A recent study of 2000 women found they lost five and a half weeks' sleep a year due to the menopause, waking up on average 2.7 times a night. Photo / Isabella and Zsa Fischer, Unsplash
For months, Debbie Baisden's eyes would snap open between 2am and 3am as if her internal body clock had switched on an alarm. With sleep elusive, Baisden would go downstairs and busy herself with work until the rest of her family woke up.
"I'd lie in bed, feeling anxious that I couldn't go back to sleep, so it just made sense to get up and do some marking or housework," says Baisden, 55, a former teacher and now pub landlady from Terling, Essex.
After a year of just four or five hours of sleep a night, Baisden was exhausted and fragile, living a sort of half-life. "I wasn't even 50, but I suddenly felt so old and tired; all my normal tasks seemed 10 times harder and I kept forgetting things, turning up at the shops, not remembering what I had to buy and I even lost confidence in my ability to teach," she recalls. "I put on weight because I'd grab chocolate to give me a temporary boost. I started to feel very low and cried a lot even though I never used to be a crier. I just couldn't see an end to the sleepless nights. I hated them."
At the time, Baisden was teaching BTEC business at a sixth form college, running a mobile bar business, building a house and performing comedy, so she put her struggles down to stress, but when she started getting night sweats – a tell-tale symptom of the menopause – she realised it was hormones. "I started to research the menopause online and tried alternative therapies, such as lavender oils and chamomile teas, and I even discovered natural progesterone cream," she says.
"These helped in the short term, but the lack of sleep felt so ingrained, I couldn't seem to get in front of it."
Baisden is one of many women whose sleep is dramatically affected by the menopause. A recent study of 2000 women found they lose five and a half weeks' sleep a year due to the menopause, waking up on average 2.7 times a night, and experience a variety of other issues, including night sweats, insomnia and heart palpitations.
"Menopause affects sleep in two ways," says Dr Naomi Potter, GP, founder of menopausecare.co.uk and co-author of Menopausing with Davina McCall. "First, the symptoms of menopause – anxiety, night sweats, restless legs, joint pain and needing the toilet – can disturb sleep. Then there's the depletion of the hormone estrogen, which affects certain neurotransmitters to the brain and disrupts sleep mechanisms.
"Estrogen also helps keep our body temperature low at night and without it you have temperature deregulation, which leads to hot flushes and sweating. Progesterone decline is also involved in sleep disturbance since it has a sleep-inducing, calming effect by acting on brain pathways."
Speaking earlier this month, McCall revealed that sleepless nights were a fixture of her own perimenopause, at 44, when she was constantly "exhausted". The TV presenter, 54, who now uses hormone replacement therapy (HRT) to manage her symptoms, says night sweats and waking up in wet sheets gave her flashbacks to her days of drug dependency when she was in her 20s.
Dr Shahzadi Harper, GP and ambassador for new online platform Issviva Menopause, says that a decrease in melatonin, another vital hormone for sleep, is also a factor: "Secretion of melatonin is partly influenced by testosterone, and levels of testosterone – and therefore melatonin – decrease during the menopause, often compounding the problem."
On average, about 12 per cent of women experience sleep complaints. As women reach a perimenopausal and menopausal age, that number increases dramatically to between 40 and 60 per cent - and comes at the worst possible time.
"It's a 'perfect storm' of hormone turbulence and big responsibility," says Dr Potter. "When menopause strikes, women can be struggling with empty nests, ageing parents, stressful jobs, established relationships going awry ... this can be a very stressful time and sleep disruption only makes things worse."
Studies show that vasomotor symptoms, an umbrella term used to describe hot flashes (often called hot flushes) and sweating, affect up to 80 per cent of women during the menopause transition. Data from Study of Women's Health Across the Nation in 2011 revealed the duration of a flash usually ranges from one to five minutes, but some last up to 60 minutes and they are consistently associated with poorer sleep quality and chronic insomnia.
"Sleep is extremely important," says Dr Laila Kaikavoosi, a menopause specialist doctor at the Online Menopause Centre. "It helps with our thought process and combats disease by getting rid of free radicals (unstable atoms that can damage our cells). If we don't have enough sleep, the stress hormone cortisol increases and can have serious health consequences on those who have a genetic predisposition towards diabetes, high cholesterol or high blood pressure."
