Menopause and Sleep are NOT BFFs. One of the most challenging symptoms from the menopause transition is sleep disruption and insomnia. And I certainly wasn't immune to this - in fact, this was one of the the first symptoms that presented itself in my menopause transition. But it took me a while to link the two and make steps to fix it.
The hormonal changes that happen during menopause are responsible for so many of the symptoms that show up as we transition to post menopause. The disruption of sleep has a heightened and flow on affect to many of the symptoms I was personally experiencing. Menopause definitely messed with my sleep and when I speak to others about some of the challenges they are experiencing with their menopause transition, lack of sleep is often a conversation starter.
As we age, magical melatonin, the hormone responsible for our sleep - wake cycle, begins to taper off, causing more sleep disturbances. Blended with dropping oestrogen and progesterone and you have a potent mix for that all night dance party.
Melatonin is responsible for more than our circadian rhythms. Blood pressure, body temperature and the release of other hormones can also be affected. Understanding this about my body, I began sleep tracking, which requires using a sleep tracker or wearing a smart watch to bed. The daily data and trends helped me to understand the importance of the sleep cycle and the optimum amount of sleep needed for my gender and stage of life. I learnt what quality sleep meant and which activities will cause sleep disruption.
When I began to use the sleep tracking app and added the specifics for my gender, age and activity levels, I could see the sleep cycle targets I should be aiming for and the patterns in my own sleep, or lack of. The sleep tracker begins to record data once you lie down in bed. The descriptions and targets for a sleep cycle are provided with my personal metrics.
While sleeping, we experience a series of “sleep cycles” that comprise of REM — rapid eye movement — and non-REM sleep.
REM sleep is associated with dreaming and usually has the most impact at the back end your sleep. REM sleep is for mental restoration and converting short term memories into long term ones. This would be likened to backing up your memory on your computer or smartphone. The goal for REM sleep is 15–25% of total time sleeping.
For non-REM Sleep, there are 3 stages and some baseline goals for a 50 year old woman. For example, if you aim to consistently reach 7 hours of sleep per night.
❖ Stage 1 — between awake and asleep. The recommended target is 12–24% of total sleep time, or between 1–1.5 hours.
❖ Stage 2 — light sleep where your body temperature and heart rate lowers and breathing regulates. The target is for 40–60% of total time asleep, between 3–4 hours.
❖Stage 3 — Deep Sleep gives physical and mental restoration. Aim for 8–16% of total time asleep, between 1–1.5 hours sleep
The most common time to wake for perimenopausal women is between 2.00–4.00am when REM sleep is starting to lengthen. Being awake during 1–2 sleep cycles affects the brain’s ability to “back up”. Over time, the negative impact can include forgetfulness, brain fog, fatigue and feeling impatient.
Consistently waking up through the night will wreck havoc on your hormones. That 2.00am — 4.00am window is where you need to be asleep for hormone regulation to avoid the fall out of further perimenopause affects. You want to be asleep but your changing hormone production is keeping you awake!
Here is a list of the hormones and the changes:
DECREASING MELATONIN — Melatonin regulates our sleep-wake cycle. Melatonin naturally decreases with age.
INCREASING CORTISOL — This hormone increases with age and stress.
DECREASING SEROTONIN — Our “happy hormone” decreases as we age, which is linked to feelings of heightened anxiety and/or depression.
DECREASING OESTROGEN — Having less oestrogen makes it harder to fall asleep and stay asleep, and has a direct impact on serotonin levels. Less oestrogen means less serotonin. Falling oestrogen levels affect body temperature regulation as well. Cue hot flashes and night sweats.
DECREASING PROGESTERONE — Progesterone helps us to relax. Decreasing levels of progesterone produce less of a sedative affect.
INSULIN AND CORTISOL — Higher levels of insulin and cortisol in the body will slow down overnight fat burning and make it harder for melatonin to help you rest and sleep. Hence the correlation between poor sleep and increasing fat, particularly to the belly.
TIPS FOR MANAGING SLEEP DISRUPTION
If you are reading this and feeling the frustration at not being able to sleep through the night, I feel you. I got you. That sensation of half-functioning throughout the day and all the other fallouts from a sleepless night are debilitating. Here are a list of things you could try and gradually make daily conscious changes for the betterment of your life in this next stage. I recommend that you start with one or two of the suggestions below that feel easy to implement, and then gradually add on more, as some of these tips will challenge aspects of your current lifestyle.
❖Prioritise your natural rhythm. Working longer hours, staying up later and watching TV well into the night are messing with our body’s circadian rhythm. Melatonin production relies on our body to wake up and go to sleep at the optimal times. Waking up with the sun (6–7am) and getting outside into the natural light, when possible, optimises our master internal clock.
❖At night, reduce screen time or “blue light”. This is another inhibitor of melatonin production. Using blue-light blocking glasses, the night setting on your devices and shutting down devices 60–90 minutes before going to bed can improve the quality of your sleep.
