Healthy eating lowers risk of sleep apnoea

From news-medical.net

By Pooja Toshniwal Paharia

In a recent study published in the journal Nutrients, researchers in the United States analyse the relationship between diet quality and various sleep outcomes in the Bogalusa Heart Study (BHS).

Background

Cardiovascular diseases (CVD) are the leading cause of death in the United States, with one person dying from CVD every 34 seconds in this country. With about 122 million adults currently living with CVD in the U.S., it is imperative to identify risk factors associated with the disease to reduce its occurrence.

Certain lifestyle-associated risk factors, such as diet and sleep, can be modified to lower CVD risks. In fact, a balanced diet has been shown to prevent CVD development, whereas sleep apnoea and insomnia have been repeatedly linked to an increased risk of CVD. Studies have largely focused on the association between these activities and health outcomes; therefore, data on the interaction between nutrition and sleep are limited.

Short-term studies support the concept that diet and sleep are cyclical, as sleep affects next-day food intake, and diet impacts sleep through metabolic pathways. In fact, high-quality diets are reportedly associated with improved outcomes of sleep.

However, many of these studies included non-diverse groups such as males or females only and Mediterranean diet followers only. Another common limitation of these studies is that many only evaluated one sleep parameter, such as sleep duration, with a single measure to determine dietary quality.

About the study

In the present cross-sectional study, researchers investigate the association between diet quality and different sleep outcomes, such as sleep apnoea, healthy sleep patterns, and insomnia, in the BHS study cohort of white and black adults of both sexes. The researchers also determined whether the impacts varied by socioeconomic status, race, and sex.

The study cohort consisted of individuals who participated in the BHS study between 2013 and 2016 and completed sleep questionnaires and diet assessments. The Lower Mississippi Delta Nutrition Intervention Research Initiative’s (Delta NIRI) Food Frequency Questionnaire (FFQ) was used to assess diet. Over a six-month period, the participants provided four one-day diet recalls.

The team matched Delta NIRI components to the U.S. Department of Agriculture (USDA) Food Patterns Equivalent Database (FPED) data published between 2015 and 2016. The Nutrient Database for Scientific Research was used to estimate nutrient intake. The Healthy Eating Index (HEI) 2015, Alternate Healthy Eating Index (AHEI) 2010, and Alternate Mediterranean Dietary Pattern (aMed) were used to construct diet patterns.

The Women's Health Initiative Insomnia Rating Scale (WHIIRS) was used to assess insomnia, whereas the Berlin Questionnaire was used for snoring and sleep apnea, and the healthy sleep pattern scores for overall sleep health. The International Physical Activity Questionnaire (IPAQ) was used to assess physical activity, and the total metabolic equivalent of task (MET) minutes per week was determined. The Centres for Epidemiologic Studies Depression (CESD) scale assessed depressive symptoms.

Multivariate Poisson regression modeling was performed using generalized estimating equations (GEE) to estimate prevalence rate ratios (PRRs). Models were adjusted for covariates such as age, sex, body mass index (BMI), race, physical exercise, level of education, status of employment status, caffeine consumption, depressive symptoms, having bed partners, and frequent usage of sleeping pills.

Data adjustments were also made for household size, census tract Index of Concentration at the Extremes (ICE), pediatric individuals in households, census tract Modified Retail Food Environment Index (mRFEI), smoking habits, alcohol consumption, and illicit use of drugs.

Study findings

Out of 1,298 individuals, 224 individuals with implausible calorie intake exceeding 4,800 kcal/day, 43 individuals with a prior history of stroke or heart attack, 123 worked in shifts, seven individuals with missing sleep or diet data, and 77 individuals with missing covariate data were excluded from the analysis. As a result, the final sample cohort included 824 individuals.

The participants' mean age was 48 years, 30% were black, 36% were men, about 30% had depression, and over 50% were obese. Among the participants, 44% had an increased risk of insomnia and sleep apnea, whereas sleeping patterns were considered good among 23% of the participants.

A mean score of 45 was obtained for AHEI-2010. Higher AHEI-2010 quintiles were more likely to be observed among older individuals, females, more educated individuals, never-smokers, alcohol drinkers, and individuals who were not depressed.

Higher food quality, as determined using AHEI 2010 scores, was related to a reduced sleep apnea risk score post-adjustment. There was no significant relationship between HEI 2015, aMed, insomnia symptoms, or a good sleep score.

AHEI-2010 and HEI-2015 were inversely related to a high risk of sleep apnea. Individuals in Q5 of the AHEI-2010 had a 41% lower likelihood of being at high risk for sleep apnea than those in Q1. Analyzing AHEI-2010 as a continuous variable showed that the correlation was significant, with a 12% reduced prevalence of high sleep apnea score per 10-point rise in AHEI-2010.

A greater AHEI-2010 was related to being positive on the sleepiness component but not the snoring component. In the unadjusted model, the researchers found a modest association between healthy sleep patterns and the AHEI-2010.

The relationship between AHEI-2010 and sleep apnea risk was greater among women than men. Notably, this relationship was also stronger among those with a higher level of education.

Fruits, long-chain omega-3 fatty acids, sugar-loaded beverages, red and processed meats, and alcohol had significant inverse associations when comparing Q5 to Q1. The sensitivity analysis, which was performed by excluding BMI from the covariates, yielded similar results.

Conclusions

Higher food quality was associated with reduced sleep apnoea risk scores among semi-rural, lower-income populations in the south eastern U.S., where health disparities are common. These findings elucidate how diet quality affects sleep and, as a result, support the incorporation of high-quality food products into health interventions that may improve the efficacy of sleep therapies while simultaneously reducing the risk of developing CVD.

https://www.news-medical.net/news/20230427/Healthy-eating-lowers-risk-of-sleep-apnea.aspx

Cognitive Behavioural Therapy Works With Most Kinds of Insomnia. It Might Work With All.

From managedhealthcareexecutive.com

Insomnia is responsible for a lot of angst — and worse. Treatment is fairly straightforward. But for one cause of insomnia the mechanism of treatment — and whether it works — remains elusive.

Perhaps the biggest surprise in a recent Journal of Sleep Research review article about insomnia is that we don’t know much at all about how the main treatment works for one of the three causes.

An estimated 10% of adults worldwide have clinical insomnia, the result of having trouble falling or staying asleep or not sleeping well. For some, it’s a minor inconvenience. For others, it’s a major disruption that causes problems with memory and concentration. Chronic insomnia raises the risk of high blood pressure, coronary heart disease, diabetes and cancer.

Cognitive behavioural therapy tailored for insomnia (CBT-I) is considered the best treatment. Medications will certainly put you to sleep, but they work better when paired with therapy, especially in the long term.

The most effective CBT-I intervention is called sleep restriction, although it really means restricting the amount of time spent in bed, and also limiting activities there to just sleep and sex (no reading or watching television).

Other successful interventions involve addressing dysfunctional beliefs and attitudes about sleep and selective attention to sleep-related issues, other worries and excessive ruminating, as well as curbing evening intake of caffeine and alcohol.

In their aptly named article, Mechanisms of cognitive behavioural therapy for insomnia, lead and corresponding author Ellemarije Altena, Ph.D., an associate professor at the University of Bordeaux, and colleagues at other universities and clinics in France, the U.K and Canada, review the main causes of insomnia, which CBT-I interventions work with them, and what is known about the mechanisms of action. They also suggest areas for future research. The article was published in early March.

The three main “factors” — as the authors refer to them — in insomnia and the CBT-I interventions associated with them are:

Behavioural. Habits like irregular bedtimes and consuming drinks containing alcohol or caffeine close to bedtime are common issues. Restricting sleep to a specified, regular period, with mandatory go-to and get-out-of bedtimes increases consistency and forces patients to confront their fears (usually about not sleeping) and break a cycle of avoidance that perpetuates insomnia. How this intervention works is obvious, and evidence shows it is successful.

Cognitive and emotional processing. Increased worry and rumination about issues related to sleep and not as well as over-attributing functioning problems during the day to insomnia are primary examples. Key interventions involve “cognitive restructuring,” which focuses on increasing patient awareness of the ineffectiveness of dramatizing thoughts and dysfunctional beliefs about lack of sleep and how they can aggravate insomnia, and encouraging alternative thoughts, such as scientific findings that the consequences of lack of sleep usually aren’t as bad as people think. Cognitive restructuring also is supported by data.

Physiological. This factor involves an enhanced state of arousal regardless of stimuli. Interventions include relaxation techniques. This intervention is plagued by a lack of information about its mechanism, let alone data from electroencephalogramsor other technology supporting rates of success. Indeed, the authors note that the “hyperarousal” concept of insomnia has recently been debated, largely because it also is seen as a factor in conditions that often exist alongside insomnia, most notably in more severe manifestations of post-traumatic stress disorder.

The authors note that a big part of the problem measuring success of any of these interventions is the quality of data on adherence. Definitions vary from study to study and adherence usually is self-reported. Correctly recording adherence to regimens that may include activities when you’re half-asleep or groggy isn’t easy. Patients may also have a tendency to report that they are following a doctor’s suggestions more closely than they really are.

Another challenge is that insomnia often is associated with — and is a significant predictor of — depressive disorders, which themselves are associated with sleep apnea, another comorbid condition, and often occurs with anxiety and bipolar disorders as well.

The good news is that insomnia and mental disorders can be treated simultaneously in many cases.

https://www.managedhealthcareexecutive.com/view/cognitive-behavioral-therapy-works-with-most-kinds-of-insomnia-it-might-work-with-allll- 

Sleeping Habits: Facts and Tips for Better Rest

From ptcpunjabi.co.in

Here are some facts and advice regarding sleeping patterns to assist you in getting a better night's sleep

Even though it's an important component of our daily routine, many people have trouble sleeping. Obesity, diabetes, cardiovascular disease, and mental health conditions like anxiety and depression are just a few of the health issues that can develop from not getting enough sleep. Here are some facts and advice regarding sleeping patterns to assist you in getting a better night's sleep.

Your sleep quality is equally as important as its amount

The quality of your sleep is important in addition to simply obtaining enough hours. The many stages of sleep that your body experiences, such as deep sleep and REM (rapid eye movement) sleep, are crucial for bodily repair and memory consolidation. Establish a regular sleep schedule to enhance the quality of your sleep.

Your sleep may be disturbed by blue light from modern devices

The production of the sleep hormone melatonin can be suppressed by the blue light emitted by electronic gadgets like smartphones, tablets, and computers, making it more difficult to fall asleep. Avoid this by limiting your use of electronics right before bed, or by wearing blue-blocking eyewear or a blue-light filter.

Your sleep may improve with exercise

Frequent exercise has been demonstrated to shorten the time it takes to fall asleep and increase the quality of sleep. Try to work out for at least 30 minutes most days of the week at a moderate level, but avoid working out too close to bedtime because it can be stimulating.

Your bedroom atmosphere has an impact on your sleep

Your sleeping environment has an effect on how well you sleep. Maintain a cold, quiet, and dark bedroom, and spend money on a supportive mattress and pillows. If noise is a concern, try using earplugs or a white noise generator.

Medical attention could be necessary for chronic insomnia

Millions of people suffer from insomnia, a common sleep disease. It may be necessary to seek medical attention if you have chronic insomnia, which is characterised by trouble falling asleep or staying asleep at least three evenings a week for three months or more. See your healthcare physician about your treatment options, which may include medication or CBT, if you suffer from chronic insomnia.

Moreover, it should be noted that having adequate sleep is crucial for our general health and well-being. We may enhance the quality and quantity of our sleep by forming healthy sleeping habits and developing a calming bedtime ritual. A few things to keep in mind are to pay attention to the quality of your sleep, refrain from using electronics just before bed, exercise frequently, make your bedroom comfortable, and seek medical assistance if you experience persistent insomnia.

https://www.ptcpunjabi.co.in/lifestyle-news/sleeping-habits-facts-and-tips-for-better-rest-414240 

Many of us are using fitness devices to track our sleep but could they be making our anxiety worse?

From abc.net.au 

More people are taking sleep-tracking devices to bed than ever before.

Generally speaking, a sleep tracker measures the length and/or quality of your sleep, and they are increasingly being incorporated into popular fitness "wearables" such as Apple, Garmin and Fitbit watches.

On a daily basis, users can access a range of statistics about their previous night's sleep, including how much time they spent in REM (rapid eye movement) sleep, and how many times they were woken up.

By way of an algorithm, this data is often then translated into a sleep "score" (such as a percentage), indicating how "well rested" they are.

In the case of some fitness devices — particularly those marketed at elite athletes — this "sleep score" will also inform how much exercise it is recommended they do the following day.

However, just how accurate are they, and how much attention should you be paying to your data?

Apps will often provide users with a score indicating how well they have slept. (Getty Images)

The 'dark' side of sleep tracking

Johns Hopkins school of medicine neuroscientist Matthew Reid warns that fixating on daily sleep scores can have a negative psychological impact, especially on those people with existing sleep problems.

In one study led by researchers at The University of Oxford, participants with insomnia were divided into two groups and given fake or "sham" feedback on their sleep.

One group was told they had a "positive" night's sleep, the other a "negative" night's sleep, and were then asked to rate their mood and sleepiness.

Those who were given a fake "negative" score, rated themselves as much sleepier, and their mood significantly worse than those who were given a fake "positive" score, and vice versa.

"Where I see tracking devices being detrimental is in people with sleep disorders like chronic insomnia," Dr Reid says.

"Unfortunately, those are the kind of people who are generally attracted to these kinds of devices … they're hyper-focused on their sleep, to the extent they're preoccupied by it.

"Clinically, we've always tried to stay away from using objective markers of sleep because, in many cases, insomnia is a disorder of sleep perception, rather than a disorder of sleep itself.

"Throwing daily feedback into the mix for those individuals can be very stressful and, potentially, make their sleep worse."

Athletes at particular risk of 'orthosomnia'

Over the past few years, anxiety driven by sleep trackers has increased to the point where a new term, "orthosomnia", has been coined to describe the "obsessive pursuit of optimal sleep", driven by the use of technology.

Sunshine Coast sleep physician David Cunnington has seen this phenomenon play out first-hand in his work with AFL clubs.

Dr Cunnington says athletes often find themselves preoccupied by the relationship between their sleep data and what they have done on any given day.

"I see a lot of athletes drive themselves bananas [looking at daily numbers], because they're all about the '1-percenters' — finding the variables that will improve performance," he explains.

"But the inherent variability in sleep-tracking devices will give you an almost random kind of result that won't show any correlation or clear relationship [between your behaviours and sleep]."

Dr Cunnington has even seen examples of clubs threatening players with missing selection if they are not getting enough sleep before games.

He says this kind of approach is counterproductive.

"If you're already anxious about sleep, that kind of thing absolutely does your head in," he says.

Reading in bed? Here's why your tracker may think you're asleep

Dr Olivia Walch from the University of Michigan completed a PhD in applied mathematics on sleep and circadian rhythms.

Like Dr Cunnington, she says sleep trackers are not yet accurate enough to predict something as complicated as which behaviours lead to better sleep outcomes.

She explains this by outlining how the algorithms built into sleep trackers work.

Many, she says, start with the assumption that, if you're moving, you're awake, whereas, if you're still, you're probably asleep.

"So, especially in cases where you've got someone with insomnia, the 'are you moving test' is pretty bad," she says.

"That's because they might be awake for long periods of time but lying very still [in order to try to fall asleep]."

In these cases, the wearable may assume the person is asleep, while the same might happen if someone lies very still in bed watching a TV show or reading.

Instead of measuring a sleep tracker's "overall" accuracy, then, Dr Walch argues that we should focus on how well they predict when you are awake, versus when you are asleep. "For most devices, sleep accuracy is about 93-99 per cent, which is pretty high," she says. "But your wake accuracy could be anywhere from 20 to 60 per cent, depending on the device."

Dr Walch assures that wearables are now using much-more-advanced algorithms than the "are you moving" test (technically referred to as the "standard actigraphy" approach).

However, she says, that has not automatically translated into a big leap in accuracy.

In fact, standard actigraphy outperformed Garmin devices at accurately identifying periods of wake in a 2021 paper.

"To be clear, Garmin nailed every sleep in that paper," she says.

"But [Garmin] missed a lot of the wake data. So they went a little heavy on the 'sleep pedal'."

Dr Walch adds that devices will also differ in terms of how much they are programmed to pick up on sleep or naps that happen outside of "standard" bedtime hours.

Some, for example, will focus almost exclusively on picking up overnight periods of sleep.

"If you're only looking for sleep at night, you're less likely to have an embarrassing error where you say somebody was asleep in the afternoon when they were just kind of sitting around," she says.

"But this has a drawback for shift-workers, or anyone outside of a nine-to-five schedule, who will be sleeping or napping during the day and need credit for that. All of this is just to say — device choice matters."

The stages of sleep

Experts agree that where sleep trackers routinely fall down is determining which "sleep stage" someone is in.

Measuring REM and non-REM sleep

• Sleep involves at least two distinct phases: rapid eye movement (REM) sleep, and non-REM sleep
• Non-REM sleep can be further divided into categories such as 'light', 'deep' and 'slow wave' sleep
• Many wearables offer nightly statistics on how much time you spend in each stage
• The 'gold standard' for measuring sleep stages is brain activity via EEG (electroencephalogram) traces
• EEG traces are an integral part of a lab-based sleep study (or 'polysomnography')

Wearables use a combination of factors — such as heart rate, and again, movement — to "guesstimate" what sleep stage someone is in, resulting in the underwhelming accuracy of 60-75 per cent.

"It's a bit like putting lipstick on a pig," Dr Cunnington says.

"Heart-rate can help you tell if someone is in REM or non-REM sleep because, in non-REM, you tend to have a more regular heart-rate, whereas in REM, it becomes more chaotic.

"But once you start to try and substrate non-REM sleep into light and deep, wearables don't do particularly well."

Experts also warn against paying too much attention to how much sleep you spend in each stage — regardless of device accuracy.

Dr Reid says that, as a general rule, REM sleep will account for 20-25 per cent of the sleep cycle, and deep sleep for up to 25 per cent.

Those numbers, however, do not take into account recognised differences across age groups, or by sex.

For example, deep (or slow wave) sleep tends to decline as you age, while females have been found to have more deep sleep than males, but report poorer quality and more disrupted sleep.

As Dr Reid explains it, the amount of sleep we get on a day-to-day basis changes in response to what's going on in our bodies.

This means it's not really possible to say whether a particular amount of REM or non-REM sleep is "optimal".

A more important measure, Dr Cunnington says, is how someone "sequences" through different sleep stages throughout the night.

Sleep occurs in "cycles" that last somewhere between 60 and 120 minutes. 

"Within each cycle, you should be getting some light sleep, deep sleep, light sleep and then REM sleep, in that sequence," he explains.

Over the course of the night, and with each subsequent cycle, you should also expect your deep sleep to decrease, while REM sleep increases.

You may be the best judge of your sleep

As a rule, Dr Reid advises against looking at your daily numbers, and to listen to how you subjectively feel.

"Do you feel well rested? Do you feel sleepy during the day? If you were to have a nap, how long do you think it would take you to fall asleep?" he asks.

"These are the kind of markers that you're getting restorative sleep, and are far more important than what percentage sleep you got in each phase."

Dr Cunnington agrees. In his work with sporting clubs, as well as with clients, his advice is to stop fixating on daily numbers, and think about sleep more holistically, over a longer period of time. "I'd look more at the average amount of sleep you're getting across the week, and also include rest," he says. "So rest, for an athlete, would mean 'feet up' time. For a professional worker, it's something non-task oriented.

"Focusing on those things across the span of the week — instead of daily scores — just means that, if you're behind, you have an opportunity to build in more rest and downtime."

https://www.abc.net.au/news/2023-04-23/sleep-tracking-stages-fitness-wearables-accuracy-anxiety/102040328

Everything You Need to Know About Menopause and Sleep

From verywellhealth.com

Menopausal symptoms can affect sleep at various stages of menopause. Menopause, sometimes called the "change of life," causes hot flashes and mood swings. Additional symptoms might include sweating, weight gain, and vaginal dryness.

Sleep disturbances are quite common in menopause, and prevalence seems to increase with age. Sleep disorders in menopause range from 16% to 42% of people in premenopause (before any transition has occurred), 39% to 47% in perimenopause (the transitional phase to menopause), and 35% to 60% in postmenopause (more than 12 months after the last menstrual period).

While anyone can experience sleep problems with menopause, they are reported more frequently and at more severe degrees in Black people than White people. This disparity can be due to socioeconomic factors affecting Black people, such as structural racism in the healthcare community that can affect their care, increased life stress and mental health issues from ongoing discrimination, increased risk of health comorbidities, and more.

This article covers the connection between menopause and sleep, the symptoms and stages of menopause and how they affect sleep, how people of colour are affected, treatments for poor sleep in menopause, and more. 

FG Trade/ Getty Images

Menopause and Sleep: What's the Connection?

Menopause occurs because of hormone level declines—mainly oestrogen, progesterone, and testosterone. These hormones regulate your reproductive function and menstrual cycles. They will also affect your mood, energy, libido (sex drive), cognition, and sleep. 

As these three main hormones fluctuate during the different stages of menopause, they will affect your sleep. In fact, by the time people reach perimenopause, they already struggle with falling asleep and staying asleep at night.

Another reason for sleep troubles as people age is melatonin levels. Melatonin is the body's natural sleep hormone. Melatonin levels decrease with age, and low levels of this hormone impair the circadian rhythms that control sleep onset and maintenance.

Melatonin level decreases are not necessarily related to menopause. They typically decrease before this transition and affect people of all sexes equally.

Menopause Disparities in Black Women 

Not only are Black women more likely than White women to experience insomnia and other sleep disturbances during menopause, a 25-year study also found that Black women were more likely to reach menopause sooner (8.5 months earlier than White women) and they tend to have worse menopausal symptoms, like depression, hypertension, and vasomotor symptoms.

Note that when research or health authorities are cited, the terms for sex or gender from the source are used.

What Menopausal Symptoms Affect Sleep?

Not getting enough sleep can affect all aspects of your life. Lack of sleep makes you forgetful, irritable, and depressed. It also affects your fatigue levels during the day and makes you less alert and attentive, which could increase your risk of a fall or an accident. Research shows poor sleep can worsen menopausal symptoms, especially hot flashes.

Menopausal symptoms will vary from person to person and throughout menopause, starting at perimenopause and continuing throughout menopause. Symptoms that might lead to sleep problems include:

Hot Flashes and Night Sweats 

A hot flash can be described as a sudden and unexpected heat sensation over the body. Night sweats are hot flashes that occur at night and disrupt your sleep.  

Hot flashes are typically accompanied by sweating and start in the face, spreading into the chest and down. They can be short lasting and occur for less than a minute or as long as five minutes. Chills might follow a hot flash.

Bladder and Vaginal Symptoms 

A 2015 study found up to 63% of people in menopause experienced bladder and vaginal symptoms at night, which affected their sleep. Such symptoms included needing to urinate frequently at night, soreness and irritation, urinary and yeast infections, and painful, penetrative sex. These symptoms result from thinning, drying, and inflammation of delicate tissues. 

Mood Changes 

Mood changes common in menopause are anxiety, depression, and irritability. Difficulty with falling asleep can lead to these symptoms, and one of the main causes of depression is insomnia, according to a 2019 Journal of Menopausal Medicine report.

That same report finds people in menopause who experience both depression and hot flashes have a lower quality of sleep than those who are not depressed. 

Joint and Muscle Pain

Joint and muscle pain are common in menopause and can keep you up at night. A 2018 study found that musculoskeletal (muscle and joint) pain affects 21% of people in menopause.

Musculoskeletal pain is commonly associated with fatigue, mood changes, sleep disturbances, increased body fat percentage, anxiety, or stress. It is also affected by lack of physical activity and the presence of degenerative conditions like arthritis, osteoporosis, and more.

Statistics on Menopause in Women of Colour

The circumstance and factors linked to menopause are unique to women based on race, ethnicity, hormones, body differences, and more. Results from a Study of Women's Health Across the Nation (SWAN) show women of colour tend to enter perimenopause and menopause earlier than White women. They may also have longer transition times and experience more severe menopause symptoms, including sleep problems, hot flashes, and vaginal symptoms. 

The duration of hot flashes and night sweats in non-Hispanic White women was 6.5 years, 8.9 years for Latinx women, and 10.1 years for Black women. The SWAN study also found Black women with higher fat percentages had the most prolonged and severe hot flashes. 

What Sleep Issues Are Associated With Menopause?

Menopause sleep troubles will vary from person to person. Sleep troubles associated with menopause include insomnia, breathing troubles related to sleep apnoea, and restless legs syndrome. 

Insomnia

Insomnia refers to chronic troubles falling asleep and staying asleep. People with insomnia report not experiencing restful sleep, frequently waking up at night, waking up early, and fatigue and sleepiness during the day. 

Insomnia is common in menopause due to hormonal changes and menopausal symptoms. Your risk for insomnia will increase as soon as you start having hormonal changes. The more significant the changes, the higher your risk for insomnia. 

Sleep-Disordered Breathing

Some research shows that sleep-disordered breathing (SDB) and obstructive sleep apnoea (OSA) are more common after menopause.

What Is Sleep-Disordered Breathing?

"Sleep-disordered breathing" is a general term for sleep conditions that affect regular breathing patterns during sleep. Obstructive sleep apnoea is a type of SDB.

Before menopause, the risk for sleep apnoea is much lower than afterward. Around 20% of people will develop OSA during menopause, and the risk for OSA is higher in menopause than at any time before and increases postmenopause.

Restless Legs Syndrome (RLS)

RLS causes an uncontrollable urge to move the legs, especially when sitting or lying down at night. While RLS is not explicitly linked to menopause, the condition is common with aging.

Periodic limb movement disorder (PLMD) can also affect sleep and leads to cramping or jerking of the legs every 20 to 40 seconds. One or both conditions can affect people in menopause and disrupt their sleep. 

Menopause Stages and Sleep

Menopause can be a long-term transition in which hormones shift and decrease. With each phase, people can experience sleep problems, many of which can affect their health and quality of life.

Premenopause

Premenopause is the reproductive years when you do not experience menopausal symptoms. Throughout your life, your hormones will shift, and there will be changes to oestrogen, progesterone, and testosterone. These different shifts can affect your sleep and even lead to sleep problems.

Some people experience sleep troubles before and during their periods due to hormonal fluctuations. Both premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are linked to insomnia, frequent night awakenings, and non-restorative sleep.

PMS vs. PMDD

PMS causes emotional and physical symptoms leading to menstruation, whereas PMDD appears to be a more severe form of PMS.

Perimenopause

Perimenopause is the transitional phase toward menopause. For most people who menstruate, perimenopause typically begins in their 40s, although it is possible to experience it earlier. Perimenopause lasts about seven years but can last as long as 14 years. 

According to a 2017 Centres for Disease Control and Prevention (CDC) survey, more than 25% of perimenopausal women report trouble falling asleep, and 30.8% report trouble staying asleep for at least four days a week. At least half of perimenopausal women report awakening at night and feeling tired four or more days a week.

Menopause and Postmenopause

You reach menopause when you have not had periods for 12 straight months. The time after that is called postmenopause. Progesterone is no longer produced, and oestrogen is produced at low levels. While the symptoms of menopause might ease, sleep troubles might continue. 

According to the previously referenced CDC study, more than 55.1% of postmenopausal women report poor sleep, waking up tired and unrefreshed four or more times a week. Around 27% of postmenopausal women report trouble falling asleep, while around 36% report difficulty staying asleep.

Can Menopause Treatments Improve Sleep? 

Oestrogen and hormone replacement therapies can increase oestrogen and progesterone levels. When hormone levels are balanced, symptoms like hot flashes, mood swings, and insomnia will improve.

But these therapies can present serious risks for some people, especially those with a personal history or risk for blood clots, heart attacks, and some cancers. If your healthcare provider prescribes hormone therapy, they will prescribe the lowest effective dose for a short period. 

Lower doses of antidepressant drugs, including Paxil (paroxetine) and Celexa (citalopram), can relieve menopausal symptoms, including hot flashes. Some antidepressants might even help improve your sleep quality.

Over-the-counter (OTC) sleep aids, such as melatonin, can help improve your sleep. Your healthcare provider can also prescribe sleep medicines to help you sleep. Prescription sleep medicines should only be taken for short periods and do not cure sleep problems like insomnia.

Some alternative medicine practices, such as yoga, acupuncture, and meditation, can help you to relax and improve your sleep. They might also improve hot flashes, night sweats, and other menopausal symptoms.

Cognitive behavioural therapy (CBT) might also help improve sleep and menopausal symptoms. With CBT, a therapist can help you recognize behaviours affecting your sleep quality and recommend healthy habits to promote better sleep.

How to Sleep Better During Menopause

If you are experiencing sleep problems related to menopause, you should contact a healthcare provider. They can recommend treatments and sleep strategies to help manage menopausal symptoms and improve sleep.

The National Institute on Aging recommends the following ways to improve your sleep during your menopausal transition and beyond:

• Follow a regular sleep schedule and avoid naps in the afternoon or evening.
• Develop a bedtime routine. A bedtime routine that can help with sleep might include reading, listening to music, or taking a warm bath.
• Avoid watching television or using a mobile device in your bedroom.
• Keep your bedroom quiet and at a comfortable temperature.
• Exercise regularly but not too close to bedtime.
• Avoid large meals, alcohol, and caffeine close to bedtime.
  

Summary  

Sleep problems in menopause are common and might be attributable to hormone changes and symptoms like hot flashes, mood swings, joint and muscle pain, and vaginal dryness. Sleep problems seem to increase based on the stage of menopause and can vary from person to person. Sleep troubles are also more common and more severe in Black women. 

You can improve sleep troubles by managing menopausal symptoms with hormone replacement therapies and antidepressants. Melatonin and prescription sleep aids might also improve sleep. Additional options for managing menopausal symptoms and sleep are CBT, alternative medicine practices like acupuncture and meditation, exercise, and good sleep habits. 

https://www.verywellhealth.com/menopause-and-sleep-7376634