Menopause is the natural biological process in a woman’s life that marks the end of the menstrual cycle and reproductive years, typically occurring in the fourth or fifth decade(s) (40s or 50s). Menopause can be a challenging time for many women, especially when it comes to getting a good night’s sleep.
“Vasomotor symptoms” (hot flashes, night sweats, palpitations, and migraines) are common symptoms seen during menopause. Hot flashes occur day and night at unpredictable intervals, often lasting approximately 3 to 4 minutes. They may be worsened by alcohol, smoking, obesity, physical inactivity, and emotional stress. Hot flashes can impact sleep, subsequently impacting the health, functioning, well-being, and daily quality of life in women experiencing them.
WHY SLEEP IS IMPORTANT
Sleep is critically important for good health at every stage of life. Sleep deprivation is associated with numerous health problems, including diabetes, impaired immunity, heart disease, osteoporosis, kidney disease, Alzheimer’s disease, and obesity. A lack of sufficient sleep is also associated with moodiness, anxiety, depression, an inability to focus, forgetfulness, irritability, and procrastination. Adding to the list, memory, judgment, motivation, job performance, relationships, and outlook, including the threshold in which we perceive events to be stressful, are all negatively impacted by sleep deprivation.
A lack of sufficient sleep can also affect balance and coordination, increasing the risk of falls. Drowsy driving has been deemed just as dangerous as drunk driving. A lack of sleep can also lead to decreased pain tolerance.
MENOPAUSE AND SLEEP
Menopause affects sleep. Sleep challenges during menopause and post-menopause are in the range of 40% and 63%, compared to the tentative 30% range in premenopausal women.
Hot flashes, which affect up to 75-85% of women during menopause, are the primary predictor of sleep problems that negatively impact sleep quality. Research has shown that women with moderate-to-severe hot flashes report problems with frequent nighttime awakenings as much as three times more than women without hot flashes.
During the menopausal years, the risk of sleep disorders increases, with one common disorder being sleep apnea. In fact, post-menopausal women are two to three times more likely to develop sleep apnea compared with premenopausal women. During menopause, levels of estrogen and progesterone decrease, increasing the chances of developing obstructive sleep apnea. In addition to affecting sleep quality, untreated obstructive sleep apnea can lead to serious health conditions, including high blood pressure, heart disease, and stroke.
Insomnia is the difficulty of falling or staying asleep. According to the National Sleep Foundation, as many as 61% of post-menopausal women report insomnia symptoms. It is a common experience during the menopausal years and may occur as a result of hormonal changes, hot flashes, night sweats, or the reduction in melatonin.
Menopause increases the prevalence and severity in symptoms of Restless Leg Syndrome (RLS). RLS is a neurologic disorder that causes an urge to move one’s legs, which occurs mostly at night and is accompanied by an uncomfortable sensation.
STRATEGIES
Effective treatments and management strategies are available to help ensure sufficient sleep during menopause:
Allow yourself enough time to sleep every night. Sufficient sleep is the first thing you should schedule in your 24-hour day. That time is non-negotiable. Schedule everything else around your sleep time. Keep a consistent sleep schedule that permits sufficient sleep every day.
- Get Natural Light in the Mornings
Your inner circadian rhythm responds to changes in light and will stop producing melatonin, which makes you feel sleepy, when you are exposed to daylight. Do your best to work near a window during the day. A study published in 2013 demonstrated that office workers who sat near windows slept 46 minutes longer than those who did not work near windows.
Exercise is crucial for sleep quality. Regular exercise has been shown to help menopausal women easily fall and stay asleep. In a study published in 2015, participants who exercised reported a significant improvement in perceived sleep quality. And the better your sleep, the more likely you are to get exercise. Try evening exercise if you can’t make it to the gym at 6 AM. Contrary to popular belief, evening exercise doesn’t always wreak havoc on sleep.
Eating a healthy diet contributes to better sleep quality, and better sleep quality contributes to your ability to make healthy food choices.
Write down your to-do list, worries, etc., before going to bed. Tasks and emotional turmoils tend to appear more manageable on paper. Writing a to-do list will help you decompress from your day and fall asleep faster. A study published in 2018 demonstrated that writing a specific to-do list for 5 minutes at bedtime may help people fall asleep faster.
- Create a Relaxing Bedtime Routine
Swap out your nighttime screen time for reading, knitting, coloring (in other words, something relaxing). Make sure your calming activity can be done under dim lighting.
