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menopause sleep: middle aged woman can't sleep

How To Keep Menopause From Wrecking Your Sleep

Every biological woman will, inevitably, move through the menopausal transition, a period marked by the gradual decline of ovarian function. And, unfortunately, the vast majority (up to 60 percent!) will struggle with sleep during this time. It’s a cruel double-whammy.

“Getting quality sleep is incredibly important during menopause because it helps keep associated symptoms manageable,” says sleep psychologist Dr. Shelby Harris Psy.D., director of sleep health at Sleepopolis. However, the hot flashes and heightened stress levels symptomatic of menopause can make it tough for menopausal women to get the rest they need. As such, “finding ways to improve sleep quality is critical for overall well-being during this time,” she says. 

But why, exactly, is menopause so disruptive to sleep quality? We’ve got answers—as well as three research-backed tips for getting proper rest during this transition.  

  • ABOUT OUR EXPERTS: Dr. Shelby Harris Psy.D., is a sleep psychologist and the director of sleep health at Sleepopolis. Jack Dell’Accio is a certified sleep coach, a sleep researcher for the Mayo Clinic’s Well Living Lab, and the founder of sleep performance company Essentia. Dr. Donna Adams-Pickett, M.D., Ph.D., F.A.C.O.G., is a gynecological surgeon and the founder of a coalition of over 800 Black OB/GYNs to share resources and guidance with women in need of healthcare. Sharon Gam, Ph.D., C.S.C.S., is an exercise physiologist and certified strength and conditioning coach. 

The Importance of Sleep Throughout Menopause

Sound sleep plays a crucial role in overall health, regardless of age, gender, and menopause status—but for people going through menopause, it may be especially important. 

“Sleep is essential for brain function, including memory consolidation, cognitive function, and emotional regulation,” says certified sleep coach Jack Dell’Accio, a sleep researcher for the Mayo Clinic’s Well Living Lab and founder of sleep performance company Essentia. Given that the hormonal ups and downs associated with this life phase commonly lead to symptoms of brain fog and crummy memory, per the National Council on Aging, prioritizing sleep throughout it is crucial. 

In addition to safeguarding your cognition, sleep also influences physical health profoundly, affecting metabolism and immune function, which may help buffer against the metabolic and immune changes that happen at this time, says Dell’Accio. 

Read More: Nutrition Tips For Every Stage Of A Woman’s Life

Further, sound sleep helps lower the risk of certain chronic conditions. Indeed, research has shown that people who report trouble logging quality sleep have an increased risk of chronic diseases like cardiovascular disease, type 2 diabetes, and cancer. 

There is also a strong link between sleep and mental health—and mental health issues like anxiety and depression are exacerbated by poor sleep, according to the American Psychological Association. As such, adequate sleep during menopause is essential for maintaining psychological balance (which can get thrown off throughout the transition), as well as enhancing overall quality of life, notes Dell’Accio. 

Why Sleep Takes A Hit During Menopause 

The main offender that causes more than half of those going through menopause to struggle with sleep? Estrogen. 

Aside from supporting the maturation and release of eggs, the ovaries’ main job is to pump out estrogen, explains gynecological surgeon Dr. Donna Adams-Pickett, M.D., Ph.D., F.A.C.O.G., founder of a coalition of over 800 Black OB/GYNs to share resources and guidance with women in need of healthcare. As ovarian function slowly extinguishes, estrogen levels fluctuate. While estrogen may be best known for supporting sexual function and reproduction, the hormone also has its hands in body temperature regulation and overall mood, she says. Unfortunately, when these elements get thrown out of whack, sleep can, too. 

Usually, estrogen works on a part of the brain colloquially known as the body’s “thermostat” (the hypothalamus) to keep your body in its temperature sweet spot, says Adams-Pickett. During the menopause transition, when estrogen levels fluctuate, this thermostat becomes confused and starts to tell your body that you’re too warm. The result: You feel too warm! Because estrogen is a vasodilator, meaning it supports the widening of blood vessels for blood flow, this feeling of warmth is further compounded by the fact that dropping estrogen levels impede the body’s ability to dissipate heat. And so you have menopause’s telltale symptom: hot flashes. 

“Hot flashes are marked by the sudden sensation of warmth and flushing in your face and upper body,” explains Harris. They are also usually accompanied by sweating. “When hot flashes happen at night, they can cause you to wake up sweating and make it difficult to fall back asleep,” she says. After all, it’s hard to drift into dreamland when you’re drenched. 

“Estrogen fluctuations and decline can also lead to mood swings and increased stress,” says Harris. (According to research, that’s because estrogen increases the production of feel-good chemicalsas well as receptors of those chemicalsin the brain). “These mood swings can sabotage sleep quality and make it harder to sleep well through the night,” she says. 

Often, the thoughts that accompany feelings of agitation and irritation can simply make it harder to fall asleep, says Harris. Further, these mood changes can create a physiological experience of stress in the body, prompting it to churn out the stress hormone cortisol. High cortisol levels have been linked with insomnia, increased waking, and shortened sleep time overall.  

How General Aging Contributes To Sleep Issues 

Women generally go through the menopausal transition between the ages of 45 and 55. As such, some of the sleep issues individuals experience at this stage are as much a symptom of generalized aging as they are with menopause more specifically. The fact is, it’s quite common for individuals to experience changes in sleep patterns, as well as sleep quality declines, with age, according to Dell’Accio. 

