Written by Benjamin Semmens, Registered Nutritionist (BHSc)

Are you going through menopause and having difficulty getting to sleep? You’re not alone! Sleep disturbances during the menopausal period are extremely common! Approximately 12% of women experience sleep issues. However, this number increases dramatically up to around 40% as women age into their late 40s to early 50s! (1)

Many women experiencing menopause report many sleep complications including difficulty falling asleep and staying asleep, coupled with waking up early and frequently throughout the night! (2)

Menopause occurs one year after the cessation of a woman’s period around the age of 52. While perimenopause occurs before menopause for around 7-10 years that is characterised by the gradual decrease in production of hormones oestrogen and progesterone in a woman’s ovaries.

Changing's in these hormones can lead to sleep disturbances caused by hot flashes (night sweats), sleep-wake cycle abnormalities, sleep-disordered breathing insomnia, mood disorders, and painful medical conditions. All of these symptoms and disorders make getting a good night’s rest extremely difficult! (6)

There are also other complications that have been linked to sleep deprivation (less than 7 hours a night) such as increased risk of heart disease, diabetes, mood disorders, obesity, and even increased risk of death! (5)

In this blog you’ll learn about how menopause contributes and causes sleep disruptions, the potential risks of using hormone replacement therapy (HRT), and how to naturally improve sleep during menopause!

How does menopause affect sleep?

Oestrogen and progesterone are involved in many processes in the body that include mood regulation, appetite, sleep, and sex drive and the reduction of these hormones can lead to many complications!

For example, low levels of oestrogen can result in hot flashes, night sweats, heart palpitations, headaches, insomnia, fatigue, bone loss, and vaginal dryness. While low levels of progesterone cause periods to become irregular, heavier, and longer during perimenopause (7).

Oestrogen plays an important role in regulating neurotransmitters (nerves in the brain) such as serotonin (aka happy chemical), that affects our circadian rhythm aka sleep-wake cycle.

Oestrogen also helps to keep our temperature low at night and has an antidepressant effect. Meaning that the loss of oestrogen can lead to increased body temperature, poorer mood, and more restless sleep! (8)

Our circadian rhythm (internal body clock) becomes less regular as we age, and this can lead you feeling tired earlier and waking up earlier in the morning that results in less sleep. Hence, why older adults and menopausal women have an increased risk of insomnia (9).

As you age the chances of having other conditions increases and makes getting restful sleep even more difficult. Conditions that are common in older adults include snoring, sleep apnoea, restless legs syndrome, periodic limb movement disorder, arthritis, joint pain, muscle tension, nerve conditions and fibromyalgia.  

Some of these conditions can cause frustrating aches and pain. If you find yourself struggling to get sleep because of pain make sure to check out last week’s blog How To Sleep Well Even if You’re Suffering from Chronic Pain!

To make matters worse, many older adults take pain medications that can make their quality of sleep even worse. Over the counter (OTC) pain medications such as aspirin and ibuprofen can increase the time it takes to fall asleep. It’s believed that these drugs inhibit our natural sleep hormone melatonin that is already compromised as we age (10).

Opioids that include codeine and morphine can cause insomnia. While these medications can alleviate pain, they can disrupt our deep sleep stage (REM) sleep that plays an important role in learning, memory, mood, and tissue repair. In theory, this could lead to sleep deprivation and exacerbate your pain even further! (11).

Photo credit: Getty Images

How can I manage sleep issues caused by menopause?

There are pharmaceutical treatment options for menopause such as hormone replacement therapy (HRT) that replaces hormones lost during menopause. These drugs have shown to be effective in relieving symptoms of menopause such as hot flashes, insomnia, and mood disturbances (12).

In early perimenopausal years, HRT can be effective for menopausal related symptoms and short-term use may only have a minor risk of side effects. However, long term HRT is associated with serious side effects in some women and is associated with developing blood clots, strokes, breast cancer, heart attacks and gallbladder disease (13).

That’s why doctors are recommended to prescribe HRT at the lowest effective dose to manage menopausal symptoms and only short-term to prevent more serious side effects. Before taking HRT, it’s important to first discuss with your doctor the risks and benefits, as there are also many alternative options for managing symptoms of menopause (14).

In some cases, doctors may also prescribe anti-depressants that can relieve menopausal symptoms such as hot flashes. However, anti-depressants also have many side effects such as feeling agitated, shaky or anxious, feeling and being sick, digestive issues, insomnia, headaches, low sex drive (15). 

How to naturally manage sleep issues caused by menopause!

1. Eat your phytoestrogens!

Phytoestrogens are compounds found naturally in plants that act like oestrogen in the body. Phytoestrogens are found in particularly high amounts in soy products such as tofu, tempeh, soybeans, and soy milk. 