The quality of your mattress is crucial with the onset of menopause. The physical changes that come with aging, in addition to the changes that accompany menopause, warrant your investment in a mattress, high-quality bedding, and/or accessories that contribute to your comfort. Investigate cooling mattress, pillow materials, and moisture-wicking fabrics for bedding and pajamas.
A larger sleep surface may be desirable for optimizing sleep during menopause. For instance, a jump from a queen-size to a king-size bed will give you more room if your restless sleep is disturbing your bed partner or your bed partner is disturbing you. You may also find that beds with dual controls can help. Adjustable or lifestyle-based beds can come in handy when finding a comfortable sleep position is challenging.
- Consider Sleeping Separately
If you find that you and your bedpartner get better sleep in separate beds, even if on occasion or temporarily, by all means, do it. It’s essential for your health as well as your relationship to be well-rested. Contrary to popular belief, independent sleeping is not a sign of relationship problems. However, not getting enough sleep may lead to relationship problems.
No matter what problem you have ever had, it is tenfold worse at three o’clock in the morning. Even though it sounds difficult, when you are grappling with a problem at three o’clock in the morning that seems catastrophic, tell yourself to let it go. The issue, when analyzed at night, can be distorted, exaggerated, and out of proportion compared to when it’s dealt with during waking hours.
Avoid bright lighting if you get up to use the bathroom in the middle of the night. Try placing dim nightlights in the bathroom or hallway to assist you. Do not check emails or look at screens during the night if you wake up.
- Practice Mindfulness Meditation, Yoga, or Tai Chi
In a study published in 2018, it was stated that eight weeks of mindfulness meditation training improved sleep quality, quality of life, attention levels, and reduced vasomotor symptoms in postmenopausal women with insomnia. A 2004 study found “statistically significant improvements” in sleep patterns for insomniacs who participated in a simple daily yoga class.
Cognitive behavioral therapy for insomnia (CBT-I) is an effective technique for treating insomnia, with the American College of Physicians recommending it as a first-line approach. CBT-I can help you avoid negative thought patterns that promote insomnia and develop healthy sleep habits, relaxation techniques, and other behavioral techniques that improve sleep. Research published in Menopause demonstrated that cognitive behavioral therapy for CBT-Meno was effective in improving self-reported depressive symptoms, sleep difficulties, vasomotor symptoms, and sexual concerns.
Don’t use alcohol as a sleep aid or have an adult beverage close to bedtime. Alcohol increases the risk of sleep disturbances and may be a trigger for hot flashes.
“Trying” to sleep can be stressful. Instead, focus on relaxing and resting. Sleep will follow.
- View Sleep as a “Vital Sign”
Address sleep at every healthcare provider encounter. See a sleep specialist for ongoing sleep problems or any symptoms of sleep disorders. Be sure to promptly report trouble falling asleep, frequent awakenings, witnessed breathing pauses during sleep, gasping or choking out of sleep, frequent nighttime urination, unrefreshing sleep, daytime sleepiness, and any other sleep issues to your healthcare provider. Pay attention to sleep problems at this stage of life and don’t assume these are an inevitable part of aging.
SLEEP: A TOP PRIORITY
People (especially women) need to view sleep as a daily biological need, not a luxury to indulge in as time permits. Be proactive about your sleep health. Sleep deprivation can lead to serious health problems, compromise your well-being, increase your risk of accidents, impair your performance, and negatively impact your quality of life.
Sufficient sleep is of utmost importance during menopause and all life stages. Seeking help with sleep problems can significantly reduce the challenges associated with menopause. Be unapologetic for your need for sleep, and get help to live a healthy, happy life.
Sufficient, quality sleep is critical for health and overall well-being at every stage of life. Sleep has numerous benefits. It helps maintain a healthy immune system, improves concentration and memory formation, prevents accidents and injuries, and keeps depression at bay. When we are well-rested, we are more productive, better able to problem-solve, and more resilient.
The menopause chapter of a woman’s life can certainly be optimized by maximizing sleep health through committing to a healthy sleep lifestyle, practicing good sleep hygiene, obtaining sleep disorder screenings and treatment, and continuous dialogue about sleep with healthcare providers.
Helpful resources are available, including the National Institute of Aging, which features the Study of Women’s Health Across the Nation, and the American Academy of Sleep Medicine’s Sleep Education: Women and the North American Menopause Society. The University of Michigan has a free online sleep course entitled From Sleep Disorders to Sleep Health. Sleep Foundation Hotline: 1-833-I-CANT-SLEEP.