Throughout a woman’s life, events surrounding reproduction will cause fluctuations in hormone levels. Though healthy and normal in many cases, these fluctuations can still contribute to sleep issues. Women often experience symptoms of insomnia timed around their monthly menstrual cycle, and any mother can tell you that pregnancy can be a tough time to consistently get enough high-quality sleep. According to a National Sleep Foundation poll, 78% of women report more disturbed sleep during pregnancy than at other times, along with higher levels of daytime exhaustion.
However, one of the most challenging times for sleep that a woman will face is perimenopause, a.k.a. the time during which she transitions to menopause. According to a 2017 study by the CDC, perimenopausal women were more likely than either pre- or postmenopausal women to get less than 7 hours of sleep. That’s an important threshold in sleep science. Postmenopausal women also suffer, reporting more trouble than premenopausal women of the same age in getting to sleep, staying asleep, and waking up feeling rested.
How Does Menopause Contribute to Sleep Problems?
Many of the sleep disturbances women experience during the transition to menopause are rooted in changes to hormone levels that have otherwise remained relatively stable throughout a woman’s life. Hormones are the long-distance communicators in our bodies. Their role is critical to so many of our body’s functions, it’s no surprise that changes to our hormone balance can cause a variety of challenges.
As perimenopause progresses, a woman’s ovaries gradually but significantly decrease their production of estrogen and progesterone, two hormones with profound effects on sleep. Estrogen helps facilitate proper REM sleep activity and is involved in the metabolism of serotonin, a key mood and sleep-mediating neurotransmitter. Estrogen also helps regulate body temperature. Changing estrogen levels during menopause lead to the familiar phenomenon of hot flashes, increasing the frequency of waking up during the night.
Progesterone also contributes to healthy sleep. It interacts with the regulatory system for GABA, another neurotransmitter critical to achieving healthy sleep, to decrease anxiety. Higher levels of progesterone are also associated with lower incidence of sleep apnea, a common cause of sleep disturbance that can increase with menopause.
Beyond the purely physical changes that menopause brings, psychological stressors can also play a role in subpar sleep. With most women experiencing menopause in their 40s and 50s, the perimenopausal period often coincides with other significant life stressors. Think: caring for teens or aging parents (sometimes all at once!), planning for retirement, and maintaining high performance in senior level jobs.
Many who struggle with sleep are familiar with the feeling of racing thoughts at night and being unable to “turn our brain off” and relax. Normal daily anxiety is provided greater opportunity to disrupt sleep due to more frequent nighttime awakenings caused by menopausal hot flashes. In fact, menopause is associated with an increase in mood disorders, including anxiety and depression, and many researchers believe that at the root of this increase is chronic lack of sleep.
What Can I Do to Sleep Better During Menopause?
The good news is that the same types of sleep hygiene interventions that help people get quality ZZZs when they’re not going through menopause will also help those struggling with the extra midlife burden. The best place to start? Consistency. A consistent bedtime and routine to relax and get ready for bed goes a long way towards reaping the benefits of better sleep. You can begin to build your “sleep ritual” at any level and then add steps over time that you find to be beneficial. Here are a few key areas to pay attention to:
Temperature: It can be so hard to sleep if you’re too warm, and the hot flashes associated with menopause can make this underlying issue all the more troublesome. Start with your thermostat set to around 65 degrees Fahrenheit and adjust to your preference. Err on the side of a bit too cool and choose your bedsheets and blankets to fine tune for maximum comfort.
Lighting: The darker, the better! As night falls, lower the level of overall lighting in your space to the minimum that is safe to get around. The decreased artificial light will allow your body to naturally begin the first steps of the transition to sleep, including releasing melatonin, the primary sleep-regulating hormone.
Disconnect: Shut down those phones and laptops, not just to avoid exposure to the blue light that inhibits melatonin release, but also to give your mind a break from the stress of the day and prepare to slip into a restful night of sleep. Take some time after dinner to answer those last emails or texts and then transition from screen time to a book, some music, or another non-digital, non-stressful activity.
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