Do you find sleep difficult during perimenopause and menopause? 40-60% of women experience sleep problems in menopause, so please be reassured that you are not alone. Sleep problems can involve difficulty getting to sleep, staying asleep, waking early, not getting enough restorative sleep or a combination of all these. Let’s discuss sleep and menopause and the hormonal changes we find in the menopause transition which can significantly affect our sleep.
What symptoms can affect sleep?
Symptoms of menopause can be unusual and affect your temperature regulation, your emotions, your cognition, and your memory, and can give your physical symptoms, all of which can keep you awake at night. Some common symptoms that may affect your sleep are:
Night sweats:
Women who experience these are most likely to have disturbed sleep in menopause. They are often woken by rapid alternations in temperature which wake them.
Tip: Keeping the room cool is helpful as this makes it easier to sleep.
Anxiety, mood changes and worry:
Anxiety and mood changes are very common during perimenopause. Being anxious about things can make it hard to fall asleep at the beginning of the night and can mean it is hard to get back to sleep if we wake up. It is easy to lie there tossing and turning for hours, worrying.
Tip: set aside a time in the day to write down your worries so that at night time you teach your body that your bed is for sleep and sex, not for tossing and turning. If you are awake for longer than what feels like 15 minutes, get up and go to another room which is dark and warm and go back to bed when you feel sleepy.
What else can affect sleep?
Stress and life:
Juggling life in the modern world during perimenopause can have its challenges, it can be an incredibly busy and stressful time of life. You may be working, managing children, relationships, extended family and often, women put their own care last. There can be so much to do that we don’t find time to prioritise our sleep, and often go to bed too late.
Tip: be relentless with self-care and time to reduce stress, set regular bedtimes and time to put the screens away, avoid alcohol, have a walk outside each day, try to eat a balanced healthy diet, with enough protein.
How do Hormonal changes affect our sleep?
Our hormones carry messages from one part of the body to the other. Most of our perimenopausal and menopausal symptoms come from a fall in the hormone oestrogen. There are other hormonal changes which happen around menopause which can affect sleep.
Oestrogen
When oestrogen levels drop our sleep can be affected, it may take longer to fall asleep and the total amount of sleep we get can be reduced. We may find it more difficult to regulate our temperature and we may wake more in the night.
Progesterone
In most women can be sedating and can make us feel sleepy. It also helps to regulate breathing through the night. As we stop ovulating, levels fall during the menopause transition, so it can become harder to fall asleep. This hormone has been linked to breathing disorders that can affect us at night, like sleep apnea. Obstructive Sleep Apnoea can lead to symptoms like morning headaches, mood disturbances and nightmares.
Cortisol
As our stress hormone levels rise as we age, this can contribute to feelings of stress and anxiety, which can affect our sleep.
Melatonin
Is a hormone produced by the pineal gland in the brain. It is released about 2 hours before our usual sleep time, sending messages to our internal body clock to get ready for sleep. We produce less melatonin as well age, the levels can decrease during the menopause transition. This can also make it harder to sleep at night.
Why is sleep so important for our health?
Both lack of sleep and menopause can increase the risk of cardiovascular disease and problems with mental health, cognition, bone health, immune function, and metabolic health.
What can we do to help our sleep?
Make sleep a priority, and try to avoid staying up late finishing jobs or working or watching TV. Try and teach your brain that your bed is for sleep and sex only. The longer we lie in bed awake, the more we loosen this association.
Set a regular bedtime and plan a relaxing lead-up to this. We often try and recover from a poor night’s sleep by having an early night, but our bodies may not be ready for sleep, so we may lie tossing and turning, which doesn’t help. It is much better, if possible, to maintain the same regular bedtime and getting up time.
Set aside worry time in the day. It can affect our ability to sleep, and if we are anxious in the night, it can trigger the flight or fight response, which stops us from sleeping. One way that can help is to think of emotions as being transient and short-lived. Feeling them, understanding them, and then allowing them to dissolve away will help us regain control of our thoughts and calm our brains. It can take 90 seconds to identify an emotion and let it pass if you simply just notice it. Calm effective breathing can help, using your diaphragm and the whole of your lungs. Do click on the link to find out more about breathing and sleep.
Make sure to get some morning daylight on your skin, light has a powerful effect on our circadian rhythm, and fitting it in with a walk or some form of movement will help, 20 minutes wakes us up and sets our body clock to sleep at night.
Taking HRT, Hormone replacement therapy, can help improve sleep in perimenopause and menopause.
Cognitive Behavioural Therapy for insomnia (CBT-i) can be helpful. We can teach our brain’s how to behave, and we can form habits which involve negative thinking and behaviours. CBT-i can help to address these and help us teach our brains healthy sleeping habits. It can be done using a self-help tool in a book, in a group or in a 1:1 session. It can also be used to help with night sweats and hot flushes. It is recommended by NICE and is very effective.
Eat a healthy balanced diet, and keep active in the day, as much as possible.
Dr Carys Sonnenberg
