Menopausal Sleep

Or should I say Menopausal lack of sleep? 

There are many reasons for sleep issues at this stage of life and unfortunately half of you won't sleep tonight, stress and anxiety could be keeping your mind busy all night. Cortisol (one of your stress hormones) should peak around 7 am in the morning and drop around 11 pm. If this hormone doesn't drop by evening sleep is almost impossible. Stress, worry, and anxiety all increase cortisol levels. Cortisol increases blood sugar levels by converting stored glycogen into active blood sugar. Trying to sleep while being in a stressed-out state is like trying to sleep after drinking an energy drink that is filled with sugar - its virtually impossible. 

(I'm going to link the article on Menopausal Moods here, if you think your insomnia is anxiety based, please go back and read this article, as for best results you will need to work on improving your anxiety first).

Melatonin is the hormone responsible for sleep. It works in opposition to cortisol. It starts to rise as the sunsets and drops as the sun rises. Hence most of us could benefit from going to bed earlier and getting up earlier. Natural light exposure helps regulate it and unfortunately, blue light and other artificial light dimish it. Blue light is emitted from television screens, computers, tablets, and phones. Some devices allow you to reduce the amount of blue light you are exposed to by using filters. There is also blue light blocking glasses. It's advisable to avoid all screens 60 minutes before bed. It's also worth looking into your household lighting. It's worth investing in lamps so you can reduce your general lighting exposure the closer to bedtime you get.

Progesterone is a great sleep-promoting hormone. Some of you during your fertile years might have noticed it's harder to sleep just prior to your periods. If this was you, your body was responding to your dropping progesterone levels. For me, this was one of my first signs of peri-menopause. As you get closer and closer to menopause your progesterone levels reduce and sleep may become a real struggle. Night sweats may also be waking you during the night.

Dietary factors like caffeine and sugar can also contribute to a sleepless night. If your blood sugar levels are imbalanced and you are waking hungry during the night, we may need to look into your insulin level. In a future article, I will discuss correcting insulin and blood sugar levels and link it here. Alcohol can also affect sleep (and blood sugar levels), a little can sometimes help you get to sleep but a little too much can give you a restless night. Might be best to avoid while you are re-establishing a better sleep routine. 

A more serious possible reason behind sleep disturbances is sleep apnea. Sleep apnea affects over 1 million Australians. Sleep apnea occurs when the walls of the throat come together during sleep and block off the upper airways. This leads to a halt in breathing until the brain recognises its lacking oxygen and signals you to wake up. Breathing then returns to normal as oxygen levels regulate. Many people living with this condition have no idea they have it. Sleep apnea is diagnosed with a sleep study. This can be done from the comfort of your own bed. You need to hire a polysomnogram. Check your local chemist and see if they rent these out. It's roughly $100AUD. A sleep study measures your blood oxygen levels, brain activity, heart rate, and breathing. These results are uploaded from the machine and sent to a sleep doctor for a report and possible diagnosis. this report takes around 5 days. Alternatively, your GP can refer you to be tested in a sleep clinic.

Health issues linked with a lack of sleep include:

• increased weight
• lower moods and higher tendency towards depression
• increased brain fog and cognitive decline. Sleep is needed for the consolidation of memories and without enough of it, the brain struggles to remember. Sleep deprivation increased amyloid plaque deposits by 25%. Amyloid plaque accumulation is a possible cause of Alzheimer's
• links with blood sugar disorders such as diabetes
• increased risk of cardiovascular disease especially with elevated blood pressure
• decreased immunity
• increased hormonal disruptions
• increased stress levels and lower tolerance for stress
• increased risk of any cause of death! Scary stuff!!!

Lifestyle factors to improve sleep include:

• Go to bed at a reasonable time every night. Set yourself a bedtime alarm if you need to.
• Set the scene, your bedroom is for intimacy and sleeps only. Remove the tv and remove any clutter you have been storing in this room. Make sure the room is dark. Consider if you need to buy light reducing shutters, a new more comfortable bed, new pillows, cooler sheets, etc.
• If you are having night sweats consider buying specialised nightwear, there are many different brands but I personally like Cool Jams. These pajamas are softer and lighter than cotton and dry faster. There are also many different bedding options. Have you heard of the OOLER sleep system? This is a water-powered mattress pad that regulates the temperature of your bed. You can set it to be warmer when you go to bed and cooler during the night. You can also set a different temperature for different sides of the bed - this might be a marriage saver!
• Consider your bedrooms electro-radiation field, are you sleeping with your phone beside your bed? If you are, please move it or at least turn it on flight mode at night. Moving it is a better option, that way you are not tempted to check your phone during the night. Is your modem nearby? If you use WIFI at home, please switch it off or put a timer on the device so it automatically switches off during sleeping hours. It's also worth checking your fuse box isn't on the other side of your wall where your bedhead is.
• Regular exercise can help physically tire you so you are more likely to sleep. Exercise during the day is better than at night as exercise near your bedtime may stimulate and make sleep difficult. Exceptions to this rule include calming exercises like yoga, pilates, and tai chi.
• Try deep breathing, prayer and or meditation to calm your mind before bed.
• Try a hot bath, consider adding Epsom salts or essential oils like Lavender to enhance your relaxation.
• Establish a bedtime routine, when you bring home a newborn baby you need to teach it a sleep routine, do you have a routine or do you need to re-establish one?
• Where possible go for a nighttime stroll, getting outside and away from artificial lights can help to naturally increase your melatonin levels, dim your lights at home before you leave so your good work isn't undone by a blast of artificial light as your return home.
• Try to spend some time outdoors every day. This helps to reset your melatonin/cortisol ratios.
• Lose weight if you need to as carrying extra weight increases your chances of sleep apnea and insomnia.
• If you drink coffee, try to make your last cup 8 hours before bed.
• Play classical or relaxing music to help you unwind.
• Drink herbal teas such as Chamomile
• Toxins from cigarettes can also impact on your sleep, best to quit smoking

Key supplements for sleep include:

• Magnesium - this mineral is a relaxant, good for insomnia, headaches, muscle cramps, and anxiety. It's especially good if your issue is getting to sleep in the first place.
• B12 - this vitamin regulates sleep-wake cycles and is ideal if you're waking during the night.
• L-theanine is a constituent in green tea that relaxes you. This can help if your sleeplessness is due to stress, worry or just having a  busy head. Research also indicates it may be useful for improving cognitive function, emotional status, heart health, reducing obesity, and even the common cold.
• Melatonin - in parts of the world this is available over the counter but here in Australia, it's a scripted product so you will need to see your doctor to try this out.

Looking at Herbal options:

• Black Cohosh was found to be a safe and effective way to improve sleep. It increased the duration of sleep and the reduced the frequency of wakes during the night. 
• California poppy works well if pain, especially nerve pain is keeping you awake, it may also reduce anxiety.
• Fennel is good for insomnia, hot flushes, vaginal dryness, vaginal itch and may help improve sexual satisfaction.
• Lemon balm is a fantastic herb for women with a busy head, so it comes as no surprise it can also improve sleep.
• Zizyphus is my favourite herb for anxiety. It can also reduce the amount of time it takes to get to sleep and can increase your total sleep time during the night, other benefits include improved cognition and memory.

I provide this information not so that you can self-prescribe but to let you know there are healthier, safer and effective options out there to improve your menopausal transition.