As if menopause wasn’t challenging enough, worrying that you can’t sleep properly every night can make it all feel even more stressful. Even if you’re not experiencing brain fog and irritability – if you find you can’t get a good night’s rest each night, you soon will be. Insomnia and Menopause Insomnia around menopause happens […]
As if menopause wasn’t challenging enough, worrying that you can’t sleep properly every night can make it all feel even more stressful. Even if you’re not experiencing brain fog and irritability – if you find you can’t get a good night’s rest each night, you soon will be.
Insomnia around menopause happens for a number of reasons. Sometimes it’s the inevitable result of other menopausal symptoms: it’s hard to sleep well if you need to get up to pee at night because your bladder function has changed. Or if you find yourself up in the night changing drenched sheets because of uncontrolled hot flushes.
As women in the sandwich generation, we often face the combination of hormonal changes driving anxiety symptoms, and the challenge of juggling our own families’ problems with those of our ageing parents: it can all add up to finding yourself laid frustrated and exhausted, staring at the ceiling yet unable to quieten your brain for long enough to get the rest you sorely need.
Insomnia can also happen even if you don’t identify with having any of the issues above. Oestrogen and progestogens are intrinsically involved in the natural processes regulating our sleep cycles. When the balance between the two gets out of sync, it can significantly affect the quality and duration of our rest. Oestrogen and progesterone also influence how much melatonin is secreted by the pineal gland – the hormone regulating sleep:wake cycles.
Research shows that women in peri-menopause and menopause get less of the most vital deep (stage 3) and REM (stage 4) parts of the sleep cycle – meaning that even if we do get to sleep, we might not get enough of the type of sleep that allows us to wake, refreshed and ready to face the day. It’s also when our body heals and repairs: something that we really need as we age.
Here at Spiced Pear Health, want to help you get your sleep back on track. We know good sleep is the foundation for getting on with doing all the other things you want to do to tackle this stage of your life in a proactive way.
If it’s safe for you to have Hormone Replacement Therapy, then sort this out first.
Replacing oestrogen, with or without progestogen, is really important. It will help smooth out the hormonal peaks and troughs of perimenopause, letting your body recover its normal sleep cycles. Oestrogen replacement will also help prevent the other issues that can create restless nights: hot sweats, joint aches, needing to pee, or itching.
HRT will also help with your psychological wellbeing, reducing anxiety by generally turning down the fight:flight noise of your autonomic nervous system, which can get amplified at this stage.
Not all progestogens have the same effect on sleep: progesterone (P4 – the body-identical type) is associated with increased sleepiness and research shows it increases the amount of deep (type 3) sleep. Where insomnia is an issue, we try to prescribe this type in preference.
If you can’t have, or don’t want HRT, there are other prescription medications that can help. Gabapentin, or anti-depressant drugs, can be helpful in improving mood, anxiety and flushes. Melatonin is also an option, and there is growing evidence it can really help.
Some women find these really useful. Anything that improves your general wellbeing has a good chance of improving your menopausal symptoms and sleep through reducing cortisol, the stress hormone. There is some evidence for valerian root, and isoflavones such as soy and red clover. Some people suggest other supplements such as CBD, passionflower and tryptophan, but one of the issues with this area of menopause treatment is that the studies we rely on are not of great quality. It can also be difficult to be sure of the right dose to use, and supplement quality is not well regulated. Acupuncture and reflexology have been shown to be helpful too.
Paying attention to diet is particularly important in perimenopause and menopause. It is an area where individualisation is really vital, according to your personal values and your body. The evidence supports the overarching principles of clean eating: focusing on fresh produce, high quality proteins, whole grains and low sugar. For non-vegans, many dairy products are high in glycine, which has been shown to promote deep sleep in menopausal women.
Many foods can naturally increase estrogenic activity in the body, and may help sleep by reducing flushes: these include flax, grapes, peanuts, berries, plums, barley and soy. Omega-3 rich foods have also been shown to help. It may also help to be aware that high sugar, high fat and spicy foods can worsen flushes.
If this is an area that you are particularly keen to focus on, you might want to consider discussing it further in an appointment with our nutritionist – just have a look at our Trusted Partners page.
We know it can feel hard to find the energy, but it really can help. Regular exercise helps to settle anxiety and improve mood, and it calms the fight:flight system. It also has a beneficial effect on sleep-disrupting symptoms like flushes and joint pains. Yoga in particular has been shown to improve sleep. If you’re brave enough, cold water swimming also has evidence!
Caffeine and alcohol are big sleep thieves. Caffeine stimulates adrenaline receptors in your brain, driving your fight:flight and anxiety mechanisms. It disrupts readiness for sleep at bedtime. It also worsens overactive bladder issues, and alcohol does the same. Many women recognise that alcohol use helps induce sleep, but the problem is this is at the expense of its impact on sleep cycles: it significantly reduces the number of hours spent in REM sleep. Alcohol intake is also closely linked to breast (and other) cancer risk – so it’s one of the lifestyle factors you might want to think more carefully about at this point in life.
Cognitive behavioural therapy techniques can be brilliant for many women experiencing insomnia. It is useful to understand that when it comes to insomnia, the meaning you give it is very important. Most women get their night sweats in the early hours of the morning. Much of the restorative, deep stage 3 sleep happens in the first few hours of the night, however – meaning that if you wake up at 3am drenched, you might find it useful to remember that your body will already have taken much of the deep rest it needs to survive tomorrow.
If you wake, try to focus on having had “good enough” sleep, and resist the urge to think of it as a disaster – if we do that, we magnify the whole issue and set up anxiety for the same thing happening the next night. Try and calmly remember that you will have had many disturbed nights over the years, and you have always managed. Yes, you may well feel under par the next day: but when we allow that to make us anxious, we set off the fight:flight system again, and set ourselves up for even more restless nights as a result.
Sleep apps can help with remaining relaxed when you can’t sleep. Listening to soothing noises or stories, or relaxation routines, can be really helpful. Trying to concentrate on more than one thing at once is actually really hard: when it comes to sleep apps, for once this fact actually works in our favour – the soothing stories or noises can hold our attention well enough to stop us mentally going through our never ending to-do list, and let us drop off.
Consider using layered bedding, natural-fibre nightwear, and having a cooler ambient room temperature at night. Lots of women find splitting the bedding helpful, so they can sort out the temperature they need without it needing to suit their partner, too. It also helps to reduce the impact of their body heat on yours, keeping you cooler.
The practical preparations we make for our rest matter, helping create triggers that help our brains recognise rest time is coming, and secrete the right hormones to aid that. Ensuring the bedroom is kept for sex and sleep only (rather than reading, working, or being on screens), for example, helps signal to us that coming to this room means rest.
Establish a soothing nightime routine: do the same things most nights. Make sure you don’t drink caffeine, or alcohol, or eat chocolate or heavy meals in the later part of the evening. Turn off screens so the blue- light doesn’t tell your brain its day when your body needs to prepare for rest.
Remember: if you can’t sleep, it is always better to get up and go into another room to do something quietly for a while and then try again when you feel sleepy. However the night goes, try to make sure that you get up at the same time in the morning each day and avoid napping in the daytime as this definitely makes sleep at night harder.
If you have tried all this and you’re still struggling, please talk to us. Make an appointment to discuss how things are going: we want help you get things better.
Throughout this website, we use the term women when describing people who experience hormonal symptoms. However, we acknowledge not only those who identify as women require access to menopause and hormone health information. For example, some trans men, non-binary people, intersex people or people with variations in sex characteristics may also experience menopausal symptoms and PMS/PME or PMDD, and we warmly welcome everyone who needs this support in our clinic.
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