The Silent Struggle: Menopause and Sleep Disturbance

Menopause and Sleep Disruption: Unraveling the Causes 

Sleep disturbances are remarkably common during the menopausal transition. Research shows that brain fog is the biggest problem for women in menopause.

Poor sleep and hot flashes are also major issues. Researchers believe that about 75% of women suffer from poor sleep at some stage during the menopause. Disruptions in sleep significantly impact well-being in many ways.

Many factors can interact with each other to heighten sleep problems during perimenopause and menopause.

Hormonal fluctuations

Estrogen receptors are found throughout the body, including the brain and areas that regulate sleep. As estrogen levels decline, these areas may not function as efficiently, leading to sleep problems. A decline in progesterone levels also negatively impacts sleep.

Hot flashes and night sweats

Estrogen plays a critical role in temperature regulation. Menopause can cause sudden changes in body temperature. These hot flashes can disrupt sleep and lead to waking up often.

Mood changes

Anxiety and depression, common during menopause, can significantly interfere with sleep patterns. Anxiety and depression can cause difficulty falling asleep, frequent waking and early morning waking. Once awake, anxiety can trigger thoughts that make it exceedingly difficult to fall back to sleep again.

Other medical conditions

Sleep apnea, restless leg syndrome, joint pains, and thyroid disorders can exacerbate sleep issues during menopause.

The Effects of Sleep Deprivation

The consequences of chronic sleep deprivation extend far beyond daytime fatigue. Persistent sleep problems can contribute to:

Reduced quality of life due to menopause and sleep deprivation

Sleep plays a fundamental role in our overall well-being, and we cannot overstate its importance. When we do not get adequate sleep, we significantly compromise our ability to function effectively in our daily lives. This lack of restorative rest affects us on multiple levels—physically, mentally, and emotionally.

Physically, insufficient sleep can lead to a range of health issues. Our bodies require sleep to repair and rejuvenate themselves. During sleep, important processes happen.

These include muscle growth, tissue repair, and the release of hormones. These hormones help control different body functions.

Not getting enough sleep can make us feel tired. It can also weaken our immune system. This increases the risk of long-term health issues like obesity, diabetes, and heart disease.

Mentally, the effects of sleep deprivation are profound. Lack of rest harms our cognitive functions. This includes attention, memory, and decision-making.

We may find it difficult to concentrate, process information, or recall important details. This can lead to decreased productivity at work or school, as well as an increased likelihood of making mistakes. Furthermore, our creativity and problem-solving abilities can suffer, making it challenging to tackle tasks that require innovative thinking.

Emotionally, the consequences of poor sleep are equally significant. Sleep deprivation can lead to heightened irritability, mood swings, and increased stress levels.

Our emotional resilience—the ability to cope with challenges and setbacks—diminishes when we are tired. This can result in a lower tolerance for frustration and a greater likelihood of experiencing anxiety or depression. In social situations, we might find it hard to connect with others. This can lead to strained relationships and feelings of loneliness.

Worsening menopausal symptoms

Fatigue is a complex and multifaceted condition that can significantly impact an individual’s overall well-being. When someone feels tired, it often makes other symptoms worse. This includes hot flashes and mood swings. This creates a tough cycle that can be hard to manage.

Hot flashes, which are sudden feelings of warmth that can cause sweating and discomfort, can be particularly distressing. When a person is fatigued, their body may be less equipped to handle these episodes, leading to increased discomfort and a heightened sense of anxiety. This can create a cycle.

The discomfort from hot flashes can lead to more fatigue. This makes it harder to handle the situation.

Similarly, mood swings—characterized by rapid changes in emotional state—can become more pronounced when an individual is fatigued. Fatigue can impair cognitive function and emotional regulation, making it more difficult to maintain a stable mood. As a result, a person may find themselves feeling irritable, anxious, or depressed, which can further drain their energy levels and exacerbate feelings of fatigue.

In summary, fatigue does not happen alone. It interacts with other symptoms like hot flashes and mood swings. This makes their effects stronger and makes it harder for a person to cope.

To improve overall health and well-being, it is important to address fatigue in a holistic way. This approach can reduce the impact of other symptoms and improve a person’s quality of life.

Increased Risk of Chronic Diseases

Numerous studies have established a significant correlation between inadequate sleep and an elevated risk of developing chronic diseases, including cardiovascular disease, diabetes, and obesity. When people do not get enough restorative sleep, their bodies experience changes. These changes can lead to health problems.

For instance, poor sleep quality can contribute to hypertension, a major risk factor for heart disease. While we sleep, our body does important work to control blood pressure.

If we don’t get enough sleep, this work can be affected. This can cause high blood pressure to stay high. Additionally, sleep deprivation can negatively affect the body’s ability to metabolize glucose, increasing the risk of insulin resistance and, ultimately, type 2 diabetes.

