Sleep and the Menopause

Sleep problems are very common for women going through menopause, and can have a huge impact on quality of life.

Research suggests that more than half of women notice disrupted sleep during perimenopause. Sleep problems often also occur later, post menopause.

Sleep problems can resolve themselves, but as many as 1 in 4 women will experience insomnia. Insomnia disorder is a chronic sleep problem, defined as difficulty falling asleep, waking up repeatedly during the night or waking up feeling unrefreshed for at least 3 nights a week, for 3 months or more, which has a negative impact on daytime functioning.

There are at least 5 reasons why menopause can interfere with sleep:

1. Hot flushes and night sweats.

Hot flushes are a consequence of hormonal changes. While not every hot flush will wake you up, they are linked to increased arousal in the brain, leading to lighter sleep. If you are woken up during the night, try not to get frustrated - you may not be able to prevent hot flushes from occurring, but you can make it easier to fall back to sleep. Keep a fan in the bedroom to help keep air circulating. You could try sleeping on a towel, so that it’s easy to change if you wake up bathed in sweat. Focus on getting comfortable and allow yourself to relax. Cutting back on caffeine and alcohol can help some women to reduce hot flushes, as well as improving sleep quality.

2. Pain

Recent studies point towards an increase in pain and inflammation during menopause, which can disrupt sleep. Ask your medical team about the right pain medication. Practicing mindfulness meditation has also been found to help with pain management.

3. Nocturia, or waking up to urinate at night

Lower levels of oestrogen can lead to drying of the genital tract, discomfort and strong urges to urinate; which can disrupt sleep. Treating vaginal dryness can help with this. You might also want to keep a track of your fluid intake for a week or two, to see whether cutting back on fluids in the last hour before bedtime makes a difference.

4. Stress and low moods

Menopause often occurs at a time in women’s lives that is full of emotional challenges including an empty nest, caring for elderly parents, and career transitions. Volatile hormones make women more vulnerable to poor mental health. Lower levels of oestrogen can alter the regulation of hormones and transmitters which influence mood, such as serotonin. Stress is bad news for sleep, and lack of sleep can amplify the effects of stress. Fortunately if you can get sleep under control, it can make everything else easier to cope with.

5. Higher rates of other sleep disorders, including OSA and RLS

Sleep Apnea, or OSA, is a condition where narrowing of the upper airways leads to pauses in breathing throughout night, and is often associated with snoring. OSA disrupts deep sleep and leads to extreme sleepiness during the day. Sleep apnea can occur at any age but becomes more common in postmenopausal women, probably because of a reduction of the hormone progesterone. In Restless Legs Syndrome (RLS), a sudden urge to move your legs interferes with getting to sleep. RLS seems to be more common in perimenopause, especially for women who have night sweats.

If you suspect that you’re suffering from a sleep disorder such as insomnia, OSA or RLS, and you’re having difficulty coping, speak to your doctor or healthcare team about evidence-based treatment.

Although sleep problems are very common, they are not inevitable. There are lots of things you can do to improve the quality of your sleep, regardless of what your hormones are up to.

The number one, evidence-based approach to treating insomnia, is called CBT-I or Cognitive Behavioural Therapy for Insomnia. This is a toolkit of different techniques which you try to help reinforce your natural sleep patterns, and tackle negative sleep thoughts. Hormone Replacement Therapy may also help to reduce the frequency or intensity of hot flushes.

Here are 4 of the core ingredients of CBT which could be helpful to get your sleep back on track..

• Get out of bed at the same time every day, even when you’ve had a poor night’s sleep. This anchors your body clocks, or circadian rhythm, and means you will automatically start to get sleepy at the same time each night. Your sleep is likely to be deeper after a short night of sleep to help you recover.

• Secondly, regular exercise can help you fall asleep faster, and stay asleep for longer. As little as 30 minutes of moderate intensity exercise can help you sleep more deeply. If you’re not used to exercise, get help from an exercise specialist to gradually build up your strength and fitness.

• Thirdly, feeling stressed in the evening can interfere with the body’s natural production of melatonin. This can delay the body clock and lead to lighter, more disrupted sleep. Take time to unwind and detach from the day before bed. Relaxation techniques such as progressive muscle relaxation, yoga and mindfulness can all help switch off the stress response, and lead to more restorative sleep.

• Finally, only go to bed when you’re sleepy tired: the longer we stay awake, the more pressure to sleep we build up. If you don’t feel tired, do something relaxing until your eyelids feel heavy, and only then get into bed. If you’re feeling fatigued, a short 20 minute nap after lunch can be a useful boost to mood and energy levels.