Sleep Solutions for Perimenopause & Menopause: Restful Nights Through the Change

Sleep in and around perimenopause can be hit or miss. Figuring out solutions to improve sleep is crucial since insomnia affects up to 40% of perimenopausal women during this transitional period. So many bodily changes are happening, which contribute to mental, physical and emotional challenges. Throw poor sleep in the mix and women can start to feel like a shell of their former selves. 

We’ve all been bombarded with messages about the vital role of sleep for optimal health. I won’t go into all the negative health effects of poor sleep since we do not need an extra reason to stress. I suffered from insomnia 18 months postpartum while still breastfeeding my first child. If I learned anything from personal experience it is that stressing or trying harder to sleep is not an effective sleep solution. 

What happens to our sleep in perimenopause?

Sleep goes to s#!t for several reasons during the menopausal transition.

Firstly, all the hormonal changes. I have talked extensively about the perimenopausal symptoms and it is not only the hot flashes and night sweats that cause poor sleep. It can be anxiety, depression, heart palpitations, restless leg syndrome and joint pain, just to name a few. 

With the hormonal changes comes a change in fat distribution and airways can become more relaxed leading to obstructive sleep apnea (OSA). This is more common in postmenopausal women.  

Then there are the psychological causes. Women in this phase of life are sometimes called the « sandwich generation », where they have stressors related to their own kids or general life circumstances, in addition to worrying about aging parents. Menopausal symptoms, stress and our reduced ability to cope with stress can all lead to poor sleep and worsening symptoms. See the vicious cycle?

What can we do to improve our sleep in perimenopause?

Luckily, there are solutions that can help improve sleep.

• Hormone replacement therapy (HRT) can help by managing menopausal symptoms that can cause poor sleep. Progesterone helps with relaxation, anxiety, drive to breathe and how fast we fall asleep. Estrogen increases sleep quality and quantity and decreases nighttime wake-ups. It also helps with regulating body temperature and hot flashes and may have an antidepressant effect leading to better sleep.  According to The North American Menopause Society, the majority of studies show HRT has a positive impact on insomnia.

• If sleep issues have been going on for a while, HRT alone may not solve them. The gold standard for insomnia is a fancy program called cognitive behavioural therapy for insomnia (CBT-i). It was a game changer for me and something that I would recommend to anyone suffering from insomnia. CBT-i helps to identify and change your thoughts, feelings and behaviours that impact sleep.

It is impossible to touch on everything CBT-i entails but I wanted to give you some actionable takeaways you can implement tonight. The book, Say Goodnight to Insomnia referenced below is also a great resource. My CBT-i program was based on it.

Actionable steps to improve sleep tonight

1. Our stress about sleep is actually worse than the lack of sleep. Don’t try to go to bed earlier to « make up » for missed sleep. Compressing your sleeping window and only going to bed when you’re tired leads to better quality sleep. You can slowly add on sleep time as your sleep improves.
2. If you are not able to sleep within 20-30 minutes, get out of bed. Say what?! Sounds counterintuitive but we want our brains to associate our beds with sleep, not being awake and feeling stressed. Do something semi-enjoyable but not stimulating. Then go back when you’re tired. 
3. Don’t look at the clock. The “get out of bed rule” is based on how long you think you’ve been trying to fall asleep, so avoid clock obsessing. I play a trick on myself when I wake up in the night, similar to reverse psychology with young kids. I don’t make sleeping the goal, I just focus on relaxing and enjoying the quiet. Before I know it I’m fast asleep. 
4. Go to bed and wake up roughly at the same time. If you can only focus on one then your wake-up time matters more than your bedtime for improving sleep and circadian rhythm. When you wake up, a timer in your brain starts. Melatonin starts to kick in 14h after you wake up and takes 1.5h to reach peak effect, so if you wake up late then you will naturally push back when your body is ready to fall asleep.
5. At night our logical reasoning part of the brain is lazy and the anxiety/ stress part of the brain takes over, making our problems and thoughts feel worse. Knowledge is power so reminding yourself of this in the middle of the night when your thoughts are racing can be helpful.

Sleep hygiene and lifestyle factors:

-Reduce caffeine and stop 8-10h before your bedtime

-Limit or eliminate alcohol at least 2h before bed.

-Avoid screen time before bed and if unable to do so wear blue light-blocking glasses.

-Avoid bright lights between 10 pm and 4 am. Those bright LED lights= no bueno for sleep.

-Sleep in a cool dark room. Fans can be helpful for night sweats or hot flashes. There are also fancy cooling devices for your bed but HRT could fix the root cause.

-Morning exercisers get better sleep.

– Keep a consistent sleep schedule even on weekends to prevent social jetlag

– Try to get morning sunlight as it resets cortisol and circadian rhythm.

– No large, spicy or acidic meals right before bed.

– Naps are controversial and it seems like no one can agree on an acceptable length. The Sleep Doctor recommends napping no longer than 25 mins and keep it between 1-3 pm. In place of naps, you could also do a short session of « non-sleep deep rest » (NSDR) or yoga nidra. This helps to improve physical and mental fatigue, promotes relaxation and can make up for missed sleep.

-Do whatever you can to manage stress levels. Whether it be breathing exercises, yoga, meditation, listening to music, journaling, delegating and seeking external support, boundary setting, therapy etc. Your sleep, hormones and health will thank you.

Conclusion

Sleep issues are complex and there isn’t a one size fits all approach to remedy them. Managing the menopausal symptoms with HRT and lifestyle approaches can help determine if your sleep-related issues are solely hormonal or if specific sleep interventions are needed, like CBT-i. We would love to help you find your sleep solution so you can get back to feeling your best.

References

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9. National Sleep Foundation. (May 2023.). Cognitive Behavioral Therapy for Insomnia. Retrieved from https://www.sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomnia
10. The Latte Lounge.  (December 2022). Improving Sleep in Menopause. Latte Lounge.[Audio podcast episode] https://www.lattelounge.co.uk/improving-sleep-in-menopause/
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