Oh, precious sleep, welcome

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Dear Researchers

You may find my anecdotal evidence interesting. There are two triggers for my hot flushes.  I’m not saying these are the cause, just that they occur immediately prior to and must, therefore, be associated in some way to the process.

The hot flushes started in March, so I’ve had plenty of time to watch closely and observe what’s been happening.  I’ve had to work it out for myself because the internet was very unhelpful this time.  No quick answer.  Either I couldn’t see for looking, or it’s just not there in one simple and authoritative page.

In the absence of that one authoritative page, I’ve resorted to an observational problem solving technique that involves grouping similar things together and looking for their cause. This cause can then be grouped with other similar events, objects or processes which will in turn also have a cause to be identified.  The aim is to avoid just solving the immediate problem by looking instead for the cause of the cause.

By tackling the cause of the cause there’s a better chance of actually solving the problem rather than treating symptoms.  The bonus is that more than one problem may be solved in the process.  The downside is potential unintended consequences.

What triggers my hot flushes?

The first trigger is quite straightforward.  The temperature rises when I do something while holding my breath.

You’d think that would be easy to fix by remembering to breath, deeply and slowly, when I tackle a task.

The second trigger is more complicated and harder to describe … so, perhaps some examples:

• Conversations with unfamiliar people.
• Staring at my computer screen trying to solve a problem.
• Trying to explain something, even practicing trying to explain something

The first thought was stress, and certainly there’s an element of tension in both of these triggers.

It definitely seemed to be stress the other day when a car pulled in front of me, and I slammed on my brakes, glanced quickly in the rear vision mirror to ensure the car behind was far enough behind, all the while letting out a yelp of exclamation.

The hot flush was nearly instantaneous.

Is it possible to de-stress?

One of the recommended lifestyle changes for peri-menopause is reducing stress.  Estrogen, cortisol and testosterone are some of the hormones involved in our fight-or-flight response to stress.

If Wikipedia is correct (and I know that sometimes it’s wrong), the fight-or-flight reaction begins in the amygdala (in the brain).  This then triggers a response in the hypothalamus (also in the brain).  The horomonal dominoes begin to fall and cortisol increases blood pressure, blood sugar and suppresses the immune system.

There’s a problem with this lifestyle change … I don’t see how I can do it.  My two triggers create a very minor form of fight or flight, and these triggers are everywhere.  In fact, we are encouraged to seek out a mild form of stress in order to keep our minds stimulated, creative and healthy.  I wrote last time about finding some comfort in “dulling down”.  It’s no way to live.  It’s a stepping stone to dementia.

But stress is not the full story

For example, bouts of sneezing or coughing aren’t a problem.  It’s spring here.  My sneezes are neither delicate nor polite; hay fever produces instances of sudden and violent reaction (not cool when driving!). Stressful, to say the least.

If stress is not the common factor, what is?

The triggers seem to be united by emotions and words.  Not just bad emotions, even excitement will do it. Not all words, just those that I’m struggling with.  The words didn’t even have to be spoken out loud.  (And, yes, writing this article has been a roller coaster of temperatures!)

So how is this affecting my sleep?

I wake at least once each sleep cycle and more if my nose is blocked.

Both triggers play a part.  There are times during sleep when breathing is not as deep or as restful as it could be.  Snuffly noses, colds and allergies have an impact.

But emotions and words?  After all, I’m asleep.  And regretfully, while asleep I am also dreaming.

(Now there’s a mis-named word.  The night-time ramblings I’ve seen over the last few months would be undesirable achievements.  Dreaming is the process our brain uses to deal with all the rubbish we’ve encountered during the day!)

Taking it up a level

The weeks dragged on and suddenly I realised I was increasingly using mental pictures for problem solving.  No hot flush.  Pictures are not words.

Finally, the penny dropped and another common element came into view – the hypothalamus.

The hypothalamus is one of those tiny bits of brain that does so much.  For this particular problem, I’m interested in its role in temperature regulation, emotion and memory.  Why memory?  Because it seems to be involved in my struggle to work out which word to use.  Using words and writing to work through problems relies on an ability to recall the right word when needed.

In contrast, visualisation, coughing and sneezing are outside the hypothalamus’ sphere of influence.  It seems that the visual cortex looks after images and the medulla oblongata tends to our coughs and sneezes.

Dear Researchers, am I on the right track?

What happens if the hypothalamus is a bit wonky?

The medical articles I found online are focused on the big impacts of hypothalamic dysfunction.  The clue is in the word “dysfunction”.  Anything less and we are supposed to tolerate minor fluctuations from the norm.

Yet, it’s worth understanding how the processes work.  How does the hypothalamus regulate body temperature and emotions? What influences it’s behaviour? Where might it start to go wrong?

And on that last point, according to MedlinePlus (from the US National Library of Medicine), one of the causes of hypothalamus dysfunction is inflammation.  We’ll come back to that shortly.

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When I last wrote about hot flashes, I described how increasing the amount of probiotic I drank each day dampened down the heat.  I suspect the probiotic drink has a positive effect because the nerve from the gut to the brain is connected to the hypothalamus.  I’m prepared to accept that the probiotic is helping (somehow) to regulate emotions.

I still believe the drink has a positive effect on emotions, but the hot flushes came back.  So what happened in September? What changed?

