Menopause and Sleep

HRT

Oestrogen will help to improve the symptoms of oestrogen deficiency that often interrupt sleep. Progesterone (if needed as part of HRT) has been shown to increase the amount of stage 3 (deep) sleep which will restore that ‘well rested’ feeling we all crave when we wake up and research has consistently shown that HRT can be hugely beneficial for improving sleep around the menopause.

If you have tried everything you can do yourself at home and nothing has worked for you then it is unlikely that these measures will suddenly help you to start sleeping well. At Chelvey Menopause we have the option to book a ‘lifestyle’ consultation where one of our skilled clinician will be able to take a careful history and try to unpick the cause of your insomnia and talk through other techniques (such as Cognitive Behavioural Therapy) which are highly effective at transforming sleep and can easily be put into practice yourself at home.

If you are having trouble sleeping there are many small changes you can make to improve the length and quality of your sleep.

Reduce caffeine- its difficult to tell someone who is feeling really tired that they cant have a cup of coffee in the morning but its definitely worth thinking about the timing of your caffeine. A shot of espresso has a half-life of 6 hours- that means that in 6 hours there will still be half of that shot of coffee in your blood system. So for example if you had a double shot coffee at 4pm there will still be an entire shot of caffeine in your blood stream at 10pm. Would you choose to drink a cup of coffee at 10pm if you were finding it difficult to sleep?! Remember many fizzy drinks contain high levels of caffeine also.

Alcohol-alcohol is a sedative and will help you fall to sleep but the sleep you experience is not as restorative as ‘natural’ sleep and you are more likely to wake up earlier.

Routine- going to bed at a similar time each night and waking at a similar time each morning can really help to establish a good sleep pattern.

Avoid daytime napping- we need our ‘sleep pressure’ to build through the day so that we are tired and ready to sleep at the right time and having a nap in the daytime will reduce the need to sleep when it comes to bedtime.

Sleep hygiene- try to avoid using screens just before bed as the blue pigment in the screen of the device can interrupt melatonin production which helps us to feel ready for sleep. Read a book, have a bath, listen to music- anything that helps you to unwind (that doesn’t involve a screen!).

Exercise- exercise can improve the way we sleep- try to avoid vigorous exercise in the two hours before you go to bed.

Sleeping environment- try to keep your bedroom cool and dark at bedtime and use the room only for sleeping and sex! Make your room and bed somewhere comfortable where you want to sleep.

Hormones

The two main hormones that quickly decline around the perimenopause and menopause are oestrogen and progesterone.

Our natural progesterone has a mild sedating affect within the body so as the levels of this hormone begin to fall the natural sleep cycles within the body can be disturbed.

Progesterone also has an anti-anxiety affect and an overall positive effect on mood. Lower levels of progesterone at the perimenopause and menopause may contribute to mood changes and anxiety which in themselves can affect our ability to sleep.

Oestrogen has been shown to improve deep sleep and reduce the number of awakenings through the night. Oestrogen is also associated with other substances in the brain (neurotransmitters) that regulate the sleep cycle. In addition Oestrogen helps to control the body temperature at night and keeps the body cool which in turn improves sleep. Unfortunately the reverse of this is that without adequate oestrogen levels you are more likely to have lighter sleep with more spontaneous wakeups through the night.

The symptoms associated with oestrogen deficiency unfortunately can have a part to play- hot flushes, joint aches and multiple trips to the toilet to pass urine are not the secret to a restful night of snoozing.

Melatonin is a hormone that helps our body to know when we need to sleep and helps us to stay asleep. Melatonin production is linked to oestrogen and progesterone so as these two hormone levels falls, so too does melatonin.

Anxiety and depression

Mood disturbance is a common symptom of the menopause (see our mental health information) and there is good evidence to show that mood disturbance and anxiety can severely disrupt sleep.

Menopause affects mental health and sleep, mental health affects sleep, and insomnia worsens mental health- so you can see the washing machine effect that can ensue for women around this time. Its easy to see how improving sleep can have such a dramatic effect on quality of life and why its so important for us to address insomnia as a serious and at times debilitating consequence of the menopause for some women.

Sleep apnoea

Sleep apnoea is a condition where your breathing briefly stops and then starts again during sleep. This leads to brief awakening though the night and less of the restorative sleep we all need to feel refreshed. Research has shown that women going through the menopause are more at risk of developing sleep apnoea. This may be in part due to perimenopausal weight gain in some women and there has also been a link to sleep apnoea and reducing levels of progesterone during the menopause transition. Sleep apnoea as a condition in itself can lead to fatigue, headaches, anxiety and depression.

Restless legs

Sensations of crawling and tingling at night are unlikely to help with sleep! Unfortunately restless legs is a common symptom of the menopause.

There are different ways that sleep may be affected during the perimenopause and menopause- you may have difficulty getting to sleep, problems staying asleep with frequent waking through the night, early morning wakening or less restorative type (deep ) sleep.

During the menopause we spend less time in stage 3 restorative sleep so a common complaint from women is that they suddenly seem to feel much less refreshed in the morning despite having seemingly slept most of the night.

Mood disorders are well known to cause early morning wakening and anxiety can really interrupt our ability to shut off our minds and drift off to sleep.

There are two types of sleep- Non REM and REM sleep and there are 4 stages of sleep which we cycle through several times throughout the night.

1.NREM stage 1- this is essentially dozing off and usually lasts around 5 or 10 minutes. The body hasn’t fully relaxed in this stage though the brain starts to slow down and there may be brief movements or twitches. It is easy to wake someone up from this stage of sleep.

2.NREM stage2- our bodies really start to relax and our temperature starts to drop, our heart rate and breathing slow down. This stage lasts for 10-25 minutes but each stage 2 that you experience through the night becomes progressively longer.

3.NREM stage 3- this is deep sleep and it is thought that this type of sleep is the most restorative and important sleep stage. It is when our brains remove waste and our cells repair themselves. We spend most of the time in deep sleep in the first half of the night and it is difficult to wake someone from this sleep stage. If they are woken there may be a period of disorientation lasting up to half an hour after waking. Each stage 3 lasts around 20-40 minutes but gets shorter though the night and more time is spent in REM sleep instead.

REM sleep- during REM sleep brain activity actually increases but our muscles are paralysed with the exception of the eye and breathing muscles. This is the stage of sleep when we have the most vivid dreams and REM sleep is thought to be essential for cognition, memory and learning. It is when our brains re-energize! You don’t enter REM sleep until you have been asleep for around an hour and a half and the REM stages get longer through the night- the first REM sleep stage may only last a few minutes.