The Simple Secret to Great Sleep

You already know that pregnancy pains and hot flashes can keep you tossing and turning at night. But there's a host of other, less-heralded health concerns that may be silently interfering with your shut-eye. Here's how to deal with these stealth sleep stealers, decade by decade.

New moms usually blame sluggishness or insomnia on the demands of parenthood, says Laura Corio, MD, an OB-GYN in private practice in New York City and attending physician at Mt. Sinai Medical Center. But the true culprit may be postpartum thyroiditis, which 5 to 10 percent of women develop in the year following delivery.

Typically, it starts with mild hyperthyroidism (overactive thyroid), which can rev you up and set off insomnia. After a couple of months, the condition may swing to hypothyroidism, in which a lack of thyroid hormone slows your body's functions, leaving you feeling constantly tired. If you're too jumpy to sleep or have extreme fatigue postpartum, see your doctor.

Feeling blue can pack a double whammy when it comes to sleep: Not only can depression cause sleep problems such as insomnia, but some antidepressant medications may have sleep-related side effects.

Donna Arand, PhD, clinical director of the Kettering Sleep Disorders Center in Dayton, Ohio, and an American Academy of Sleep Medicine spokeswoman, recommends a two-fold treatment for insomnia with depression: cognitive behavioral therapy, a therapeutic approach which can be used specifically to target insomnia and bad sleep habits, plus talk therapy aimed at alleviating depression, adding or adjusting medication as appropriate. (The antidepressant trazodone may help with both insomnia and depression.)

If you're waking up to pee a lot more lately, don't assume it's a sign of aging—you might actually have a urinary tract infection (UTI). "Decreasing estrogen levels in the mid-40s leads to a thinning of the lining of the vagina and bladder, which makes perimenopausal women more prone to infection," says Dr. Corio, author of The Change Before The Change. Corio adds that women in their early 40s are often very sexually active, which can also lead to more UTIs. Talk to your doc if you notice a change in your bathroom habits.

Deep, restorative sleep (called delta or slow-wave sleep) decreases in your late 40s, making nighttime awakenings more frequent. Working out more may help. Your muscles and tissues are repaired during slow-wave sleep, Arand explains. When you give your body more repair work to do thanks to increased physical exertion, it responds by stepping up the amount of slow-wave sleep you'll get.

The type of exercise that's best for triggering slow-wave sleep isn't clear, but aim for 30 minutes of moderate aerobic activity on most days, suggests Wilfred R. Pigeon, PhD, director of the Sleep and Neurophysiology Research Lab at the University of Rochester Medical Center.

Prescription drugs you may be taking for high blood pressure and cholesterol could affect your pillow time. Diuretics (used to treat hypertension) can necessitate nighttime visits to the bathroom, says Annabelle Volgman, MD, a cardiologist and the medical director of the Heart Center for Women at Rush University Medical Center in Chicago.

If your doc says it's OK, try taking your pills in the morning instead of the evening. And statins for cholesterol-control can deplete your body's muscles of co-enzyme Q10, a natural protein required for normal functioning of muscle cells; the resulting muscle aches might make falling asleep a challenge. If that sounds like you, Dr. Volgman suggests asking your doctor if you might benefit from taking a co-Q10 supplement.

Chronic snoring is a major sign of obstructive sleep apnea (OSA), a disorder in which breathing briefly stops periodically while you sleep, interrupting and worsening the quality of your snooze time.

OSA can have some heavy consequences, such as worsening or increasing the risk of developing diabetes, hypertension, or stroke. "The risk of developing sleep apnea increases after

menopause when progesterone levels drop," Arand says—possibly because progesterone may help the muscles of the upper airway stay open. Being overweight is also a big risk factor for OSA (and weight gain is a common occurrence during menopause); in some cases, slimming down can actually cure the disorder.