Driving back from a wonderful weekend with family, the weather turned unseasonably warm and, in response, I began turning on the car air conditioning.  As expected, my hands started to ache.  They always do.  (You’d think winter would be worse, but gloves and heaters keep it under control.  In summer, there’s little respite from essential fans and air conditioners.)

Suddenly, seemingly out of the blue, the hot flashes returned and increased, seemingly, at the same rate as the ache in my hands.  Sleep again declined.

This got me thinking about inflammation.  The previous time the hot flashes returned, after a brief hiatus, was when I hurt my foot.  Inflammation seems to be another common element.

How does inflammation affect the hypothalamus?

Within the hypothalamus, the master temperature controller is the preoptic area.  Here, neurons adjust the balance to regulate skin blood flow, sweating, fat burning or shivering so that we either warm up or cool down, as needed.

When we get a fever, our bloodstream is exposing the hypothalamus to pyrogens that “adjust” the point at which temperature regulation occurs.  And again, it’s about the extreme … the fever.

What about smaller deviations from the norm?  What creates these pyrogens in the first place?

Turns out, it is anything that creates lipopolysaccharide (LPS) in our bloodstream.  Apparently, the lipid portion acts as an endotoxin.

And (again) if Wikipedia is correct:

“In humans, the presence of LPS triggers an innate immune response, activating the immune system and producing cytokines (hormonal regulators).  Inflammation is a common reaction to cytokine production, which can also produce host toxicity.”

Inflammation increases the amount of pyrogens in the bloodstream.  My foot hurts, and the hot flushes start up again.  My hands ache, and the hot flushes start up again.  Of course, there has to be other factor/s involved because these aches are not new.  And clearly, the amount of LPS is not enough to create a sustained fever, but it seems enough to disrupt temperature regulation when triggered, in my case, by mild stress that is oddly associated with breathing patterns, emotions and words.

But, Dear Researchers, while I look to you to provide some solid evidence, my immediate aim is to get some proper sleep.  Perhaps tackling the problem from the inflammation side, limiting the LPS and thereby limiting the degree of disruption to the hypothalmus’ attempts to regulate temperature …?

Anti-inflammatories

So, I rock up to the local pharmacy and ask for the low-down on what’s available these days in the anti-inflammatory market.  I tell her that the pain is mild and not the problem.  I just want to deal with the inflammation.

There are creams and tablets available in the shop part of the pharmacey, where they keep the toothpaste and the bandages and the eye drops.  There are the alternative therapies in the corner, next to the perfumes.  And then she walks behind the script counter, where the hard-core medicines are kept, and comes back with a bottle of “practitioner only” dietary supplement containing curcumin.  (That’s tumeric in lay person’s language.)

But what she says next gets me so excited that it could trigger a placebo response (and I don’t care if it does).  Not only is this supposed to be anti-inflammatory but it is also supposed to deal with the LPS and be nice to my liver.

I’m sold.

What happened?

One tablet during the day didn’t help me sleep, but after a couple of days I noticed the days weren’t as bad.  So I try taking the tablet about an hour before bed and then another when I wake during the night.  Bingo.  Some nights I didn’t even take the second one.

This last week has been the best sleep I’ve had in months.

To be truthful, it’s still not great, but it is spring here.  I’m now sleeping as well as I would during any hay fever season.

Cautionary notes

There is the possibility that curcumin could bind with iron and may result in iron deficiency.  Be careful.

There is also the possibly it is a blood thinner, although the impact of one tablet a day is mild compared to the problems I have with fish oil.

A personal tip:  Do not take the tablet on a full stomach just before retiring to bed.  If any pops back into your oesophagus … not pleasant.  For me, the tablet before a light evening meal is working fine.

Conclusion

We are discussing very complex and inter-related systems – endocrine, immune and circulatory – and there is much about them I will never know.  There may be variables I’ve yet to build into my simple model.

So, Dear Researchers, there are many pieces of the puzzle still missing; many questions I’d like answered:

• is it the immune system and inflammation that creates such dramatic differences between women and their experience of peri-menopause, hot flushes and night sweats?
• why does cutting off oxygen so quickly produce a hot flush?
• is it the case that fight or flight redirects oxygen to muscles, leaving less for other functions?
• does oxygen target and destroy pyrogens in the bloodstream; it’s absence then allowing pyrogenic excesses to negatively influence temperature regulation?  Is this why adding some exercise seems to also help?
• and where is estrogen’s influence, or lack of, in all this?

Next steps

The curcumin may lose effectiveness if the inflammation gets worse, as may have happened earlier with the probiotic drink.  So I think I will look for more anti-inflammatory activities to ensure I keep on top of things.

Love my sleep!

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References

Wikipedia, “Fight-or-flight response”, viewed 22 July 2015.

Wikipedia, “Gram-negative bacteria”, viewed 18 October 2015.

Florey Institute of Neuroscience and Mental Health, “Brain regulation of body temperature”, viewed 18 October 2015

National Institutes of Health, “Hypothalamic dysfunction”, viewed 23 October 2015.

Boulant, J A, 2000, “Role of the preoptic-anterior hypothalamus in thermoregulation and fever”, Clinical Infectious Diseases, 2000, 31, Supplement 5, S157-S161.