Brain Fog and Cognitive Decline

Sleep is very important for keeping our brain healthy. It helps with memory, learning, and how well we think. During sleep, especially in the rapid eye movement (REM) phase, the brain sorts and organizes information from the day. This is essential for forming long-term memories and enhancing problem-solving skills.

When people do not get enough sleep, they often feel “brain fog.” This can mean trouble focusing, poor judgment, and less clear thinking. These cognitive problems can show up in different ways. You might have trouble focusing on tasks, remembering information, or reacting quickly.

Chronic sleep deprivation can lead to serious cognitive decline over time. It also raises the risk of neurodegenerative diseases like Alzheimer’s disease.

Research shows that not getting enough sleep can cause beta-amyloid plaques to build up in the brain. These plaques are a sign of Alzheimer’s disease. This underscores the importance of prioritizing sleep not only for immediate cognitive function but also for long-term brain health.

In summary, poor sleep affects more than just tiredness. It can lead to many health risks, like chronic diseases and problems with thinking. Prioritizing quality sleep is essential for maintaining overall health and well-being, highlighting the need for individuals to adopt healthy sleep habits and seek solutions to improve their sleep quality.

Weight gain:

Sleep balances hunger hormones like ghrelin and fullness hormones such as leptin. Lack of sleep raises ghrelin and lowers leptin, often leading to overeating.

Moreover, there is a strong link between sleep and weight management. Not getting enough sleep can cause hormonal imbalances. This can affect how we regulate our appetite. As a result, we may crave more high-calorie foods.

This can create a harmful cycle. Poor sleep can lead to weight gain. Weight gain can make sleep problems worse. This increases the risk of obesity and related health issues.

Seeking Solutions: A Multifaceted Approach

While the challenges of sleep disturbance during menopause are real, there are many potential solutions to explore. Consulting with a healthcare professional to determine the best course of action is essential.

A healthcare provider can help rule out underlying medical conditions that could be contributing to your sleep problems. They can also offer personalized advice based on your specific symptoms and medical history. Here are some options to discuss with your doctor:

Hormone Therapy

Estrogen: For women with severe hot flashes and night sweats, estrogen therapy can provide significant relief from these symptoms. Hot flashes are sudden feelings of warmth that spread through the body. They often come with sweating and discomfort. These symptoms can disrupt daily life.

Night sweats are episodes of heavy sweating while you sleep. They can cause you to wake up often and have a restless night. This can affect your overall well-being and quality of life.

Estrogen therapy helps by restoring hormone levels that may drop during menopause. This can stabilize body temperature and reduce hot flashes and night sweats. By easing these symptoms, many women can enjoy better sleep. This restful sleep is important for both physical and mental health.

Women thinking about estrogen therapy should talk to their healthcare provider. They need to discuss the possible benefits and risks. It is also important to explore treatment options that fit their health needs and situations.

Progesterone. Women with a uterus need progesterone along with estrogen when they receive Menopausal Hormone Therapy. There can be an added benefit of this progesterone. Progesterone has sedative-like effects that can promote relaxation and enhance sleep quality.

Effects can vary between women and progesterone may not be appropriate for everyone. You should weigh potential side effects and risks against potential benefits. The effects of progesterone can include:

• Reducing time to fall asleep
• Increasing total sleep time
• Improving sleep efficiency
• Enhancing slow-wave sleep

Non-Hormonal Medication for Hot Flashes

Low-dose antidepressants: Certain antidepressants can help regulate sleep and improve mood. These medications are also an option for women who cannot or choose not to take estrogen therapy.

Gabapentin: This medication, primarily used for nerve pain, can also be effective in reducing hot flashes and improving sleep.

Lifestyle Modifications for all menopausal causes of disruptive sleep

• Cognitive Behavioral Therapy (CBT) is highly effective for managing insomnia and is recommended as a first-line treatment.
• Establishing a Regular Sleep-Wake Cycle
• Going to bed and waking up around the same time each day, even on weekends, helps regulate your body’s natural sleep rhythm.

Wind-Down Routine

• Establish a consistent sleep schedule and stick to it as much as possible.
• Create a relaxing bedtime routine that helps signal to your body it’s time to sleep. This could include reading, stretching, or meditation.
• Spend 10 minutes processing your thoughts outside of bed in dim light each night. This can help manage an active mind.
• Writing down your thoughts can help clear your mind. Making a to-do list for the morning and putting it away can also help. Journaling before bed can help you set aside worries until morning.

Light Exposure

• Maximize sunlight exposure in the morning and throughout the day. Get daylight early in the day to set up the circadian rhythm, promoting wakefulness during the day and better sleep at night.
• Minimize light exposure after 8:00 PM, especially between 11:00 PM and 4:00 AM. Light at night disrupts melatonin production and sleep patterns. Overhead lights are the worst offenders. Use dim lights placed low in the room.
• Create a dark sleep environment with blackout curtains or an eye mask. If you are trying to shift your wake-up time earlier, consider using a wake-up light that turns on gradually before you plan to wake up.

