Sleepless in Menopause

I love my sleep and always was someone who needed lots of it to function. Even as a baby my parents made everyone jealous by having 3 children that pretty much slept through the night and day from week 3. Yes, you read that right. She had to regular check to see if we are still alive as it was quite unusual. Fast forward 41 years and I still need my sleep. Anything under 8 hours of sleep and I notice my mental and physical performance suffer. And unfortunately next to hot flashes and night sweats, insomnia is one of the most well-known and most experienced symptoms of menopause. It’s estimated that 40-60% of women suffer from sleep problems during menopause. A study published by the National Center of Biotechnology Information in 2019 show that 26% of women report having such severe symptoms that it affects their daytime functioning. And from speaking to a few of my colleagues and clients I definitely know that many women suffer through the day often due tolack of a good night sleep. Menopause is believed to disrupt normal sleep function through two main mechanisms:

1. Hormones: Changing levels of estrogen and follicle-stimulating hormone have been associated with problems falling and staying asleep.
2. Vasomotor symptoms (VMS): hot flashes and night sweats.

Lack of sleep is possibly the most detrimental of all menopause symptoms because it affects our body’s ability to function properly – mentally, psychologically and physically. Several studies show that even a short period of sleep deprivation affects our cognition, memory, reaction time, and ability to handle stress. And a recent study seven showed that sleeping less than 5 hours per night can lead to higher risk of being diagnosed with diabetes and an increase risk of obesity. Sleep has a key role in supporting an array of the body’s hormones and metabolism. Chronic sleep deprivation is often a factor in obesity. People that sleep less tend to eat more because they have more time to eat and tired individuals tend to eat more to combat exhaustion. From own experience I definitely can relate to that and I find it hard to eat healthy and a balanced diet on days with reduced sleep the night before. Further, sleep affects two important hormones related to appetite: ghrelin and leptin. Ghrelin, which increases appetite, is higher with a lack of sleep. Leptin, which decreases hunger is lower with lack of sleep. So, not getting enough sleep leads to losing hunger control.

So knowing all this sleep is the single most effective thing we can do to reset our brain and body health each day. However, during menopause, our hormones can make it harder to attain this brain and body reset. It’s worth trying well known basic sleep tips published by the Sleep Foundation:

 

Set Your Sleep Schedule Having a set schedule normalizes sleep as an essential part of your day and gets your brain and body accustomed to getting the full amount of sleep that you need.

• Have a Fixed Wake-Up Time: Regardless of whether it’s a weekday or weekend, try to wake up at the same time since a fluctuating schedule keeps you from getting into a rhythm of consistent sleep.
• Prioritize Sleep: It might be tempting to skip sleep in order to work, study, socialize, or exercise, but it’s vital to treat sleep as a priority. Calculate a target bedtime based on your fixed wake-up time and do your best to be ready for bed around that time each night.
• Make Gradual Adjustments: If you want to shift your sleep times, don’t try to do it all in one fell swoop because that can throw your schedule out of whack. Instead, make small, step-by-step adjustments of up to an hour or two4 so that you can get adjusted and settle into a new schedule.
• Don’t Overdo It With Naps: Naps can be a handy way to regain energy during the day, but they can throw off sleep at night. To avoid this, try to keep naps relatively short and limited to the early afternoon.

Follow a Nightly Routine

How you prepare for bed can determine how easily you’ll be able to fall asleep. A pre-sleep playbook including some of these tips can put you at ease and make it easier to get to fall asleep when you want to.

• Keep Your Routine Consistent: Following the same steps each night, including things like putting on your pajamas and brushing your teeth, can reinforce in your mind that it’s bedtime.
• Budget 30 Minutes For Winding Down: Take advantage of whatever puts you in a state of calm such as soft music, light stretching, reading, and/or relaxation exercises.
• Dim Your Lights: Try to keep away from bright lights because they can hinder the production of melatonin, a hormone that the body creates to facilitate sleep.
• Unplug From Electronics: Build in a 30-60 minute pre-bed buffer time that is device-free. Cell phones, tablets, and laptops cause mental stimulation that is hard to shut off and also generate blue light that may decrease melatonin production.
• Test Methods of Relaxation: Instead of making falling asleep your goal, it’s often easier to focus on relaxation. Meditation, mindfulness, paced breathing, and other relaxation techniques can put you in the right mindset for bed.
• Don’t Toss and Turn: It helps to have a healthy mental connection between being in bed and actually being asleep. For that reason, if after 20 minutes you haven’t gotten to sleep, get up and stretch, read, or do something else calming in low light before trying to fall asleep again.

