How to break the insomnia cycle, mitigate health risks, and reclaim rejuvenating sleep amidst night sweats and restless legs. Photo / 123rf
Sleep stress is one of the top menopausal symptoms, so getting it under control can make this life stage considerably less miserable
Sleep is the salve that kick-starts our every day. Without the right quota, we stumble through, ragged and depleted. But menopause can be a demon that shreds our sleeping hours, with surveys revealing that more than half of midlife women struggle with insomnia.
Decreased levels of oestrogen, progesterone and testosterone induce night sweats, hot flushes, restless leg syndrome and anxiety, robbing us of essential respite and rejuvenating sleep. Science shows the health implications can be significant too, leaving us more vulnerable to heart disease, cancer, obesity, diabetes and stress.
But with a little expert advice, there’s no need to take the broken hours of darkness lying down. Here’s how you can secure better-quality shut-eye.
We fall into routines – good and bad – very easily. Insomnia, exacerbated by menopausal night sweats and anxiety, can become a habitual state that is often hard to break. A recent study by Dunelm showed that most menopausal women wake up at 3.29am, and 69 per cent of those studied admitted their mental wellbeing was harmed by not being able to sleep. To turn things around, Dr Maja Schaedel, the co-founder and director of the Good Sleep Clinic, recommends sticking to a regular routine, especially waking at around the same time.
“This is because of an important process called the ‘sleep homeostasis drive’, which allows us to build up ‘sleepiness’ during the day by being awake and active and so allowing us to fall asleep easily and stay asleep throughout the night. By waking up at the same time every morning and resisting the urge to sleep in or nap during the day, we can continue to build ‘sleepiness’ for the following night, protecting our sleep going forwards.”
In his book Life Time, sleep professor Russell Foster writes about the impact of alcohol, “Alcohol causes brain activity to slow down and induces feelings of relaxation and sleepiness… But alcohol also reduces rapid eye movement (REM) sleep and decreases sleep quality, resulting in more fragmented sleep.”
Add to this the fact that alcohol ramps up your body temperature at night by widening blood vessels and increasing blood flow to the skin, and you’ve got a series of outcomes that do not benefit an already sleep-deprived, hot-flushing menopausal woman.
Dr Louise Newson, a GP and menopause specialist, explains the benefits of taking HRT for better sleep and its connection to a healthier heart. “Replacing oestrogen, progesterone, and – if needed – testosterone through HRT helps manage hormonal causes of insomnia and reduces related symptoms that can make it hard to fall and stay asleep.
“Lack of sleep is associated with risk factors for heart disease, and when it comes to hormones, oestrogen has a protective effect on your heart: it helps to control your cholesterol levels, reduces the risk of fat building up in your arteries and helps keep your blood vessels healthy.”
Research suggests that most of us need between six to nine hours of sleep a night. And many experts agree it is quality not quantity that counts. So even having just six hours of decent sleep can be beneficial for both mental and physical health.
Kirsty Vant, a cognitive behavioural therapist for insomnia (CBT-I) at the private mental health centre The Soke, says, “Menopausal anxiety can interrupt sleep. But if you are awake, don’t stay in bed worrying. Research using fMRI scans has shown that our brains work differently at night. In particular, the prefrontal cortex – the rational decision-making hub – gets less blood flow while we are sleeping.
“This contrasts with the limbic system, our emotional hub, which is more active at night than in the day, meaning the things that wouldn’t necessarily concern us can feel very disturbing after hours. Rather than lying there feeling anxious, it is better to accept that you are awake, and maybe read, or even get up for a while, focusing on being calm and relaxed.”
Data collected from Bupa’s Menopause Plan shows the most severe symptoms of menopause reported are physical and mental exhaustion, sleep problems and psychological issues such as depressive mood and anxiety.
Dr Samantha Wild, the women’s health clinical lead at Bupa Health Clinics, says: “You might experience mood swings, memory loss, phobias and low self-esteem. In my experience as a GP, it is often these symptoms that bother women the most, and this impacts the quality of sleep, which in turn can make psychological symptoms worse. It’s a vicious circle. I encourage my patients to practise mindfulness or seek CBT to give them support and coping tools.”
Dr Schaedel explains: “When we are exposed to light this inhibits the production of melatonin – the hormone which signals that it is time to sleep. If we want our body to produce melatonin it is helpful to turn the lights down low or choose blackout curtains. In order to fall asleep, we need our core body temperature to drop by 1-2C so it is best to set the temperature of your room between 16-19C. Although people often like silence to fall asleep, others find it comforting to have the hum of white noise or a fan. The important point here is to emulate the environment in which you feel safest and most comfortable.”
You might also want to layer bed linen so you can take a sheet off if you experience night sweats. Cotton bed linen and nightwear are better options because cotton is breathable and helps absorb moisture, keeping you cooler. Again, mattresses with natural fills are best – memory foam tends to make you hotter. There are numerous brands, like Soak & Sleep, specifically aimed at temperature control and managing night sweats.
Exercise guidelines for all adults are 150 minutes of moderate intensity per week. This should incorporate cardiovascular movement and strength-building sessions. In short, we need to burn off energy to be able to relax better and to manage menopause symptoms by releasing endorphins, the brain’s wellbeing chemicals, to contain feelings of stress. But try to stick to a two-hour gap between finishing vigorous exercise and bedtime to allow the body to calm down.
In Davina McCall’s book, Menopausing, she talks about the importance of exercise to improve quality sleep. Davina advocates an “excuse buddy” – someone to help motivate you and to stop you from coming up with excuses about not being able to commit to a regular workout routine. McCall also says: “Grab one of those weekly planners at the start of the week, sit down and plan exercise into your diary. Say to yourself, ‘Right, this is exercise time’, and book in some slots.”
The nutritionist Mariya Barwaniwala reveals: “Cherries, particularly tart varieties like Montmorency (or even their juice), offer sleep-promoting nutrients. Cherries have a relatively lower glycemic index (they release sugar into the bloodstream gradually) and naturally contain melatonin, aiding in sleep regulation.” A 2018 research from the Journal of Functional Foods also highlighted cherries’ ability to improve sleep quality, so you might want to introduce a glass of cherry juice or a small bowl of cherries (about a cup) as an evening treat.
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