"To Sleep, Perchance to Dream; ay, There's the Rub."
        -Shakespeare's "Hamlet" - act III, i, 65-68.

Many women with Endometriosis may, at some point, experience bouts of insomnia.   For some, it may be only temporary; for others, it may be chronic (lasting a month or longer).  If you are one of the 35+ million Americans(1) who suffer from this sleep disorder, grab your pillow and read on.

"Insomniacs" are those people who find it difficult to fall - or stay - asleep.  This sleep dysfunction occurs nearly every night for an extended period of time.  Women are affected by insomnia more than men, particularly those in the 60+ age bracket.(2)  Insomnia is described in three levels:(3)

Mild:almost nightly complaint of insufficient amount of sleep or not feeling rested after the habitual sleep episode; accompanied by little or no evidence of impairment of social or occupational functioning; or
Moderate: nightly complaint of insufficient amount of sleep or not feeling rested after the habitual sleep episode; accompanied by mild or moderate impairment of social or occupational functioning; or
Severe: nightly complaint of insufficient amount of sleep or not feeling rested after the habitual sleep episode; accompanied by severe impairment of social or occupational functioning.

Sleep is an absolute necessity for the body and mind.  Poor sleep - or a lack thereof - can result in decreased functioning, poor energy, irritability and mood swings, anxiety, fatigue and lack of alertness/awareness, to name just a few consequences.

Insomnia can occur for many reasons, including:

Pain, Stress & Anxiety
What woman with Endometriosis doesn't experience those feelings on a regular basis?  Being in a state of emotional unrest or physical pain (or both) can be a leading cause of insomnia.  Try practicing relaxation techniques such as meditation, deep breathing exercises or visualization to help relieve any fears or frustrations you might be experiencing.  Reading your favorite book or even watching TV can help take your mind off more stressful matters as well.  If you're worried about an upcoming surgery or are in pain, talk to your doctor.  There are many over-the-counter and/or prescription medications available that can help.

Medical Conditions
Pregnancy, psychiatric illnesses, depression, kidney disease, heart conditions, asthma, arthritis, cancer, hormone imbalances, menopause, sleep apnea, hyperthyroidism, narcolepsy and painful illnesses like Endometriosis can all cause insomnia.  To be certain, acute insomnia may often result prior to or following a surgery, due to anxieties and/or physical pains.  Often, addressing the underlying condition(s) can lead to better rest habits and sleep patterns in patients.  Do not be afraid to talk to your healthcare provider; one need not assume that they must live with sleeplessness as part of their already-difficult illness.  Indeed, resting the body and the mind are important step in healing.

When in doubt, check it out - it could be your medications that are actually causing the insomnia.  For instance, drugs used to treat Endometriosis like GnRHs have known side effects such as hot flashes, joint pain, headaches, depression, mood swings, nausea, decreases in energy levels, diarrhea, anxiety and...insomnia.(4) Even without the insomnia, the other effects are enough to keep anyone awake!  Sometimes, these side effects are due to the hypoestrogenic effects of the drugs; talk to your prescribing physician about therapeutic addback therapy.

Lifestyle & Environment
Changing your sleeping environment - or being in an uncomfortable one, eating heavy meals and/or drinking alcoholic beverages prior to bedtime, consuming a high intake of caffeine throughout the day, smoking, being physically inactive during the daytime, exercising within 2-3 hours of bedtime and traveling to a different time zone (or a higher altitude) can all contribute to insomnia.  Modifying avoidable behaviors you know might be contributing to your sleeplessness can help.

Why do we need sleep?

Sleep is essential to our health and well-being!  The average person requires anywhere from 5-8 hours of sleep nightly.  Sleep allows us to:

Some even believe that while we're sleeping, our dreams help us sort out emotional issues.

If counting sheep doesn't work, what else can you do?

If the measures outlined above don't relieve your insomnia, your doctor can guide you in selecting a sleep medication that may help.  There are several currently available, with or without a prescription. Some of the medications may have side effects (severe in some instances), interact with other medications you are currently taking, and/or may leave you drowsy the next day.(5)  It is important to check with your healthcare provider to find an option that is right for you.

Alternative Therapies
Nutrition - some nutritional therapists believe that supplements of certain hormones or nutrients can effectively treat insomnia, including those containing melatonin (a hormone produced by the pineal gland, responsible in part for the body's "internal clock") and serotonin (a chemical messenger that plays a role in bringing on sleep).  Other recommended supplements include magnesium, calcium and vitamin B6.  Foods to avoid include heavy or sugar-laden meals and alcoholic or caffeinated beverages, particularly in the evening.  Always consult with a licensed Nutritionist, Naturopath or other qualified health care professional before embarking on any supplemental or nutritional regimens.

Recommended herbs include Valerian, Passionflower, Chamomile, Lavender, Eucalyptus and St. John's Wort.  Be sure to speak with a licensed herbalist or other healthcare professional before adopting an herbal regimen.  For handcrafted herbal remedies for Endometriosis, insomnia and a host of other conditions, you may be interested in visiting Herbalist Carol Koenigsknecht's site, Faery Magick.

Homeopaths often recommend common treatments like sulfur, coffea cruda and nux vomica, but it is imperative to have your homeopathic remedy personalized by a Homeopathic specialist.

Acupuncture, biofeedback, hypnotherapy, QiGong and other techniques can also be helpful for relaxing and inducing sleep, as can visualization techniques.

Two other interesting approaches are wave and light therapies.  Wave therapy employs different forms of light and sound to treat sleeplessness, while light therapy aims to reset the body’s internal clock (circadian rhythms) by exposing a patient to very bright lights in the morning and throughout the day, then reducing exposure in the evening through the use of dimmed lights and darkened eyeglasses.  Research has shown that such therapies can have a positive, significant effect on insomniacs.(6)

Whatever approach you may take, alternative or otherwise, insomnia is treatable.  Endometriosis and other illnesses can impact our quality of life enough; sometimes sleep is the only relief we get.  Don't be afraid to ask for help from your healthcare professionals to obtain that which we all deserve - a good night's rest.

Happy Sheep Counting!

For more information:
National Center on Sleep Disorders Research
NIH National Heart, Lung, and Blood Institute
Two Rockledge Centre, Suite 7024
6701 Rockledge Drive
Bethesda, MD 20892

American Sleep Disorders Association
1610 14th St. N.W., Suite 300
Rochester, MN 55901

U. S. Food and Drug Administration
5600 Fishers Lane
Rockville MD 20857-0001

References:
(1) American Sleep Disorders Association.
(2) "Insomnia," Medifocus.com, Inc., 2730 University Blvd. West, Ste. 300, Wheaton, MD 20902.
(3) American Academy of Sleep Medicine.
(4) Leuprolide Acetate for depot suspension: complete prescribing information; Takeda Abbott Pharmaceuticals.
(5) "Capture the Sleep you Need - When you Need it," Wyeth-Ayerst Laboratories/American Home Products Corporation.
(6) "The Guide to Alternative Medicine," Versaware.

Copyright ©2000 by Heather C. Guidone.   All rights reserved.  Do not reproduce without express permission.

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