❖The goal is to get 7–9 hours of quality sleep based on the stages and optimal recommendations for your age and gender. Using a sleep tracker will help you understand what is happening on a nightly basis. It will only take two weeks of data before you notice the correlations in quality, quantity and how you feel throughout the day.
❖Leading up to bedtime, switch off all devices or move away from the laptop/TV/iPad. This really does mean that you won’t be watching Netflix or any device driven entertainment from bed. I have to be so disciplined with this during the work week as my sleep quality was obviously impacted with device use versus reading a book before lights out. I do enjoy the weekends for Netflix catch ups though.
❖Your bedtime ritual — and I do mean ritual. A conscious play-by-play checklist that you implement to relax your body and mind. It can be really challenging to follow through on the list when you have work and home to-do lists that flow into your evenings. The work deadline that now requires your attention after everyone else has gone to bed, the laundry that needs folding, the bills that need to be paid. I know it! One thing I have mastered the art of through the years is delegation. Recruit the family members to decrease your to-do list and explain nicely that they will enjoy a “loving, kind and all about them mum” versus “psychotic killer mum” when they can help you tackle the to-do list so you can get to bed at a reasonable hour. If your family have been on the receiving end of psycho-mum too many times, then they don’t need an explanation as to why they are now folding the laundry on Tuesdays and Thursdays
❖Caffeine-2cups maximum per day, both before 12pm.
❖Exercise — if you are planning a hard workout, get it done before midday. More gentle movement such as walks and slow flow yoga are better later in the day. Cortisol levels are at their highest after waking up and cortisol also spikes through high intensity exercise. This doesn’t help if you want to sleep, so allow your cortisol levels to decrease throughout the day and set yourself up for a better chance of quality sleep.
❖No naps — try not to nap during the day. We are trying to regulate our circadian rhythms and a nap, unless you’ve had no sleep the night before or are ill, will mess with that.
❖Alcohol really screws with sleep quality. The best nights to focus on getting quality sleep is Sunday — Friday so try to abstain until the weekend and then stop drinking before 7.00pm. Unless it’s a celebration — then go for it! I’m not a kill-joy! Those special moments in life that require celebration are important. If you have been using a sleep tracker, you will see a direct correlation between sleep quality and alcohol consumption.
❖Nutrition Tips: avoid spicy and acidic foods at night. Include high quality carbohydrates such as sweet potato, brown rice, lentils and quinoa. I have strong science based views on nutrition, and depriving yourself of healthy, complex carbohydrates is not optimal, at any stage of life.
❖Set yourself a timer to remind you it’s time to wind down and shut down your devices 60–90 minutes before you plan to go to bed.
❖Put away everything — a quick tidy up and prepping your bedroom for sleep gets you in the mood.
❖Make a list of priorities for the next day. Write it down.
❖And while you are writing, list 3–5 things you are grateful for! You know all the science about that so no preaching here.
❖Set up your bedroom candle or diffuser, or both. Research tells us that the “inhalation of lavender essential oil is a safe, low-cost practice that should be considered as a complementary option to conventional treatments, whether medical, psychological or other integrative and complementary practices” 0498 Effect of Lavender Essential Oil on Sleep in Postmenopausal Women with Insomnia: Double-Blind Randomized Controlled Trial
❖Try a simple and relaxing 10–15 minute yoga practice or stretches followed by 5–10 minutes of meditation. This is physically and mentally preparing your wind down.
❖Taking a warm and relaxing bath or shower. I found that when I lived in the tropics, it was better for my body to have a tepid shower and lower my body temperature but now that I’m back in New Zealand with four seasons, that hot shower sure feels good in the cold of winter.
❖If possible,lower the temperature of your bedroom to around 18C or 65F. If you aren’t able to manipulate your room temperature, ensure that you have cool cotton sheets and/or a bamboo blanket.
❖Use black out curtains to enhance that circadian rhythm,blocking out any street light.
❖Read — whether it’s 15 minutes or up until light’s out.
❖ Night Time Herbal Teas: any combination of chamomile, passionflower, lemon balm, lavender, oatflower, lime flower, liquorice root and valerian root are a great addition to your bedtime routine.
I know this seems like a lot to get you ready for bed and quality sleep. The key is to choose some practices and see how those work for you. Start with the tips that feel the most natural to you and repeat those for 5–7 days. Then add on one more if you feel you can improve further.
I can’t say with 100% certainty whether HRT improved my sleep or not, as by the time I had started using it, I had an excellent bedtime routine which provided me with good quality sleep. My personal opinion leans towards doing what you can from the list above as these are healthy and lifelong recommendations that will make great improvements to your symptoms overall. If HRT is not an option, then maximising these recommendations should be a priority.
RECOMMENDED SLEEP SUPPORT SUPPLEMENTS
❖ Magnesium: (gylcinate or L-threonate) 400–600mg 60 minutes before bedtime.
❖ Melatonin:3mg taken 60minutes before bedtime.
❖VitaminB6/B12:has been shown to boost serotonin levels
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