Can't Sleep During Menopause? Why It Happens and What Actually Helps
It was three in the morning. It is broad daylight, the heart is thumping, the sheets are soaked. You look at the ceiling for an hour, and then fall asleep, and then the alarm. You spend the entire following day running around without filling up.
And in case this sounds like you are not alone. One of the most widespread and most tiring aspects of menopause transition is sleep disruption. Studies indicate that approximately 56 percent of women in the pre-final period complain of persistent sleeping difficulties. But it is also among the symptoms that is brushed off most of the time, usually with a fleeting hint that one should reduce the number of coffee and attempt to relax.
In this post, a more detailed analysis of why sleep is such a battle during menopause, what exactly is occurring in the body, and what evidence supports as actually useful, beyond the generic advice, is considered.
Menopause does not affect sleep through one mechanism. It influences it in a number of ways; they tend to overlap and support one another. This knowledge makes it far easier to understand why it is often necessary to use more than one approach to fix sleep at this stage.
The most discussed reason for menopause sleep disruption is night sweats, hot flushes that occur during sleep. When a hot flush occurs at night, the temperature of the body is skyrocketing, you wake up sweaty and then the following cooling down of the body may take in another 30 to sixty minutes to make you fall asleep. Repeat this two or three times a night and the quality of sleep goes down at a rapid rate.
However, here is what is less known: there are women who do not sleep well during menopause even in cases where night sweats are not the main problem. This is to say that the hormones themselves are directly contributing to sleep, not just to hot flushes.
The calming hormone is commonly referred to as progesterone, and this is partly due to its sedative influence on the nervous system, which is gentle in nature. It assists the brain in relaxing and it becomes easy to fall asleep and sleep. In fact, progesterone is the first to decrease in perimenopause, and it may occur many years before oestrogen decreases considerably.
That is one of the reasons why many women begin to notice the change in sleep patterns in their early and mid-40s, much earlier than they would think that menopause would be applicable. More wakefulness in the middle of the night, less time in light sleep, poor ability of going back to sleep after waking, all this can be related to falling progesterone even when periods remain regular.
The role of oestrogen in sleep cycle regulation is in the brain. It affects the manufacture of serotonin, which participates in mood and sleep, and the duration taken in more profound and more restful periods of sleep. The amount of sleep does not change, but the quality of the sleep does when oestrogen levels become erratic in perimenopause.
This is what makes some women report of their sleep during menopause as feeling thin or unsatisfying. They may be technically in bed all eight hours but wake up totally unrefreshed. The structure of sleep, the rhythm of night deep and light cycles, has been broken.
Mood and anxiety are also influenced by hormonal changes during the transition. And anxiousness is one of the most potent sleep-disturbers that exists. When the brain is alert anxious it is unable to move to the relaxed mode of sleep. A slight rise in background anxiety, the type that may not seem dramatic in normal daytime conditions, is sufficient to cause the brain to remain hyperactive at night.
Most women in their 40s and 50s are also carrying a heavy burden when it comes to life tasks: they have to take care of children and their ageing parents at the same time, work in a demanding job, and deal with relationship transitions. All of this is topped by the hormonal changes of perimenopause, and it is sleep that frequently suffers as a result.
And this is the section that is hardly ever referred to. Obstructive sleep apnoea, or the partial closing of the throat during the sleeping-time of a person, so that the sufferer is now and then prevented from inhaling, is the danger which awaits the woman after menopause. A study that compared postmenopausal women to pre and perimenopausal women had the result that postmenopausal women were 48% more susceptible to screen positive on sleep apnoea.
Sleep apnoea is linked to poor restful and broken sleep and is related to daytime drowsiness, brain fog, mood swings, and long-term heart disease. The symptoms are quite similar to menopause symptoms and this is one of the reasons why it is so easily missed. In case you are a loud snorer, or you have noticed your partner halting your breathing during sleep, or you are waking up without feeling refreshed despite what seems like a reasonable amount of time in bed, it is worth raising sleep apnoea with your GP in particular.
Assuming that the primary source of your waking is night sweats, the most reasonable place to begin will be to decrease the number of sweats instead of simply attempting to increase sleep on its own.
One of the most effective practical modifications is to keep the bedroom cool. Sleep is most often supported by room temperature of about 18 to 19 degrees Celsius and lower temperatures will work better during the menopause transition. Even when they are not able to do away with night sweats completely, a fan, light breathable bedding and moisture-wicking sleepwear can all alleviate the severity with which the night sweats disrupt sleep.
Medically, menopausal hormone therapy (MHT) is the best treatment in order to decrease vasomotor symptoms such as night sweats, and consequently enhance the quality of sleep. Women that treat their night sweats with MHT usually experience a significant increase in sleep as a direct effect. Certain studies also indicate that MHT, and especially progesterone, could also possess other direct effects on sleep other than depressing night sweats.
CBT-I is an acronym that means cognitive behavioural therapy of insomnia. It is not a symptom-focused programme but a structured programme that deals with the thoughts, habits, and behaviours that perpetuate insomnia. Sleep experts have recognised it to be the most effective long-term treatment of insomnia, and more effective than sleeping pills in a majority of cases.
CBT-I has such methods as sleep restriction therapy that seems counterintuitive but actually consolidates the disrupted sleep into a more intact block, stimulus control, which rejuvenates the bedroom with sleep instead of wakefulness, and the thought patterns that tend to develop around not sleeping, which are addressed.
It also applies to menopause in particular. Studies indicate that CBT-I can greatly reduce the extent of sleep disruption on quality of life even in the absence of the elimination of hot flushes. It is an effective solution to menopausal sleep problems as it is mentioned by Jean Hailes for Women Health.
Access varies. The best path is a GP-referred psychologist. Certain digital CBT-I programmes have been demonstrated to have significant outcomes and are also more convenient to individuals living in a regional location or with a hectic timetable.
Sleep hygiene is a fact that is dismissed as a matter of common sense, yet when practiced on a regular basis, it does indeed move the needle in the right direction in many women. The major principles that need to be considered are:
Magnesium, especially in glycinate form, has some decent evidence in its support of sleep quality as it calms the nervous system and decreases the muscle tension. During the menopause transition, many women are deficient in magnesium because of the stress demands and the change in diet. It is a low-risk supplement that is worth considering especially when sleep problems are combined with muscle tension, restlessness, or nighttime anxiety.
The hormone that the body produces naturally in response to darkness is called melatonin and that is the one that says that the body is ready to sleep. It does not calm the body the way sleeping pills do but aids in timing the sleep onset. According to Jean Hailes for Women Health, melatonin can be effective in certain female patients, especially when the issue is not the inability to fall asleep, but the inability to maintain sleep. It has an interplay with certain drugs, so it is good to mention to your GP to take it regularly.
Exercise enhances the quality of sleep in several ways. It decreases anxiety, elevates mood, and enhances the quality of sleep as it arrives. Exercise is always researched to be helpful in sleep during menopause.
A subtlety that is worth attention: acute activity carried out between two and three hours before going to bed may complicate sleep onset by increasing the body temperature and stimulating the nervous system. Exercise in the morning or early afternoon should be the most effective on the night-time sleep, and light activities such as walking or yoga in the evening should be alright.
Menopausal sleeping issues are not something that you just have to put up with. Certain circumstances will justify a medical discussion:
Sleep deprivation in menopause is a real problem and it is not a question of having to just work harder or adopt better practices. This hormonal shift directly impacts the sleep system in a variety of ways: it can be in the form of night sweats, which disrupt sleep, the progesterone calming effect, altered depth of sleep, mood and anxiety changes, which have the effect of keeping the brain too awake at night.
The positive aspect is that evidence-based approaches are really helpful. Night sweats, trying to work on the sleep patterns that will help to consolidate, trying CBT-I in case insomnia has already established itself, and magnesium and melatonin as gentle interventions are all fair starting points.
When sleep issues are chronic, extreme or accompanied by loud snoring, do not dismiss it as a mere case of menopause. Your GP can assist you in overcoming what is causing the disruption and identifying a method that suits your circumstances.