How Menopause Affects Sleep
What’s keeping you up at night?
As a woman, I’m acutely aware of how my sleep has fluctuated in the last couple of decades and will continue to fluctuate over the next few decades as a result of various hormonal, physical and psychological changes. And it’s not my imagination. The stats back it up.
In adolescence, girls tend to report sleep difficulties more frequently than boys.
Adult women are twice as likely to experience insomnia symptoms than men.
Interested in bearing children? 46-78% of you may be at risk of developing a sleep disorder during pregnancy (with the quality of sleep declining towards the third trimester).
Due to fluctuating hormone levels, being more prone to developing a mood disorder (such as anxiety and depression), and the overlap of caregiver responsibilities and work, there are so many factors that affect sleep for women throughout their life.
And then comes menopause…
Menopause and Sleep Challenges
Sleep issues are common, with sleep disorders affecting 39 to 47% of perimenopausal women and 35 to 60% of postmenopausal women.
The most common sleep complaints reported by women going through menopause include hot flashes, falling asleep, staying asleep and sleep-disordered breathing and women are at an increased risk of developing insomnia, sleep apnea and restless leg syndrome.
What’s going on?
In general, as you age, your sleep-wake cycle changes and loses its consistency. You also produce less melatonin. You may begin to feel tired earlier, and wake up earlier in the morning, and you gradually start spending less time in deep sleep, which is harder to wake from. And then to further complicate things, women’s sleep can be disrupted by the symptoms that accompany menopause.
Menopause occurs because as women age, their ovaries decrease the production of estrogen, progesterone and testosterone and this can have a knock on effect on mood, appetite, energy, sex drive, cognitive and emotional function and sleep so it’s a significant time of major hormonal, physical and psychological change.
In regards to sleep, estrogen and progesterone help regulate your sleep-wake cycle and also act as a protective mechanism against sleep apnea. Estrogen also helps regulate your body temperature at night and even has an antidepressant effect. So during perimenopause and menopause, when levels of estrogen and progesterone are declining, you may experience higher body temperatures, lower quality sleep, anxiety, and poor mood.
Women may begin taking medications, whether due to menopause or other symptoms of aging, which may interfere with their sleep. And physical pain or discomfort such as sore joints, body aches, and bladder problems associated with age can also contribute to sleep problems.
What’s important to think about is that while the mood and sleep changes that occur with menopause could be linked to the hormonal changes, it’s also possible they’re brought on by other life stresses or conditions that happen to occur around these years. For example, empty nesting, being part of the sandwich generation (ie caring for aging parents and children at the same time), having concerns about their careers or aging may also increase stress for women.
It’s not always clear cut what’s causing what but we do know that this particular period in women’s lives can bring about a lot of change so it’s important to view sleep issues from a top down, holistic perspective.
Supporting Sleep In Menopause
When I work with clients, I like to stabilize the foundation of a good sleep, which includes:
Getting the right light at the right time
Getting bright light exposure (ideally outdoors) in the AM and anytime throughout the day and limiting bright light (especially blue light) in the hour before bed.
Keeping a consistent sleep/wake schedule
Prioritizing sleep and waking up and going to bed at the same time each day (7 days a week).
Winding down
Setting limits and keeping boundaries between busy and activating day to day activities and sleep, which includes implementing a consistent wind down routine.
But for menopause in particular, there are a few other practices that have also been known to be helpful to alleviate sleep issues:
Hormonal support
In certain cases, sleep disturbances are often well treated with low doses of estrogen and possibly progesterone but this is something you’d have to discuss with your primary healthcare practitioner and get tested for.
Keeping cool
Wearing and sleeping in and on natural fiber materials that can wick away sweat and help regulate your temperature is key. Natural cottons and bamboo are great to sleep in. In terms of your bedding, try out materials like pima or supima cotton, percale, Egyptian cotton, bamboo and linen, silk or jersey. Anecdotally, clients have found it useful to suck on an ice cube when they’re having a hot flash at night - this helps keep them cool without having to drink a whole glass of water and then running the risk of additional sleep disruptions as a result of having to go to the bathroom.
Keeping calm
Making time to process your thoughts and feelings and engaging in regular stress-reduction practices is important as sleep and stress have a bidirectional relationship - you need sleep to balance your stress hormones but stress and anxiety can make it difficult to sleep. Cognitive Behaviour Therapy and mind body techniques such as guided imagery, breath work and yoga have found to be useful in addressing some of the anxieties that surround sleep.
Poor sleep may be a symptom of menopause but there are ways to improve it. If you’re finding that your sleep has changed for the worse during this transitional time, give me a call and we can discuss how to get you back on track.