Sleep Environment:

• Make your bedroom like a cave: dark, quiet, cool, and comfortable. The ideal temperature is between 16-19C but find what works best for you.
• Use a fan to help you keep cool if you’re experiencing night sweats or hot flashes.
• Use earplugs or a white noise machine to block out distracting noises.
• Choose cool bed sheets and find the right pillow.
• Remove technology from the bedroom to avoid screen time before bed. Avoiding screen time from 90 minutes before bed has been shown to reduce the time taken to fall asleep and improve sleep quality. Books and audio books before bed can give a more restorative sleep.

Diet:

• Avoid large, heavy, fatty, fried, or tomato-based meals right before bed.
• Before bed snack: If you’re hungry before bed, have a small, balanced snack with complex carbs and lean protein. Good options include cereal with milk, cottage cheese and fruit, whole wheat crackers and peanut butter, nuts, yogurt.
• Protein: Ensure you are consuming enough protein throughout the day.
• Hot drinks: Avoid hot drinks before bed especially if you’re experiencing night sweats or hot flashes.

Alcohol:

• Avoid Drinking Close to Bedtime: Alcohol may make you feel sleepy at first. However, as your body processes it, your sleep becomes lighter and more broken. It can lead to frequent awakenings during the night. For better rest, sleep experts recommend avoiding alcohol for at least 3-4 hours before bedtime
• Limit Drinking: Drinking too much can upset your sleep. It especially reduces REM sleep, which is important for thinking and managing emotions.
• Nighttime bathroom visits: Alcohol makes you need to urinate more. This can wake you up at night and disrupt your sleep.
• Watch for Sleep Apnea Getting Worse: Alcohol relaxes throat muscles. This can make sleep apnea worse. It can lead to breathing problems and poor sleep quality.

Caffeine:

• Limit Afternoon and Evening Caffeine: Caffeine can stay in your body for 6 to 8 hours. It’s best to avoid caffeinated drinks or foods in the late afternoon and evening.
• Know Your Sensitivity: Individual tolerance varies, but even small amounts can disrupt sleep for those who are more sensitive to caffeine.
• Monitor Hidden Sources: Be mindful of caffeine in items beyond coffee and tea, such as chocolate, energy drinks, soda, and certain medications.

Other Helpful Tips:

• Non-sleep deep rest (NSDR) and techniques like meditation and yoga nidra can help calm the nervous system and improve sleep quality. You can use these techniques in bed to unwind before sleep.
• In the middle of the night, they can help when you can’t sleep. At least your body and mind are resting instead of tossing and turning. NDSR can also be helpful to recharge when tired during the day.
• Snoring: snoring could be a sign of sleep apnea, discuss it with your doctor to see if you would benefit from a sleep study.
• Showers and baths: It is best to avoid hot showers before bed. Hot showers can raise your body temperature and can disrupt the cooling process needed for good sleep.
• The body’s core temperature naturally drops as part of the circadian rhythm to signal that it’s time for sleep. A hot shower can delay this cooling process, making it harder to fall asleep. A warm or lukewarm shower in the evening helps your body cool down. This can lead to better sleep and improved sleep quality.
• Melatonin and magnesium can be helpful to aid relaxation and sleep for some individuals.
• Track Sleep Some women find it helpful to use a sleep diary or app. This can track sleep patterns, bedtime, wake-up time, nighttime awakenings, and daily factors that may affect sleep.
• Regular exercise: Exercise can improve sleep quality but be sure to avoid strenuous activity close to bedtime.
• Be patient and persistent with your efforts. It takes time to establish new habits and see results.

Resources 

YouTube 

Non Sleep Deep Rest 8 minutes with Kelly Boys 

Non Sleep Deep Rest 10 minutes with Andrew Huberman 

Kamini Desair’s 25 minute Yoga Nidra NS  

Canadian physician Dr Denise Black discusses mood sleep and cognition in the perimenopause . 

Dr Susan Kok from the Mayo Clinic talks briefly about sleep and the menopause.  

Podcasts on sleep 

Andrew Huberman on DOAC 

Websites 

Dr Colleen Carney Canadian Sleep Expert 

National Sleep Foundation is an independent nonprofit, dedicated to improving health and well-being by advancing sleep health. 

Books 

Dr Daniela Steyn discusses sleep and solutions in her book Thrive through the menopause. 

Oakville Library and Libby offer tons of free online audiobooks to listen to in bed. 

Disclaimer 

It is important to note that the information provided here is general in nature and should not be considered a substitute for personalized medical advice. It is essential to consult with a healthcare provider to discuss the best treatment options for you based on individual circumstances and medical history.