BBC Morning Live doctor issues key message to anyone who struggles to sleep

A BBC Morning Live doctor has urged anyone over the age of 45 who struggles with sleep to ask their GP about one important thing. Speaking on the breakfast show, Dr Xand van Tulleken was responding to a viewer who said she is going through the menopause and finding it difficult to sleep.

According to the NHS, "menopause occurs when your periods stop due to lower hormone levels. It usually affects women between the ages of 45 and 55, but it can happen earlier."

In response, Dr Xand explained that it can be a "tricky" situation due to the wide range of symptoms involved. He added that some doctors may dismiss concerns.

He explained: "Menopause is a huge issue that affects many people's sleep, and menopause is tricky because there are so many different symptoms that can mask other things. But it can also be easy to miss. You can be in a situation where you're being under-treated for menopause or other symptoms get dismissed because your GP says it's just menopause - so the first thing I would say is talk to your GP about menopause."

Dr Xand pointed out that the viewer did not specify whether she is taking Hormone Replacement Therapy. HRT, for short, is a treatment designed to alleviate menopause symptoms by replacing the hormones oestrogen and progesterone, which naturally decline as menopause approaches.

Menopause symptoms HRT can help to treat include:

• sleep problems
• hot flushes
• night sweats
• mood swings
• anxiety and low mood
• vaginal dryness

Talking about HRT, he noted that you could try it and if it is not for you, to come off it. He explained: "That might be something to discuss, even if it was for a short period of time, it doesn't have to be forever. I think sometimes the health dangers of HRT have been really exaggerated, particularly for doctors of my generation."

The NHS have said people can usually take HRT if they are having menopause symptoms. However it may not be suitable if you:

• have a history of breast cancer, ovarian cancer or womb cancer
• have a history of blood clots - you may need to use patches or gels rather than tablets
• have untreated high blood pressure - your blood pressure will need to be controlled before you can start HRT
• have liver disease
• are pregnant - it's still possible to get pregnant while taking HRT, so it's important to use contraception until 2 years after your last period if you're under 50, or for 1 year after the age of 50

The viewer also mentioned fibromyalgia. This is a long-term condition that causes pain all over the body. As well as widespread pain, other symptoms of fibromyalgia include:

• difficulty getting to sleep or staying asleep, which can make you feel very tired (fatigue)
• problems with mental processes (known as "fibro-fog"), such as difficulty concentrating or remembering things
• headaches
• increased sensitivity to pain
• muscle stiffness
• irritable bowel syndrome (IBS), a digestive condition that causes stomach pain and bloating
• feelings of frustration, worry or low mood

Discussing this chronic condition, the doctor explained that it is a greatly "misunderstood" health issue that can significantly disrupt sleep. Acknowledging that it can be "very, very difficult for people to manage," he encouraged people to seek help and ask whether they can be referred to a sleep clinic. In the meantime, while waiting for support from a clinic, GP or other specialist, he reminded people that, according to the NHS, maintaining a regular bedtime and ensuring your bedroom is cool and dark are essential. He also emphasised avoiding caffeine and alcohol at night to help the body unwind.

He also pointed out that having a "regular wake-up time can make a big difference as well." Additionally, if possible, aim for 150 minutes of aerobic activity each week. This doesn't need to be strenuous-activities like "briskly mowing the lawn" or other forms of light movement count, too. He advised that you should "try and keep an eye on how much you're doing as it can make a big difference to your sleep."

Symptoms of iron deficiency anaemia - something he noted could also be causing your sleep issues - can include:

• tiredness and lack of energy
• shortness of breath
• noticeable heartbeats (heart palpitations)
• paler than usual skin
• headaches

Less common symptoms of iron deficiency anaemia (that are not usually connected to pregnancy) include:

• hearing ringing, buzzing or hissing noises inside your head (tinnitus)
• food tasting strange
• feeling itchy
• a sore tongue
• hair loss - you notice more hair coming out when brushing or washing it
• wanting to eat non-food items, such as paper or ice (pica)
• finding it hard to swallow (dysphagia)
• painful open sores (ulcers) in the corners of your mouth
• nail changes, such as spoon-shaped nails
• restless legs syndrome

Concluding his advice, he said: "Your GP should be looking at other causes of exhaustion and tiredness like iron deficiency anaemia and thyroid problems. Distinguishing between tiredness and sleepiness is key."