Sleep in the menopausal years

Changing hormones in the menopause create sleep issues for a lot of women. A Sunday Times survey reported 65 per cent of 45-54 year olds and 65 per cent of 55-64 year old women rated their quality of sleep as bad or very bad.

Whether it is struggling to go off to sleep, restless legs, needing to go to the toilet, waking in the early hours and not being able to get back to sleep or waking up throwing off the duvet in the midst of a hot flush. Lack of or disruption of sleep can have knock on effects to all areas of health and well being.

Why is Sleep Affected in the Menopause?

Poor sleep in the menopause, is mostly caused by fluctuating hormones. The hormone fluctuations not only affect sleep quality but can cause symptoms such as hot flushes, restless legs, anxiety and poor blood sugar regulation, which can also disturb sleep. On top of that as we age the production of melatonin, the sleep hormone, reduces, affecting sleep quality. And cortisol, our stress hormone which is important in the sleep wake cycle, can also be higher than it should be in the evening. Which means going off to sleep is very difficult and waking in the morning even harder! But there are things we can do to help improve the quality of sleep. Helping us get the optimal 7-9 hours of sleep.

1. Practice Good Sleep Hygiene

  • Our body loves a predictable schedule. Going to sleep and waking up at the same time every day (even the weekend- sorry!) is a great tool to create better sleep. It helps our body know when to produce the sleep hormone melatonin, which in the post-menopausal years can use a bit of a helping hand.
  • Dim the lights and turn off all screens at least 60 minutes before bed to stop them interfering with the production of melatonin. If you really have to look at a screen in this time use your phones night time mode, a blue light blocking app like f.lux or wear blue light blocking glasses.
  • Take a warm bath about 60-90 minutes before bed, to reduce the core temperature which helps sleep. Body temperature can be dysregulated in the peri-menopause and tends to be higher post-menopause. Use a generous amount of Epsom Salts which is rich in magnesium which can also help support sleep and aid relaxation.
  • Keep your bedroom cool, clear and dark. Aim for around 20C or 68F to optimise sleep.
  • Promote relaxation and reduce stress levels to lower the stress hormone cortisol.
  • Try to be in bed by 11.00pm at the latest (10.00pm is better!). Make sure you allow time to get the optimal 7-9 hours of sleep.
  • Try to expose yourself to natural daylight first thing every morning, as close to waking as you can. Getting at least 20 minutes is optimal but some exposure is better than none. Exposing yourself to natural light in the morning helps set the body’s natural internal clock.

2. Control Bedtime Fluids

As bladder control and pelvic floor muscles weaken in the menopause, waking up to go to the toilet and then struggling to get back to sleep is a common problem. Simply by avoiding drinking fluids 1-2 hours before bed could help stop or reduce the need to urinate. But make sure you drink regularly during the day so you aren’t dehydrated. Dehydration can worsen symptoms such as brain fog, hot flushes, low energy and aches and pains which can all be related to the menopause.

3. Avoid alcohol in the evening

Try to avoid alcohol in the evening as it is disruptive to sleep and can cause or worsen hot flushes. Although many people think alcohol makes them sleep better. It actually acts as a sedative which means you may get off to sleep quicker but it is very disruptive to the sleep patterns the body needs. Alcohol also activates the fight or flight part of the nervous system, which causes fragmentation of sleep meaning you are more likely to wake up frequently.

4. Avoid Caffeine After lunch

Try to avoid caffeine after lunch. Caffeine has a half life of about 5-6 hours. This means that if you have a caffeinated drink at 6.00pm you may still have half the dose of caffeine at midnight! Caffeine can block a chemical in the brain called adenosine which is important for making you feel sleepy before bed. It also reduces restorative sleep, which means you may not wake up feeling refreshed and restored. Remember caffeine is found in tea, coffee, energy drinks and dark chocolate.

5. Eat a Nutrient Rich Diet

Eating a nutrient rich diet can be beneficial for sleep in the menopause. Think about eating a rainbow of colours of plant foods such as vegetables, fruits, herbs, beans, pulses and wholegrains to help optimise your gut bacteria. A 2019 study concluded that a more diverse gut microbiome promoted deeper, more restful healthier sleep.

Don’t forget magnesium rich foods such as dark green leafy vegetables, beans, pulses, avocado, salmon and seeds. As there is research to support magnesium benefits sleep.