The brain fog from lack of sleep can gradually erode confidence, too. "It degrades our cognitive capabilities on a day-to-day basis until women feel they can't perform at work," says Dr Harper. "I see this a lot in my clinic."
Lesley Hirniak understands this well, having experienced menopause symptoms four years ago. "As soon as I went to bed I'd feel nerve-type pain in my legs, shoulders and arms. I just couldn't get comfortable and would toss and turn for hours," says Hirniak, 54, a mum of two and hair salon owner from Peterborough. "I'd take painkillers every night but I knew this wasn't good for me."
A friend suggested taking a few drops of CBD oil under her tongue every night before bed, which seemed to ease the leg pain, but then the hot flushes started.
"The night sweats would wake me every hour and I'd be sweating one minute and shivering with teeth chattering the next," says Hirniak. "It was unbearable. During lockdown I couldn't work, so at least I could rest and relax during the day, but when I went back to work, I felt like I was the walking dead and barely functioning. I couldn't recall one client's name and I'd been doing her hair for 25 years. I felt absolutely hopeless, even thinking my staff were laughing at me."
After muddling through for nearly three years, Hirniak finally went to her GP, who insisted she couldn't have HRT until she was technically in menopause – and had been period-free for a year. However, through her own research, Hirniak discovered that HRT can help in perimenopause, when hormones are swinging from high to low. She insisted and was eventually given HRT, Elleste Duet, in tablet form, but suffered with heavy monthly bleeds and had to come off after eight months.
"Ten days ago, I was prescribed the gel form of HRT and I'm feeling very hopeful," says Hirniak. "My hot flushes have already eased so I'm excited to see what happens."
Dr Potter says HRT is often the solution for women struggling with sleep issues. "HRT works in replacing the hormones you're deficient in, which then has a knock-on effect on the symptoms that are keeping you awake," she says. "But women should look at it from a holistic angle as well and take the opportunity to address any life issues – stress, the constant coffee runs, sugar and so on – that could also be making things worse."
Baisden, who wrote a comedy show about insomnia and menopause, went on HRT three years ago and is very pleased with the results. "At first I went to the GP and they gave me a blood test which said I wasn't menopausal so I just went away and struggled on, doing my own research on how to treat it naturally," she says. "But then my sleep got so bad I decided to see a doctor privately and they put me on HRT with a daily pump of Oestrogel and Utrogestan tablets every evening and I found my sleep improved within six weeks of taking it. Of course, I still get sleepless nights, but I don't have the urge to get out of bed anymore because now I know sleep will return."
Various studies have shown HRT to be effective in relieving menopausal symptoms, with one clinical trial saying it improved sleep quality by "alleviating the frequency of nocturnal movement arousals".
But it isn't the only option to help menopausal sleep disturbances. "Cognitive behaviour therapy has been proven to manage the menopause experience and to help with anxiety and insomnia, but it's not always a quick fix and may take around eight sessions," says Dr Harper, who advocates changes to lifestyle too.
She recommends getting 10 to 15 minutes of daylight every single day, ideally combined with a brisk walk, and to do something relaxing – like having a hot bath – later in the evening. Other tips include wearing an eye mask at night as "women around this age are light and noise-sensitive, and wearing one blocks out the light and boosts melatonin production". Harper also recommends counting back from 99 if you can't sleep.
"When we're anxious, our breathing becomes shallow, and counting down slows and deepens breathing which will aid sleep," she says.
Dr Potter insists sticking to a regular bedtime and getting-up time – even after a terrible night's sleep – and avoiding external props such as alcohol or coffee, especially in the evenings before bed, will all help.
"If you do wake up in the night, try not to lie in bed ruminating – just get up and read a book then go back to bed when you naturally feel sleepy," she says.
Reducing stress is also key. "Practice mindfulness, yoga or just put your phone down regularly," she adds. "It can make a real difference."
Now's also the time to take a good look at diet. "A Mediterranean diet with lots of avocados, nuts and olive oil is good for balancing hormones, as is reducing the amount of fried or processed food you eat," advises Dr Kaikavoosi. "Sleep in a well-ventilated room too, and make sure your pyjamas are lightweight and made from natural fibres, like cotton, to keep you cool."
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