Seven Pillars of Healthy Menopause #4 Sleep

Is Sleeplessness a Peri/menopausal Problem?

Sleep's great isn't it? It's good for us both physically and mentally - it's like moisturiser for the soul, it just smooths everything over and makes our days - as well as our nights - easier.

Our sleep does suffer in perimenopause and that's partly because our thalamus, which regulates sleep is one of the areas in the brain that's affected by the drop in oestrogen.

But there may be other factors such as hot flushes, bladder or bowel discomfort, pain, increased sensitivity to light and sound. Or it could be the anxiety or other emotional upset that comes with perimenopause that's having an impact on your sleep.

So it's worth keeping track of what's going on. You could keep a notebook by the bed, or use my tracking tools, or an app on your phone. But do be aware that devices such as smart watches and fitbits that track our sleep have been known to cause a 'nocebo affect' - they can actually worsen our sleep because they increase our anxiety about the quality and quantity of sleep we get. 

How Your Doctor Can Help

There's a lot your doctor can do to help. HRT is usually very effective at helping with sleep and there are other options your doctor might have - such as gabapentin and certain anti-depressants although that's obviously a conversation to have with your doctor.

If it's your bladder waking you, vaginal oestrogen may be a big help, but there are also other drugs available too. Please don't assume that these difficulties are an inevitable part of the experience of being a woman or getting older.

Your doctor is, however, unlikely to prescribe sleeping tablets. Sedation is not sleep - it does not come with the benefits of sleep, and many forms of sedation are habit forming.

Natural Remedies

A lot of natural remedies contain valerian which may or may not be effective and may or not cause drowsiness. It's probably worth a shot, but you should also check for interactions with any other medicines or remedies that you take.

There’s some evidence that melatonin is effective in helping us sleep — though it’s more likely to help you get to sleep than stay asleep, and it doesn’t seem to work for everyone.

Lavender on the pillow or in body cream helps a lot of people and there is some evidence for this, so if you like the smell then it may well be a win-win.

And it's worth mentioning that a lot of people find CBD to be highly effective.

Magnesium may help. Be careful not to overdo it and make sure you are getting supplements from a reputable source. Leafy greens, nuts and seeds are also great for magnesium.

Epsom salts are magnesium sulphate and many people find soaking their feet in a footbath of Epsom salts helps them sleep. 

Lifestyle Change and Sleep Hygiene

It’s human nature to want to find quick fixes, but they’re not always the best. Sleep hygiene usually has some benefit if you stick at it.

1. Make sure your room is comfortable — cool and dark. And that may mean turning down the heating and helping the other people in the house stay warm!
2. Keep a cap on your caffeine content — and keep your caffeine consumption to the morning and early afternoon. I mix really good quality ground coffee with really good quality decaffeinated coffee as a way of halving my caffeine intake without sacrificing pleasure.
3. Avoid too much alcohol. It will depress your nervous system — which will most likely bounce back in the early hours of the morning and yank you back to wakefulness.
4. Get sunlight during the day — it builds up your store of melatonin and helps your brain work out when to be awake and when to be asleep.
5. Avoid bright light — and especially blue light at night, because it confuses your brain when it’s trying to work out when to be awake and when to be asleep.
6. Don’t eat too much, or do too much brain work late at night. Find a bedtime routine that gives you time for calm before bed.
7. Exercise creates endorphins which help you sleep.
8. Manage your stress and anxiety. You might well tell me you’re not stressed, or not ‘that stressed’ right now. But sometimes we don’t realise how stressed we are until a period of stress finishes and we look back. And with the possible exception of Tibetan Monks, everyone is stressed right now.
9. Try a bit of yoga. The corpse pose is perfect for making sure you’re not bringing the tension of your day to your bed, trapped in your body. It also helps to breathe with your belly, focus on your breath and breathe out for slightly longer than you breathe in.
10. Relax your face. Seriously, lie there and pretend it’s melting into your pillow. Then empty your mind. Easily said than done. So lie there and think of nothing. Literally the word ‘nothing’. Every time a thought comes let it go and replace it with the word ‘nothing’. If I can stick at it, it always works.
11. Cooling down your face can help to activate the parasympathetic nervous system and calm you down. This is likely to be particularly helpful if anxiety is behind your insomnia. There are those that recommend wild swimming or a cold shower — but I’m just going to keep a damp flannel in the fridge!
12. If you can’t sleep. Get up. Do something that isn’t sleeping in a place that isn’t your sleeping place and then repeat your routine.

Good luck!

This is one of the subjects that I regularly tackle in workshops and courses which I run in schools. Nailing this one has a massive impact!

A longer version of this article has been published on Medium.