Cultivate Healthy Daily Habits

It’s not just bedtime habits that play a part in getting good sleep. Incorporating positive routines during the day can support your circadian rhythm and limit sleep disruptions.

• Get Daylight Exposure: Light, especially sunlight, is one of the key drivers of circadian rhythms that can encourage quality sleep.
• Be Physically Active: Regular exercise can make it easier to sleep at night and also delivers a host of other health benefits.
• Don’t Smoke: Nicotine stimulates the body in ways that disrupt sleep, which helps explain why smoking is correlated with numerous sleeping problems.
• Reduce Alcohol Consumption: Alcohol may make it easier to fall asleep, but the effect wears off, disrupting sleep later in the night. As a result, it’s best to moderate alcohol consumption and avoid it later in the evening.
• Cut Down on Caffeine in the Afternoon and Evening: Because it’s a stimulant, caffeine can keep you wired even when you want to rest, so try to avoid it later in the day. Also be aware if you’re consuming lots of caffeine to try to make up for lack of sleep.
• Don’t Dine Late: Eating dinner late, especially if it’s a big, heavy, or spicy meal, can mean you’re still digesting when it’s time for bed. In general, any food or snacks before bed should be on the lighter side.
• Restrict In-Bed Activity: To build a link in your mind between sleep and being in bed, it’s best to only use your bed for sleep with sex being the one exception.

Optimize Your Bedroom

A central component of sleep hygiene beyond just habits is your sleep environment. To fall asleep more easily, you want your bedroom to emanate tranquility. While what makes a bedroom inviting can vary from one person to the next, these tips may help make it calm and free of disruptions:

• Have a Comfortable Mattress and Pillow: Your sleeping surface is critical to comfort and pain-free sleep, so choose the best mattress and best pillow for your needs wisely.
• Use Excellent Bedding: The sheets and blankets are the first thing you touch when you get into bed, so it’s beneficial to make sure they match your needs and preferences.
• Set a Cool Yet Comfortable Temperature: Fine-tune your bedroom temperature to suit your preferences, but on the cooler side.
• Block Out Light: Use heavy curtains or an eye mask to prevent light from interrupting your sleep.
• Drown Out Noise: Ear plugs can stop noise from keeping you awake, and if you don’t find them comfortable, you can try a white noise machine or even a fan to drown out bothersome sounds.
• Try Calming Scents: Light smells, such as lavender, may induce a calmer state of mind and help cultivate a positive space for sleep.

If your insomnia is more severe, here are some scientifically proven options:

Cognitive-Behavioral Therapy (CBT)

CBT is a well-researched form of treatment for insomnia. It focuses on helping you identify and replace thoughts, attitudes, feelings, and behaviors that cause or worsen sleep problems with thoughts and habits that promote sound sleep. The goal of CBT is to improve your ability to respond to challenging and stressful situations.

Physical Activity

Women who exercise are less likely to be depressed, more likely to sleep better, and overall report more positive effects on menopause symptoms. Regular exercise has also been linked to improved sleep. For exercise to help improve sleep, try to avoid exercising close to bedtime. Morning workouts will be more beneficial. Moderate intensity workouts and walking have been shown to offer the best results for better sleep and less anxiety. Other helpful practices include mindfulness exercises such as Hatha yoga and Tai Chi.

Hormone Therapy (HRT)

This is a polarizing topic, but from a research perspective HRT remains the most effective option. There is an abundance of research indicating the benefit of HRT on menopause symptoms, especially hot flashes and insomnia. But it is obviously a very personal choice having to take into consideration many aspects and needs to be talked through with your GP.