanax® will also do the trick. I prescribe Xanax® 0.25 mg and have patients cut them in half. It shuts their heads off at night so they can sleep through the misery of menopausal nights. I may sound like a big drug pusher to some readers. I don’t think that I am; each patient must be evaluated individually. I talk to them extensively about the risks of every drug that I prescribe for their symptoms. My patients are usually very apprehensive about starting any of these regimens, but when they walk out of my office, they are fully aware of my intention to put them on low (even sub-clinical) doses.