Can’t sleep? Menopause may be the culprit

There is nothing worse than not being able to sleep. The initial boredom as the minutes tick by; the encroaching panic as you count your thousandth herd of sheep; the existential abyss of 3 a.m. when your deepest regrets compete for attention with remembering you need to change the furnace filter.

And while the causes of sleeplessness are many — caffeine after noon, blue light before bed, that second glass of wine with dinner — there’s one common culprit that’s harder to predict: Your hormones.

In particular, sleep disruption is a common symptom of the hormonal changes that begin with perimenopause and continue in menopause (defined as not having a period in over a year) and beyond. Given that perimenopause can begin in your early 40s — occasionally as early as your 30s — leading up to the “menopausal transition,” which is before your period stops for good, but while you’re experiencing symptoms like hot flashes, mood changes and irregular periods, and, well, post-menopause is the rest of your life, that’s a sizable population of sleepless folks struggling to get eight hours of restorative shut-eye during some of the most demanding phases of their lives.

“Often the complaint is frequent awakenings during the night,” says Judith R. Davidson, a psychologist and somnologist (that’s a sleep doctor) at Queen’s University, and author of a guide to “reversing insomnia” called “Sink Into Sleep.” “If you’ve had sleep difficulties like insomnia before the menopausal transition, you are more likely than those who have not to continue to have sleep difficulties, and they may worsen.”

In fact, 40 to 56 per cent of people in the menopausal transition and post-menopause report difficulty with sleep, according to Davidson, who adds that hot flashes are often the cause. On the flip side, she notes, up to 60 per cent of people don’t report sleep difficulties with menopause, so … reasons to be hopeful if you’re not there yet.

What can you do to combat hormone-related insomnia, if you’re experiencing it? We asked Davidson for her evidence-based expertise for falling, and staying, asleep.

Address the hot flashes

“Know that it is normal to have some sleep disruption due to hot flashes,” says Davidson. “Hot flashes occur as estrogen levels drop. They seem to involve both a shift in the internal temperature set-point and an arousal — these happen at the same time.” She adds that people have hot flashes for a median 7.4 years, although this can vary widely among individuals.

She recommends “in the moment” interventions like cooling your forehead with a damp cloth or removing blankets and turning on a fan when you’re in the midst of a hot flash.

Seek sleep help if you need it

Davidson defines insomnia as “trouble falling or staying asleep at least three nights per week, that interferes with functioning and that persists for at least three months.” What’s the best way to deal with it? “If the awakenings start becoming longer and are interfering with your well-being, then cognitive-behavioural therapy for insomnia (CBT-I) has been shown to be the most helpful intervention for women with hot flashes and insomnia.”

There are a number of digital CBT-I resources she recommends, including Sleepio, Somryst and Haleo, which can help you tackle your insomnia without even having to change out of your PJs. A bit like having a sleep therapist in your pocket, these are apps that offer “sleep training” on your phone, taking you through everything from how to properly track your sleep to behavioural changes that will help you sleep better.

As for medication, Davidson says she hasn’t seen “good evidence” for medications to help with sleep disruption specifically related to menopause, but that’s a conversation you should have with your own primary care provider.

Try not to stress about trouble sleep

We’ve all been there: You’re up at 3:30, your alarm goes off at 6, and you’d do anything to get a split second of REM before your hectic day starts in, oh great, only two hours now. The worst thing you can do is start worrying about sleep in the middle of the night, says Davidson. “This can prolong the awakening. I know it’s easier said than done, but worrying, problem-solving, analyzing and planning are all mental activities that tend to prolong nighttime awakenings.”

Instead, consider getting out of bed entirely and going into another room, doing something calming that’s not scrolling TikTok, and trying again when you feel sleepy.

Practice good “sleep hygiene”

Good sleep starts when you’re awake. Davidson’s list of tips for what she calls “sleep hygiene” (or habits): Getting fresh air and movement during the day, turning off electronics at least an hour before bed, managing your stress levels through activities like meditation and journaling, and watching your alcohol intake. The Sleep Health Foundation suggests avoiding alcohol for at least four hours before bed, while binge drinking (defined as more than four drinks in one sitting for women) can disrupt your melatonin levels for up to a week. Also: Watch out for sneaky sources of caffeine, like dark chocolate or hot cocoa.

Nap if you need to

One piece of advice we particularly like: Take a nap during the day if you get sleepy. Per Davidson, the optimal nap time is between 1 and 4 p.m.. One Harvard study found that a 45-minute siesta can improve your ability to learn, while another in the Journal of the American Geriatrics Society reported that over 65s who napped for between 30 and 90 minutes performed better on memory tests. (A note of caution: Those who napped for longer than an hour and a half performed just as badly as those who didn’t nap at all.)

Sarah Laing is a Toronto-based freelance contributor for The Kit and the Star, writing about celebrity, culture and lifestyle. Follow her on Twitter: @sarahjanelaing

SHARE: