From honehealth.com
Crappy sleep? We hear you loud and clear. Here’s what experts say can help
When you’re in perimenopause or menopause, getting a good night’s sleep is like winning the lottery: The odds are not in your favour. Just look at the numbers. Between 39 and 47 percent of women experience perimenopause insomnia. The rate of insomnia jumps to 60 percent for women after menopause.
“A trifecta of physical changes, mood changes, and societal demands that make sleep a big problem,” says Shelby Harris, Psy.D, the director of sleep health at Sleepopolis.
During the menopause transition, which starts between 45 and 55 and can last for a decade or more, symptoms from declining oestrogen levels can make it hard to fall and stay asleep. Plus, during this time in mid-life, many women are juggling careers, kids, and even aging parents, which can lead to insomnia-inducing stress.
Beyond feeling tired and cranky⸺which is bad enough⸺chronic insomnia (struggling to sleep three times a week for three or more months) can have long-lasting effects on your body and mind. Poor sleep or not enough sleep can increase women’s risk of osteoporosis, cardiovascular, and metabolic disease. A 2023 study published in Nature and Science in Sleep found women who experience early menopause face higher risks of cognitive decline, for reasons that may include sleep issues like insomnia. The research suggests addressing sleep problems could help protect your brain.
Perimenopause and Menopause Insomnia
During perimenopause and menopause, the primary cause of insomnia is shifts in hormones like melatonin and oestrogen. Declining oestrogen levels can cause hot flashes and night sweats that disrupt sleep. Stress and an increase in mood disorders like anxiety and depression can also make it hard to fall and stay asleep.
Hormone changes
Oestrogen and progesterone, the two main hormones that fluctuate and eventually decline during the menopause transition, help to regulate sleep.
“Specifically, they will allow certain parts of the brain to go through the different cycles and the firing of neurons that allow your body to fall asleep, stay asleep, and have good, restorative sleep,” says sleep expert Dylan Petkus, M.D.
“If you have a day where oestrogen spikes way high or way low, it will destabilize how your brain can initiate sleep and govern sleep,” he says.
Oestrogen supports the pineal gland in the brain, which governs the release of melatonin, the hormone that regulates your sleep-wake cycle. The less melatonin you produce, the less sleep you get. Lower levels of progesterone can also make it difficult for your body and mind to relax into sleep. Progesterone promotes relaxation and drowsiness by increasing the production of GABA (gamma-aminobutyric acid), a neurotransmitter that calms brain activity, making it easier to fall asleep and stay asleep longer.
Perimenopause symptoms
For women in perimenopause and menopause, hot flashes and night sweats can disturb sleep. Oestrogen is once again the culprit here. The hormone helps regulate the body’s internal thermostat in the brain’s hypothalamus. When production dips, it can bring on these vasomotor symptoms. A drop in oestrogen can cause the thermostat to overreact which causes the body to heat too quickly. After you sweat your body begins to evaporate the water, which can bring on chills or cold flashes that wake you up.
“People are uncomfortable from these night sweats,” Dweck says. ”They end up waking up as a result of that physical discomfort with the need to even change their bedclothes or sleep clothes.”
Mood swings
Fluctuations in oestrogen and progesterone can lead to mood swings that can cause or worsen insomnia. Progesterone has a relaxing, calming effect on the body. As ovulation winds down during menopause so does your progesterone. In turn, anxiety and mood swings can increase.
Oestrogen influences the production of key neurotransmitters, including serotonin, a feel-good hormone that regulates mood. Serotonin is also needed to make melatonin for sleep. It’s tough to be cheerful when you’re exhausted — and if you’re anxious or irritable, sleep can be even more elusive.
The risk of developing anxiety and depression increases during perimenopause and menopause as well.
Sleep conditions
Oestrogen and progesterone shifts can cause sleep apnoea and restless leg syndrome, common sources of menopause insomnia.
For years, sleep apnoea—a sleep disorder that causes snoring and repeated pauses in breathing— was considered most prominent in men or people who are overweight. But now researchers acknowledge that during menopause women develop the condition as well. Women with severe hot flashes and night sweats may be at a higher risk of developing the condition.
“Hormonal changes cause a loosening of the muscles of the airway, which can cause snoring,” Harris says. “It doesn’t have to be loud, obnoxious snoring, like we think of with a lot of older men.”
Restless leg syndrome—a disorder that causes an uncontrollable urge to move your legs— also increases during menopause due to hormone changes. Most women experience this condition at night.
“It makes it harder to stay still and to go to sleep, because you feel restless in your body,” Harris says.
Physical symptoms
Menopause-related aches and joint pain can keep women awake at night. These issues primarily stem from increased chronic inflammation, which comes from—yep—hormone shifts.
Declining oestrogen levels elevate levels of pro-inflammatory cytokines and other inflammatory markers associated with difficulty falling asleep, poor sleep quality, and increased fatigue. Lack of sleep can increase inflammation in the body, creating a cause-and-effect cycle.
“If you’re not sleeping well, your inflammatory markers throughout your body will be higher,” he says, “So not only are you sensing more pain, but now you have more inflammatory markers.”
How Long Does Menopause Insomnia Last?
Perimenopause can last between four to 10 years, and your insomnia may last the entire time.
Some women find when they reach menopause, insomnia goes away as their hormones level out. For others, says Petkus, low levels of oestrogen and progesterone may continue to wreak havoc on sleep.
Treating Insomnia in Perimenopause and Menopause
Women have lots of treatment options for the menopause symptoms that cause insomnia, ranging from medications to therapy practices.
HRT
Hormone replacement therapy (HRT, also called menopause hormone therapy or MHT), is effective at treating various symptoms of menopause. The combination of oestrogen and oral micronized progesterone, a synthetic-like hormone, mimics progesterone in the body, which successfully combats sleeplessness for many women.
“Some women will get relief from their sleep disruption by taking hormone therapy,” Dweck says.
Progesterone is also thought to improve sleep quality by increasing non-REM 3 sleep, the deepest level of sleep Dweck notes some women will still experience insomnia or disrupted sleep after taking HRT.
“So we know it’s not just 100% oestrogen related to sleep disruption in menopause,” she says
Birth control
If you’re in perimenopause another to consider is the Pill. Using hormonal birth control may ease insomnia by balancing hormones. One thing to consider: The Pill can hide the symptoms of perimenopause and menopause, which makes it harder to know what’s going on with your body. Taking the Pill after age 35 can also slightly increase the risk of serious health conditions, including stroke and heart attack, especially in women who smoke or have other cardiovascular risk factors.
SSRIs/SNRIs
Some women find some benefit from a low dose of antidepressants. The two most well-known are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). They keep these neurotransmitters in your brain longer so the body experiences their benefits for longer. One study using escitalopram (Lexapro) resulted in better sleep among women who took the medication.
Cognitive Behavioural Therapy for Insomnia
Cognitive behavioural therapy for insomnia (CBT-I) is a proven tool to treat menopausal insomnia. This is particularly true if your lack of sleep is due to mood changes, a racing mind, or negative thoughts.
CBT-I teaches you behaviours and thought patterns that reframe bedtime as a positive experience rather than an anxiety-ridden task. Typically, you’d start sessions with a sleep expert or therapist who’s trained in CBT-I, with the goal of being able to implement what you’ve learned yourself when you need it.
“I think CBT is helpful for that busy mind, where you have night-time wakefulness and you can’t get back to sleep because your mind is racing,” Dweck says. “And CBT may be helpful as a remedy to get those busy thoughts out of your head so that you can get back to sleep and save the daytime for all of that thought process.”
Holistic Ways to Improve Menopause Insomnia
Practicing healthy sleep hygiene is one of the best ways to set up your body and brain for less insomnia. Here’s what the experts recommend.
Get morning sun
One of the easiest ways to combat menopause insomnia is to get morning sun on your face or body. Even just 15 minutes can help with your circadian rhythms, which govern your sleep patterns and habits.
Establish a bedtime/wake-up routine
The National Sleep Foundation recommends going to bed and waking up at the same time every day to keep your body in a healthy sleep pattern.
Create a ritual around bedtime to signal to your brain that it’s soon time for shut-eye:
- Turn off your phone an hour or two before sleep.
- Take a warm bath or shower.
- Drink a cup of herbal tea.
- Read a book.
- Listen to chill music.
Manage stress
Because of hormone fluctuations during menopause, your anxiety and depression can worsen. You aren’t doing yourself any favours by going to bed feeling stressed or worried about kids, work, partner, chores, or whatever is bound to keep anyone up at night. Practicing meditation, and breathing exercises throughout the day or before bed can help quash stress and encourage better rest. Even 15 minutes a day can help.
Watch what you eat and drink before bed
Eating a heavy meal or a dish high in sugar within three hours of bedtime can throw a wrench into your sleep plans, Dweck notes.
The same goes for alcohol. Don’t drink three hours before going to bed, or limit your consumption altogether.
“Alcohol will make you tired. You may fall asleep easier, but it interferes with general sleep,” Dweck says.
Keep your room cool
The National Sleep Foundation recommends keeping bedroom temps between 60 and 67 degrees for optimal sleep. A cool room promotes in your brain that it’s time to produce melatonin, the hormone that helps you sleep.
The Bottom Line
Insomnia during perimenopause and menopause is common. It’s caused by a combination of factors, including changes in oestrogen and progesterone. Hormone replacement therapy, cognitive behavioural therapy may improve sleep, as can adopting healthy habits.
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