MenopauseMenu guest blog post by Kira Baum, ND EAMP.
Just like puberty before it, menopause is a time of great change; changing hormone levels, changing priorities, and changes in the body. Many women experience a disruption in sleep quality around this time and there are a number of factors contributing to this shift.
It can be helpful to untangle the core causes for disturbed sleep as this helps to guide treatment. In this article I will highlight four different scenarios resulting in poor sleep around menopause and outline some useful strategies for each. Of course, these are just suggestions for you to bring up with your trusted healthcare team.
You had great sleep for years with a sudden, abrupt deterioration around menopause.
This is likely due to changes in hormone levels. You may have even experienced this at other times in your life. Some women report changes in sleep during their menstrual cycle, with difficulty sleeping around the start of their period when estrogen is lowest. Increased estrogen can lead to the reverse problem. During pregnancy, estrogen levels skyrocket in the first trimester. It is believed that the increase contributes to feelings of drowsiness in those first three months.
What to do:
Some dietary changes can be helpful in this scenario. One such change is to include more phytoestrogens in the diet. These naturally occurring food compounds have an affinity to certain estrogen receptors but do not carry the health risks that hormone replacement therapy would. The most famous phytoestrogen containing food is soy and the goal is to aim for 20–30 mg of soy isoflavones per day. This is an intake comparable to the average consumption by Asian women who often report milder menopausal symptoms than their Western counterparts. This amount can be achieved by including one serving daily of foods such as soy milk, miso soup, tofu, or tempeh. If you don’t like soy products, ground flax seeds could also work.
In my practice, I also find acupuncture and herbal medicine to be extremely helpful for this type of sleep disturbance.
You’ve had a steady decline in sleep quality over the past five to ten years, made worse by menopause.
Quite often, poor sleep around menopause has more to do with aging and some of the lifestyle changes that accompany it. Aging often brings on a decline in non-rapid eye movement (NREM) sleep. This is the deep restorative sleep that helps you feel rested in the mornings. You may experience this decline in NREM as sleep that’s often interrupted by bathroom trips and bouts of wakefulness.
What to do:
Something else that declines with aging is the amount of exercise that we get, and exercise has a profound effect on our sleep. Exercise has repeatedly been shown to decrease the time it takes to fall asleep and to decrease wakefulness during the night. It also extends the amount of time one spends in deep sleep. The more the perceived exertion, the greater the effects are on deep sleep. So, if you can do something that feels strenuous, sometime not too close to bedtime, with regularity, you will see an incredibly positive effect on sleep.
Your life is busy and high stress. Sleep has been a lower priority for years.
Being a woman often means a lot of multitasking. Many of the women I see are juggling a demanding career with family responsibilities at home. Many come home late from work and still need to make dinner, help kids with homework, clean up, do laundry, and maybe hop on the computer to check on work in the evenings. Sleep gets pushed back later and later as the evening hours become the only hours for peace and quiet. Chronic high stress may also drive the body into a state of hyper-vigilance making it difficult to relax into sleep as the brain continues its multitasking mode.
What to do:
This is one of the hardest scenarios because it requires a shift in priorities. Sleep can be so helpful for everything from memory, to cognitive performance to a good mood, but it can still be extremely difficult to prioritize it. Many of us have the mentality of “work before play and relaxation.” But, what if work is never ending? And what if relaxation in the late evenings doesn’t actually replenish you the way that sleep would? Once you have committed to putting sleep on the front burner, then you can start working on all of the habits that help to nurture good sleep. This includes setting regular hours for sleep that give enough time for winding down. It can help to reduce blue light exposure in the evenings. Starting a few hours before you plan on being asleep, start turning off or dimming extra lights. Avoid screens or, at least, wear blue light reducing yellow goggles when you do use screens two hours before bedtime. Develop a soothing evening ritual that you can commit to. Your routine may involve journaling, praying or meditating, and going outside to look at the night sky.
I created a blog aimed at reconnecting people with the rhythms of nature and you may find this article and meditation helpful. It’s all about the importance of light and dark cycles.
Sleep has been disturbed by hot flashes.
What to do
My treatment recommendations for this group of folks looks very similar to those simply experiencing menopause-induced poor sleep without the heavy hot flashes. I often treat this group with a combination of dietary changes, herbs and acupuncture. Acupuncture is quite helpful for reducing the incidence of hot flashes. Give it a try for six sessions. The sessions should be no more than a week apart.
One other recommendation that I make to this group is to add in some sort of guided meditation and visualization practice. Daily practice in experiencing the hot flash and coming back to the breath, visualizing a cooling breath, and other practices can help to minimize how much women are bothered by their hot flash. You may find this mindfulness meditation from my blog helpful.
All of the disturbances above can occur together. For instance, poor sleep is known to increase depression, anxiety, and stress, all of which increase rates of poor sleep. Anxiety also increases frequency of hot flashes. Hot flashes can, in turn, interfere with sleep. Often, I end up treating them together. However, there is usually one predominant cause to focus on.
Acupuncture and herbal medicine are great supports at this time. I also like to remind patients that menopause is a new life chapter and great time to work in self care that may have been put aside over the years. This is a chance to work in more healthful eating, movement, meditation, and time to wind down.
Kira Baum, ND EAMP