This guest post was written by Jane, a reader who offered to share her story and tips for coping with insomnia. I’d like to thank her for sharing her experiences here.
Let’s talk about something half the population will experience at some point in their lives and how it affects sleep – The (peri)menopause. The brackets there are important because the perimenopause is when sleep disturbances first start for women.
Menopause & perimenopause
The perimenopause is the time just prior to and throughout the irregular cycles that characterize the lead up to the last menstrual period.
Perimenopause symptoms will appear several years before periods cease. The average age in the West is 47.5 years for the start of perimenopause and 51 years of age for the menopause itself.
These years are marked by fluctuations in reproductive hormones. This leads to an array of symptoms, with insomnia being one of the most prevalent. The average woman can expect 3.5 years of symptoms before being considered menopausal.
The hot flashes that women experience are well recognized, and indeed the punch line of many jokes. The reality though is that the less well-known symptoms are what cause most problems for women.
According to sleep experts, insomnia occurs in 40-50% of women during the menopausal transition. And women with insomnia are more likely to also report issues such as anxiety, stress, tension, and depression.
Furthermore, a 2010 analysis of data supplied by the Medical Research Council National Survey of Health, found women were 2 to 3.5 times more likely to report severe sleep difficulty whilst transitioning into menopause. In addition, they also reported night sweats, sudden waking, and bizarre and intense dreaming.
The hormone cocktail
The hormones that manage the reproductive cycle interact in complex and not entirely understood ways. Let’s take a look at how they impact on sleep.
While estrogen is a common focus of menopause discussions, progesterone has profound effects on sleep. At its optimal level, progesterone encourages sleep, whilst also acting as a respiratory stimulant to keep breathing steady.
When progesterone decreases, respiratory issues increase and recent studies suggest that respiratory issues underlie many of the nighttime symptoms women experience.
Estrogen helps to deepen sleep; its presence increases REM sleep cycles, increases sleep duration and reduces the number of instances of spontaneous waking.
Women with low estrogen and low progesterone typically wake up twice as often as women with “normal” hormone levels. Estrogen is also part of the body’s heat regulatory system, and low levels of estrogen are associated with those characteristic hot flashes.
Cortisol, melatonin and testosterone
These hormones are affected by estrogen and progesterone, and they also mix and react with each other. The exact way they affect each other is both complex and poorly understood. Essentially, a woman’s monthly reproductive cycle is a carefully balanced cocktail of hormones.
When the cycle starts to shut down, it doesn’t do so in a linear or predictable way. Many women describe it as like being on a roller-coaster – having spent years chugging along merrily on a straight track they suddenly find themselves riding wild hormonal switchbacks.
Despite the huge advances in treatments for menopause symptoms, getting the right treatment can be a tedious, stressful and trial and error process.
Testing hormone levels is a tricky business involving blood samples taken at various stages of the monthly cycle. And even then, the results can be inaccurate due to the very nature of the perimenopause.
Cognitive behavioral therapy for menopause sleep problems
For those struggling with sleep issues and are either wary of hormonal treatments or precluded them by contraindications, a recent trial of Cognitive Behavioural Therapy for Insomnia (CBT-I) produced encouraging results.
Drs McCurry and Guthrie, from Seattle, Washington published a paper in May 2016 showing that CBT-I delivered by telephone improved insomnia symptoms in peri- and postmenopausal women.
In the randomized trial 106 women were divided into two groups – a CBT-I group and a menopause education control (MEC) group. Both groups received six telephone sessions delivered over the course of 8 weeks.
Those in the MEC sessions received information focused on menopause and women’s health. Those receiving the CBT-I sessions were delivered guidance on “sleep restriction, stimulus control, sleep hygiene education, cognitive restructuring, and behavioral homework.”
Interestingly, the CBT-I was delivered by a social worker and a psychologist who underwent just a day of training in the techniques prior to delivering the telephone sessions.
At the start of the study over half of the women in both groups suffered with what was classed as moderate to severe insomnia. At the end of the study, those women in the cognitive behavioral therapy group experienced significant improvements in sleep compared to the women in the menopause education group.
Many women find some relief in herbal remedies, others swear by hormone replacement treatment. Some insist that the only true relief comes from a bespoke tailored bio-identical hormone therapy. The majority just struggle on.
Now CBT delivered by minimally trained, but supportive and directive practitioners, can at least go some way to ensuring the good night’s sleep necessary to cope with the stresses and strains of daily life.
Practical solutions to menopause insomnia
As well as seeking medical help or trying holistic medicine, there are some self-help options for dealing with the insomnia that are worth considering:
- Use natural bedding – linen or 100% cotton with a thread count around 400.
- Try a cooling mattress pad or bed fan to help regulate body temperature.
- Wear what athletes wear – modern workout fabrics are high tech and have fantastic wicking capabilities. Swap skin or pajamas for gym shorts and tops.
- Don’t worry about sleeping in separate bedrooms – if it’s an option, take it; it won’t ruin your relationship or sex life. It just means you have the opportunity to feel more comfortable and maybe get some sleep.
- Follow good sleep hygiene techniques such as avoiding using phones or TV in bed. Make your bedroom a relaxing and airy space.
- Set a specific sleep/wake schedule and limit time spent in bed at night. Aim to be asleep for 85% of the time in bed. Try to get up at the same time each morning and don’t nap during the day.
Do you have any thoughts on the ideas in this article? Have you found anything which helps you cope with insomnia, or perhaps deal with temperature issues at night? Feel free to share your experience in the comments below.