Disturbed sleep is a common, but often distressing, symptom during perimenopause and menopause but you can take action
• Sleep is vital for every system in your body
• Fluctuating and low hormone levels can affect your sleep
• HRT, magnesium and a good sleep routine can help
When was the last time you had a really good, deep sleep and woke up feeling refreshed? Can you even remember? Disturbed sleep – whether you’re struggling to get to sleep when you go to bed, wake frequently during the night, or wake up too early every morning – is a common symptom during perimenopause and menopause.
In a Newson Health survey of 5,744 perimenopausal and menopausal women, 79% of respondents reported experiencing sleep problems, making it the fifth most common symptom [1].
Why is sleep important?
There is no system in your body that gets away unscathed by a lack of sleep – let’s have a quick look at the benefits of getting a good night’s sleep:
Boosts brainpower
Getting 7-¬8 hours of sleep allows your brain cells to reorganise and get rid of the toxic waste that builds up in the day; this allows your brain to work well when you wake up. Sleep helps your thinking skills stay sharp and ready for action – learning new information, problem¬ solving, creativity, decision¬ making, focus, and concentration are all boosted when you get good quality sleep. Sleep also helps your brain stabilise and regulate your emotions, so you don’t overreact in certain situations.
Improves immunity
Poor sleep can make your body more susceptible to germs. When you sleep, your body makes proteins that fight infection and inflammation. It also produces antibodies and immune cells that work together to fight off harmful bugs.
Helps your heart
Getting less than seven hours a night on a regular basis can lead to a range of health problems, many of which can harm the health of your heart. Lack of sleep is associated with risk factors for heart disease, such as high blood pressure, raised cortisol levels, weight gain and insulin resistance, which can lead to type 2 diabetes.
Controls hunger hormones
Sleep affects your weight by controlling the hunger hormones, ghrelin (which makes you feel hungry) and leptin (the one that tells your brain you’re full). A lack of sleep raises levels of ghrelin and reduces leptin. This imbalance makes you feel more hungry, which is likely to cause you to eat more and potentially – over time – gain weight.
Why does sleep change during perimenopause and menopause?
The hormones oestradiol (oestrogen), progesterone and testosterone all have important effects on your brain, including helping the quality and duration of sleep. Low levels of these hormones can lead to low melatonin levels (the sleep hormone). Low hormone levels can lead to sleeping problems but also cause fatigue, difficulty concentrating, headaches, muscle and joint pains, and mood changes – a lack of sleep can further exacerbate these symptoms.
The hormone progesterone can be beneficial for sleep as it increases the production of GABA (gamma aminobutyric acid), another chemical in your brain that works to help sleep. Progesterone can also improve relaxation and mood and a drop in progesterone levels can lead to symptoms such as anxiety, restlessness and trouble sleeping, including a tendency to wake up frequently.
While not all women who experience poor sleep during perimenopause and menopause experience night sweats, vasomotor symptoms are usually associated with poorer sleep – it’s thought that the overlap between hot flushes and awakening is triggered by a response to fluctuating oestrogen levels [2].
How to sleep well
Because good sleep is essential to your health, it is worth doing all you can to maximise some much¬ needed downtime and let your brain work it’s magic while you sleep.
HRT
HRT is the first line treatment for symptoms of perimenopause and menopause [3]. By optimising your hormones you’ll treat the hormonal cause of your sleep disturbances plus reduce symptoms that might wake you up, for example, night sweats, stress and anxiety, or frequent urination. Women often notice they can fall asleep quicker and wake up during the night far fewer times (or even not at all). Testosterone can also often be beneficial for sleep.
A Newson Health study of 510 women – who had already been using HRT (transdermal oestrogen with or without a progestogen) – who were treated with transdermal body-identical testosterone for four months, found 21% of women reported an improvement in symptoms of feeling tired or lacking in energy [4].
Many women take micronised progesterone (Utrogestan) as the progestogen part of their HRT. Utrogestan is a natural sedative and is usually taken at night time, so can cause drowsiness for some women – an added bonus if you’re struggling to sleep.
RELATED: Utrogestan (micronised progesterone) explained
Magnesium
Magnesium is a very important mineral and is found in all of your tissues, especially your bones, muscles and brain. It activates the parasympathetic nervous system, the system responsible for getting you calm and relaxed to help prepare your body for sleep, and it also regulates the hormone melatonin, which guides sleep-¬wake cycles in your body.
A good-quality magnesium supplement with vitamin B can improve sleep, as well as lower stress levels. Drinking alcohol and coffee and experiencing stress can reduce your body’s ability to absorb magnesium.
RELATED: Do I need supplements during menopause?
Make two changes to your night-time routine
1. Keep it cool: It’s much easier to get to sleep and stay asleep if you are on the cool side of comfortable rather than warm. A room temperature of around 18°C is recommended as ideal for a good night’s sleep. You may find avoiding hot drinks before bed and having a fan in the room helps with any hot flushes or night sweats.
2. Keep it the same every night: A consistent routine is like an anchor to your sleeping patterns. Go to bed at the same time every night and wake up and get up at the same time every morning ¬ yes, even at the weekends if you are serious about establishing better sleep! A consistent routine improves not only the quantity of sleep but the quality too, leading to a real difference in how your body will function and how you feel during the day.
Other sleep-friendly habits
Avoiding (or limiting) alcohol, caffeine and drugs such as marijuana, will help you sleep better overall. While alcohol or marijuana may help you get off to sleep, they are sedatives, so they only give you an artificial kind of sleep, which does not have the same physiological benefits as ‘natural’ sleep.
Stress is a big contributor to sleep disruption and while it’s not always possible to remove stress entirely from your life, there are ways to minimise its impact: challenge your worried thoughts, slow down and breathe and keep a note of your worries on paper to take them out of your mind.
Try to reduce time spent on your mobile phone, tablet or laptop at the end of the day. Blue light in the evening disrupts your brain’s natural sleep-wake cycles. There are several ways to block blue light in the evening, including dimming or turning off the lights in your home, amber-tinted reading glasses, and apps that automatically adjust the light from your devices according to your time zone.
Keeping your room as dark as possible really helps your body’s natural sleep rhythms. Blackout blinds or curtains are great for this.
Remember… Along with nutrition and exercise, good sleep is one of the pillars of health so you should protect your sleep as much as you would your physical wellbeing. If you find your sleep deteriorating during perimenopause and menopause, act on it by talking to your healthcare professional about starting HRT, or adjusting your dose and type to minimise symptoms, and be strict about adopting sleep¬-promoting habits every day.
