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Carolyn M. D’Ambrosio, an associate professor of medicine and director of the Center for Sleep Medicine at Tufts Medical Center, fills us in

Women have a higher risk than men of developing insomnia at some time in their lives.

Insomnia is a common sleep disorder characterized by the inability to obtain sufficient sleep— typically seven to eight hours for adults, enough to feel refreshed and alert throughout the day—and leads to associated symptoms such as excessive daytime sleepiness. Patients with insomnia dedicate enough time to sleep, but they either cannot fall asleep easily (known as sleep onset insomnia), or they wake up and can’t fall back to sleep easily (sleep maintenance insomnia). Some have both. There is a tendency for insomnia to run in families, although the genetic component is not

We all know that sleep often becomes more difficult as we age. Some of us who’ve accumulated a certain number of birthday cards know this first hand! We also know that our circadian “clocks”—an internal mechanism that keeps us on a 24-hour, night-day cycle—function less well with age, and this contributes to sleep problems that can plague older adults, including:

• Difficulty falling asleep
• Trouble staying asleep
• Problems with daytime alertness

In addition to difficulty with nightly sleep, as we age we’re less likely to be able to cope with disruptions to our night-day routines, including difficulty adapting to time-zone changes, or working non-traditional hours, late at night or early in the morning.

Sleep is a critical factor in our long-term health and well being: studies show that it can play an important role in extending health and longevity and lack of sleep, in turn, can pose

THE QUESTION Women experiencing menopause-related hot flashes often do not want to take hormone therapy because of documented risks, and the effectiveness of herbal alternatives has not been proved. Might an antidepressant be an option to lessen symptoms?

THIS STUDY involved 205 peri- and post-menopausal women, most in their mid-50s, who had an average of about 10 hot flashes a day but were otherwise healthy. They were randomly assigned to take the antidepressant Lexapro (escitalopram) or a placebo daily. After eight weeks, hot flashes were fewer and less severe among those taking the antidepressant than among the others. About 55 percent of the women taking Lexapro, vs. 36 percent of those in the placebo group, reported at least 50 percent fewer hot flashes, and 19 percent (vs. 9 percent) saw a decrease of at least 75 percent.

WHO MAY

No one really knows. Menopause in women is characterized by a permanent and precipitous drop in the production of estrogen over a period of a few years. This life-changing event marks the end of fertility and can be accompanied by a constellation of symptoms including hot flashes, mood changes, and other physiological and cognitive disturbances. Men, for their part, suffer a very gradual decline in testosterone over several decades. After age 40, an otherwise healthy male’s testosterone levels decrease, on average, between just 0.5 and 1 percent each year. (A number of common conditions, like obesity, may hasten this decline.)

That doesn’t sound like the kind of abrupt shift women go through. But men have mourned their sagging vigor and vitality for decades (at least). During the 1920s, thousands of men seeking an endocrine boost