“Several factors contribute to these sleep changes,” he says. For starters, with age comes a shift in the structure of sleep, including alterations in REM sleep and deep sleep phases, leading to lighter and more fragmented sleep. Further, “a number of conditions that develop with age, such as arthritis and acid reflux, can cause pain and discomfort, which can disrupt sleep,” he says. 

The incidence of sleep disorders, including sleep apnea and restless legs syndrome, also increases with age, according to  Dell’Accio. Research published in 2020 in Missouri Medicine suggests that this is due, in part, to the body naturally producing less melatonin (the sleep hormone) as you age. 

3 Tips For Improving Sleep During Menopause 

You might not be able to stop menopause in its tracks, but you can make some lifestyle adjustments to make the transition easier—and less of a menace when it comes to sleep.

1. Find a movement practice you enjoy—and stick with it 

Many people assume that menopause marks the end of their best and most fit years. As such, they stop doing strength training and cardio, and generally move less. But exercise is as healthy a lifestyle habit for menopausal individuals as it is for anyone else, notes exercise physiologist and certified strength and conditioning coach Sharon Gam, Ph.D., C.S.C.S. Particularly for those struggling to sleep, it may just be the salve they’re looking for. 

“There’s lots of evidence that exercise improves sleep,” she says. Indeed, many studies have found that exercise improves sleep quality, both on the same night as your exercise and over the long term. “Research has even found that regular exercise is nearly as effective at improving sleep as other treatments,” she says. 

Read More: 6 Workout Tips For Improving Health Postmenopause

Sleep and exercise generally exist in an interconnected loop, says Gam. If you’re not getting good sleep, you might feel too tired to exercise, which means you keep getting suboptimal Zzz’s and not exercising. “But menopausal individuals may be able to break that cycle with just a little exercise,” she says. “In doing so, they’ll sleep better and have more energy to keep exercising—and thus keep sleeping better.” In fact, one 2023 review looked specifically at the relationship between exercise and sleep problems in menopausal women and found that exercising helped improve sleep quality in women in this life phase who had sleep disorders.  

“Exercise can also alleviate symptoms of depression and anxiety, both of which are thought to be related to sleep problems,” says Gam. As an added bonus, exercise can help individuals ward off the weight gain commonly associated with the menopausal transition. (Data suggests that individuals put on an average of two and five pounds during menopause). 

As always, it’s best to consult a healthcare professional before making any major edits to your exercise routine. But if you get the green light to move regularly, Gam recommends trying to do so in the morning—and ideally outside. Exercising in the morning can support the body’s natural circadian rhythm, as well as lead to decreased wake stages in the evening. “Getting natural sunlight in your eyes in the morning is important for setting your internal clock and promoting better sleep and overall well-being,” she says. So, if you can get outside for some morning exercise, you’ll get the additional benefit of sunlight exposure and set yourself up for better sleep that night.

2. Improve your overall sleep hygiene 

Whether you’re going through menopause or not, implementing good sleep habits—sometimes referred to as “sleep hygiene”— can significantly improve sleep quality, says Dell’Accio. But “perimenopausal, menopausal, and postmenopausal women who experience pronounced sleep disturbances due to hormonal changes may especially benefit from dialing in sleep hygiene,” he says. 

The list of tips and suggestions for boosted sleep hygiene is long, but at the top is maintaining a consistent sleep and wake schedule. “Sleep consistency reinforces your body’s sleep-wake cycle,” Dell’Accio says. “Going to bed and waking up at the same time every day helps regulate your body’s internal clock, thus improving sleep quality.”

Creating a restful bed and sleep environment is also important, Dell’Accio notes. Broadly speaking, dark, quiet, and cool environments are more conducive to sleep than bright, loud, warm environments. So, investing in elements like blackout curtains, an eye mask, ear plugs, and fans can help. In particular, Dell’Accio recommends prioritizing light-blocking curtains. “Light disrupts the body’s melatonin production, and [these curtains] help block out light pollution,” he explains. 

Limiting screen time before bed (as you have surely heard) can also help improve your ability to sleep. “Electronic devices emit blue light, which has been shown to interfere with melatonin production,” says Dell’Accio. As such, reducing screen time at least an hour before bedtime can reduce this risk, and make it easier to fall and stay asleep. 

You might also consider adding a sleep supplement to your daily evening routine. Use this guide to figure out which option might be best for you.

Additionally important is resisting the urge to reach for your phone should night sweats wake you up, he notes. Not only will the radiating blue-light exposure make it harder to fall back asleep but the content you scroll through on your phone will get your brain working and make it hard to doze back off.

3. Talk to a healthcare provider 

The above tips alone may be adequate for some people going through menopause. For others with particularly intense menopause symptoms, however, Harris recommends talking to a healthcare provider. 

“If night sweats are severe or chronic, talk to a doctor about potential treatments like hormone therapy,” she suggests. Hormone replacement therapy (HRT) usually involves taking estrogen-containing medications that replace the estrogen that the body has stopped making and thus can help improve symptoms. Progesterone-only medications may also be prescribed. 

“Other, non-hormonal medications may also help manage general menopause symptoms,” Harris adds. Some of these include blood pressure medication (clonidine) and the anti-convulsant gabapentin. Herbal products and other supplements, such as Wile Perimenopause Support, TrueYou Grace Period Menopause Support, and Health & Her Menopause Multi-Nutrient Support are also designed to support the needs of women in this life phase naturally.

If you don’t have a primary care physician you feel comfortable talking to about your system, find a menopause-informed expert near you by typing your zip code into the Menopause Society Certified Practitioner database. 

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