Phytoestrogens have shown to be beneficial in improving sleep. One study that included 1076 adults found that higher intakes of phytoestrogens was linked to optimal sleep duration and quality (16).

Increase your consumption plant-based foods including lots of soy products and reduce your consumption of meat to help improve oestrogen levels in the body to improve your sleep!

2. Try these herbal supplements… maybe?

You can also find phytoestrogens in over-the-counter herbal supplements such as ginseng, black cohosh, and red clove extract. Some studies have shown that these herbs may improve menopausal symptoms, particular hot flashes (17). 

While some studies have shown some benefit, more evidence is needed to confirm how effective these herbs are. These herbs may be contraindicated for women with breast cancer, so best to speak to a healthcare professional before attempting to supplement yourself (18, 19).

3. Melatonin 

Melatonin is your body’s natural sleep hormone. Our bodies natural production of melatonin decreases as we age and supplementing with melatonin may help to improve sleep. Low doses of melatonin have shown to improve mood and sleep onset in postmenopausal women.

While many people think melatonin is great for overall sleep, it may not be as effective as we think. Melatonin helps to induce sleep, however, does not keep you asleep. Also, you should be cautious of using melatonin long term as it reduces your own internal production of melatonin (20).

4. Cognitive Behavioural Therapy (CBT) 

CBT is a type of psychological intervention that can be used to reduce symptoms of menopause. In CBT, a trained therapist will help you to recognise thoughts and behaviours that are negatively affecting your sleep and teaches you how to replace them with more productive and healthier thoughts and behaviours to improve sleep.

CBT has shown to be effective in relieving insomnia and menopause related symptoms. One study found that these approaches have shown to be as equally effective as pharmaceuticals with longer term sustainability! (21, 22). 

5. Diet and lifestyle contributors

During menopause, hormone changes can lead to increased fat storage, loss of muscle and insulin resistance that can contribute to weight gain. Maintaining a healthy weight can also help to reduce menopause complications such as sleep apnoea (23, 24, 25, 26).

To support weight loss, you need to be eating less calories in from foods than you are using calories through movement. To increase your metabolism and support weight loss, eat smaller meal portions, more quality protein, and exercise daily. 

Check out the blog post  The Real Reason Why You're Not Losing Weight! for more information on how to lose weight.

There are also certain foods and drinks that can make getting restful sleep worse. Avoid caffeine, alcohol, smoking and spicy foods that can disrupt sleep (27).

6. Sleep Hygiene

If you find yourself waking up many times throughout the night to use the toilet, this may be because you’re consuming liquids too late at night. This can cause you to wake up frequently and further disrupt your sleep. The easiest way to avoid this is to avoid drinking liquids a couple of hours before bed.

Poor sleep hygiene is also a common contributor to sleep complications that include irregular sleep schedules and long day time naps. Aim to go to bed and wake up at the same time each night and avoid naps during the day longer than 20 minutes that can disrupt sleep further (28).

High stress levels are common in menopausal women. When you aren’t getting enough sleep, this can make you more stressed and can be a continuous cycle.

There are many different stress management techniques that are proven to reduce anxiety and stress to help you get a better night’s rest. These techniques include regular exercise, mediation, yoga, and massages.

During menopause your core body temperature rises at night, hence why you may experience hot flashes.

To help reduce overheating it’s better to wear lightweight clothing to bed or sleep naked. There are also fabrics made from natural fibres like cotton that are cooler fabrics that can help to reduce heat. Lastly, make sure your bedroom is cool, by using an air-conditioner, or keep a fan next to your bed.

If you want to learn more about some sleep hygiene techniques to improve sleep you can check out  The Complete Guide to Sleep like a Baby if You’re over 50, even if You Can’t Shut your Mind Off!

Take-home Message

If you experience sleep issues during perimenopause, menopause, or post menopause than you’re not alone! These complaints are common in menopausal women, but there are many strategies you can use to improve your sleep quality.

While some medications are effective, they also have a range of side effects so you should consider other options before medication. These include natural approaches such as a plant-based diet rich in phytoestrogens, and healthy lifestyle including regular exercise, and relaxation techniques. 

A bedroom environment is critical to help improve sleep quality. If you are experiencing anxiety and stress because of poor sleep and menopause you can speak to you doctor about seeking psychological treatment that can be beneficial for menopause related symptoms.

If you have any questions or need support with your health, feel free to email our head nutritionist Ben at ben@13seeds.com.au

Disclaimer:

This article does not constitute as medical advice and does not take into consideration your personal circumstances. Please see your medical professional before implementing the above.

References:

1. https://pubmed.ncbi.nlm.nih.gov/20845239/
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3. https://www.merckmanuals.com/home/women-s-health-issues/menopause/menopause
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