middle-aged woman sitting on the floor against a white brick wall with her hands to her head from exhaustion

First, let’s recap the phases of menopause

Perimenopause

This is the time of transition between pre-menopause (when periods are regular and predictable, the vagina is moist, a woman’s sex drive is stable) and menopause. This is the hormonal roller coaster! Hormones can fluctuate wildly, periods are unpredictable and flow can be heavy. Women notice hot flashes, night sweats, a changed sex drive and that their vaginas are much drier. 

Menopause

Technically, menopause is only 1 magical day in a woman’s life. It’s that day when a woman has not had a period for one full year. But let’s be real, it is a period of adjustment when hormones are continuing to drop. This is a time unique to each woman where she may experience symptoms ranging from a gentle breeze to a Class-5 hurricane. She may not notice any changes or she may feel her life has been turned upside down. The average age of menopause is 51-52.

Postmenopause 

Technically, this is the phase that begins once a woman has had no period for one year plus one day. For most, hormone levels have declined to a steady level but hot flashes, night sweats, and other symptoms can and do still occur. When you consider that women live well into their 80’s, 90’s, and beyond, a woman may be post-menopausal for 30-50 years. Her health now is just as important as it was before menopause.  

It’s about the SLEEP

Ask most of the women you know who are of a certain age about sleep and they will complain about a lack of it. Yes, a major hot flash at work is not great, but sweating through your pajamas, twice, causing you to get only a few hours of sleep the night before, that’s a bigger problem. Many women might be in bed for 8 hours, but they are not sleeping soundly and they certainly don’t feel rested in the morning.

Here are common hormonally related sleep disturbances and conditions:

  • Night sweats – Altered brain chemistry messes up our internal thermostat so it overreacts and tries to dissipate heat by dilating blood vessels on the skin big time to cool us. Sweat glands ramp up to reduce the heat.
  • Shivering following a hot flash/sweats – Damp skin cools us too much, causing a shiver response.
  • Heart palpitations – Everything is on red alert, so the brain tells the heart to get with the program and speed up! All this causes more stress and maybe another hot flash.
  • Sleep apnea and snoring– Postmenopausal women are two to three times more likely to have sleep apnea compared with premenopausal women. Snoring is a sign of sleep apnea.
  • Depression and anxiety – Loss of estrogen and hormonal fluctuations can affect or trigger mood disorders, as can loss of sleep over time.
  • Sleep fragmentation – Whether you’re aware of waking or not, we know from some terrific research that women in all phases of menopause have “mini-awakenings” triggered by mini-night sweats and hormonal fluctuations that move women frequently out of deep, restorative sleep into lighter sleep.

Grace Pien, M.D., M.S.C.E., an assistant professor of medicine at the Johns Hopkins Sleep Disorders Center, explains. “There are changes in the brain that lead to the hot flash itself, and those changes — not just the feeling of heat — may also be what triggers the awakening,” she says. “Even women who don’t report sleep disturbances from hot flashes often say that they just have more trouble sleeping than they did before menopause.” Women have trouble falling asleep, waking during the night, and awakening too early and not being about to go back to sleep. 

Lack of sleep leads to irritability, trouble focusing, and depression.

Tips for Better Sleep During Menopause (and pretty much anytime)

  • Break the Worry Habit

Naturally, when you start to have trouble sleeping it becomes a worry. Watching the clock and calculating the dwindling hours you will get is a huge stressor which makes it even harder to sleep. Try to think of worry as a bad habit, just like nail biting. When you start to do it, consciously remind yourself that it is not helpful and refocus. 

This is where a meditation practice can be helpful. Sitting quietly and focusing only on your breathing, and practicing over and over the gentle pushing away of unwanted thoughts and refocusing back to the breath can help you be able to do this in daily life. Walking meditation, yoga, or tai chi, which combine movement with meditation can also help in this way.

  • Exercise Regularly

Easier said than done when you are feeling wiped out. But even moderate intensity exercise can improve sleep, energy, mood, and mitigate weight gain which can make menopausal symptoms more severe. Remember, exercise doesn’t necessarily mean working out in a gym or running for miles. Add a walk on your lunch break, jog up and down the high school bleachers near your home, find an exercise video you like.

  • Eat Dinner Earlier

Eating later, especially a big meal, can interrupt sleep. Your body is dealing with digesting, and maybe heartburn, along with everything else that’s going on. An early healthy meal in the evening is the way to go.

  • Practice Good Sleep Hygiene

First, cool it. Sleep researches agree the ideal room temperature for sleep is around 65˚F. So, open the windows or turn down heat well before bedtime. Lightweight cotton bedclothes and cotton sheets provide breathability that won’t trap your body heat.

This is also when a spare room comes in handy. Not only is it annoying to have a bedpartner slumbering away contentedly while you suffer, but a warm body heating up your space does not help. Who knows, your tossing and turning and flashes could be disturbing your partner, and moving when you’re having a bad night could make you both happy. 

The usual advice applies; Try to go to bed and wake up around the same time every day, even on the weekends, easy on the caffeine and alcohol close to bedtime. No tech in bed is also a good idea. 

For more tips, see my blog 8 Tips to Better Sleep

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