Have you recently discovered that sleep is not at the top of your skill set? Maybe you have difficulties falling asleep—or staying asleep. Maybe you wake up from night sweats, drenched and needing to change your pj’s. You might find yourself awakening too early in the morning with no chance of falling back to sleep. Or you awaken once a night or more to pee. Whatever the problem, the recommended nightly 6 to 7 hours of uninterrupted sleep are only a dream.
More than 50% of women report sleep problems as they progress through the menopausal transition, experiencing insomnia and night sweats. Almost one in ten postmenopausal women have sleep apnea, a potentially serious disorder. And 1 in 4 menopausal women reports sleep problems severe enough to interfere with daytime functioning because they’re feeling fatigued or brain-fogged.
Many factors can contribute to sleep issues, some related to perimenopause and menopause, and others related, rather, to aging or illness. Here, we’re addressing only the reasons related to the hormonal fluctuations of the menopausal transition. These generally begin in your early 40s, when your ovaries (and other organs) start to produce lower levels of estrogen and progesterone, and higher levels of follicle-stimulating hormone (FSH). Throughout your reproductive years, as estrogen levels diminish, FSH levels rise to stimulate your ovaries to release another egg (follicle). As you enter menopause and you produce less estrogen, you eventually stop ovulating, causing your FSH levels to remain elevated. In fact, sustained high FSH levels are often used to confirm menopause.
The changes in these particular hormone levels have all been linked to poor sleep quality and a greater risk of frequent night-time awakenings. Growing evidence suggests fluctuations in estrogen levels, common during perimenopause, also trigger changes in your brain that may contribute to (or possibly cause) sleep problems. In addition, declining estrogen levels affect the body’s ability to use and absorb magnesium, a mineral that helps your muscles relax; low magnesium levels have been linked to insomnia.
Production of progesterone, a hormone considered ‘calming’ because of its sedative benefits, also declines during perimenopause, and once you’re through with menopause, stops altogether. Diminished progesterone levels can cause sleep problems, anxiety, and stress, and, in a kind of unfortunate loop, stress can induce other changes that further lower progesterone levels.
Hormonal changes also cause pesky symptoms of menopause: hot flashes and night sweats, even urinary frequency. Women often associate hot flashes and night sweats with sleep problems—especially nighttime awakenings and chronic insomnia. Obviously, if you’re waking to drenched sheets and pj’s from night sweats, you're not likely to feel refreshed in the morning.
Should you be concerned about your health if you’re having trouble sleeping? While many sleep problems are a temporary nuisance, some can be serious and need to be evaluated. Occasional insomnia—such as waking from night sweats once or twice a week—can be frustrating, but likely won’t lead to other medical concerns. On the other hand, chronic insomnia that has persisted for at least a month and causes daytime consequences—can lead to heart disease, high blood pressure, and a weakened immune system, not to mention substantial daytime sleepiness, fatigue, and irritability.
But there’s plenty you can do to help you sleep better.
1. Don’t eat large meals before bedtime. Avoid spicy or acidic foods because they can trigger a hot flash.
2. Avoid smoking, caffeine, and alcohol—especially before bedtime.
3. Exercise to maintain a healthy weight—but don’t exercise at least two hours before you hit the hay.
4. Try to get direct sunlight for vitamin D.
5. Use a fan or air conditioner to increase air flow and cool the bedroom.
6. Keep the bedroom dark at night.
7. Sleep in a lightweight fabric like cotton or one that wicks away your sweat; avoid heavy blankets. Keep an ice pack near your bed to help you cool off if you awaken with night sweats.
8. Establish and keep to a sleep schedule—even on the weekends.
9. If you awaken and cannot fall back to sleep after 20 minutes, leave the bed to do something relaxing until you feel sleepy.
10. Find ways to help reduce stress: meditation, yoga, deep breathing, massage, or a warm bath or shower before bed.
If these steps aren’t sufficiently helpful, talk with your health care provider (HCP). Depending on your symptom(s) and how bothersome they are you might consider a short course of hormone therapy, antidepressants, or sleep aids. A word about over-the-counter supplements like phytoestrogens, melatonin, black cohosh, flaxseed oil, soy isoflavones, magnesium, vitamin D, and calcium: Talk with your HCP before adding anything to your daily regimen.
You don’t have to yawn your way through your 40s and 50s. Get the help you need now to put you on the road to recovering your zzzzzzz’s.