Menopause and Sleep

5 Ways Menopause Sabotages Sleep
Woman Stress
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Want to know one of the most telling signs that you're nearing or in the midst of menopause? The concept of eight hours of uninterrupted sleep sounds as precious -- and as out of reach -- as fitting into the jeans you wore in high school. According to a comprehensive report on menopause and sleep by the National Sleep Foundation, 61 percent of women between 45 and 60 say they suffer from sleeplessness and other sleep problems. Adding insult to injury, most women don't consider this problem serious enough to seek treatment. In fact, in a separate survey of women suffering from menopause-related sleep problems, 62 percent said they hadn't talked to a healthcare professional about their symptoms.

Yet recent research shows that poor sleep and lack of sleep raise your risk for high blood pressure, diabetes, weight gain, and immune system dysfunction. It's time to get some help!

Here are the five most common ways menopause sabotages sleep -- and what to do about them, so you can once again get a good night's rest.

How Night Sweats Affect Sleep

Nothing prepares you for the first time you wake up drenched in sweat, with your pj's stuck to your back and the pillow attached to your cheek. Ugh. But even when you don't have full-blown night sweats, temperature fluctuations can keep you from achieving deep, restorative sleep.

What's going on?

One of the lesser-known functions of estrogen is regulating your body temperature. As estrogen levels decline, your inner thermostat goes haywire. In addition, other menopause-related problems can complicate sleep. For example, depression is a common issue during the menopausal years, yet some of the most common antidepressants can increase night sweats.

What to do

  • Double-check your medication list. A number of medications are known to trigger night sweats. Chief among the culprits are tricyclic antidepressants, which can cause night sweats in up to 22 percent of the people taking them; and the SSRIs Zoloft, Prozac, and Celexa, which list night sweats as a side effect for a smaller percentage of users. If you need to be on an antidepressant to help with mood issues, talk to your doctor about switching to one less likely to cause night sweats.

  • Focus on the physical. Accept, as best you can, that night sweats are going to plague you and make comfort a priority. Buy light cotton pj's that breathe. Put a small fan near your bed that you can turn on when you need a fresh breeze. Keep a window open whenever possible. And keep an extra set of pj's and a pillowcase next to the bed, so you can swap clothes and linens in the middle of the night if you need to.

How Hot Flashes Affect Sleep

While it's tempting to lump hot flashes in with night sweats, they're actually two different symptoms. Many women experience one but not the other, or find one to be primarily a daytime problem while the other afflicts them at night. And, as is true for so many menopause symptoms, the pattern is different for everyone. Hot flashes, which come on very suddenly, disrupt sleep by making you uncomfortable and irritable, whether they trigger sweating or not.

What's going on?

Lower levels of estrogen and progesterone are making your body's inner thermostat temperamental. In other words, your body temperature becomes disconnected from external temperature; it could be 65 degrees in your bedroom but you feel like someone's blasted the heat to 95. In addition, your thyroid gland, which regulates metabolism and body temperature, may malfunction during the menopause years and exacerbate hot flashes.

What to do

  • Experiment with herbal remedies. Many women find relief for hormonal imbalance with natural supplements containing black cohosh and other herbs. Some popular supplements, such as Remifemin and Estroven, come in morning and evening versions, with the evening supplements specifically formulated to help you relax and sleep.

  • Get tested for thyroid problems. Hypothyroidism, caused by an underactive thyroid gland, can mess with your body's ability to regulate temperature.

  • Keep an extra blanket handy. Turn down the thermostat and regulate your temperature with blankets, throwing them on and off as needed. You may need to do this several times throughout the night, depending on the wackiness of your internal thermostat; that's your new normal.

How Mood Swings Affect Sleep

Life can be stressful at any age, but hormonal changes wreak havoc with your ability to stay serene. Extreme mood swings -- one woman describes them as "PMS on steroids" -- can leave you sleepless with anxiety at night, then unable to get out of bed due to depression the next day.

What's going on?

Progesterone, one of the two key female hormones that decline with menopause, plays a key role in regulating mood and calming the central nervous system, which allows relaxation and drowsiness to replace the day's nervous energy. As progesterone production declines, it can leave you more vulnerable to feeling anxious and wired, hence the proverbial "worried mind" that won't let you sleep.

What to do

  • Keep track of when you feel anxious, angry, or oversensitive. Making a monthly chart and recording your moods may help you detect a pattern. Many women find they have one or two "bad" PMS weeks a month, then they're fine the rest of the time. Figuring this out helps you identify the problem as hormonal and makes you feel way less crazy.

  • Talk to your doctor about progesterone cream. Natural progesterone cream, derived from yams and sold at health food stores, is effective for many women in combating the symptoms of low progesterone, including sleeplessness.

  • Don't be shy about getting help. For many women, the mood swings that come with PMS, perimenopause, and menopause can be severe. In fact, in up to 10 percent of women the symptoms are severe enough to qualify for a diagnosis of premenstrual dysphoric disorder (PMDD), in which hormonal fluctuations cause a profound drop in serotonin levels. If you feel like you're completely losing it two weeks out of every month, see a psychiatrist for help with mood swings and sleeplessness.

  • Experiment with supplements. A few small studies have shown that vitamin B6 and L-tryptophan or 5-hydroxytryptophan (5-HTP) are effective against mood swings and sleeplessness brought on by low serotonin levels.

How Heightened Stress Response Affects Sleep

Even women who used to sleep like the proverbial baby find themselves staring at the ceiling, roiling with anxiety-fueled sleeplessness, during menopause. In fact, the National Sleep Foundation says "trouble staying asleep" was reported by 79 percent of all menopausal women, trumping even the 63 percent who reported trouble falling asleep.

What's going on?

Experts now believe that estrogen withdrawal can trigger a surge in noradrenaline, leading to an overly vigilant stress response system. The result: You pop awake at the slightest signal, then are unable to fall back asleep. In addition, loss of estrogen makes you more susceptible to stress. And your adrenal glands' ability to release chemicals to cope with the fight-or-flight stress response often declines.

What to do

  • Eat on a regular schedule. Fluctuating blood sugar levels can cause the adrenal glands to fire out cortisol, so nutritionists recommending eat three healthy, nonsugary meals and two snacks a day to avoid stressing the adrenal glands.

  • Get moving. Exercise is one of the only proven ways to boost levels of serotonin, the stress-fighting brain chemical that makes you feel serene enough to sleep. Try to do some type of aerobic exercise for an hour a day, preferably before dinner, and you should see a marked improvement in your sleep.

  • Enhance your natural sleep cycle. Progesterone and estrogen work to make you feel sleepy and relaxed by triggering production of melatonin, a natural sleep-inducer. Calm your central nervous system naturally by taking 3 milligrams of melatonin about an hour before bedtime.

How Bladder Problems Affect Sleep

If you have to get up multiple times during the night to use the bathroom, welcome to the club. Urge incontinence and stress incontinence, both of which commonly begin with menopause, are terrible sleep saboteurs because even before the need to go wakes you up, they cause you to sleep lightly and restlessly.

What's going on?

As estrogen declines, the tissues of the bladder begin to thin, leaving them more sensitive to any type of irritation. That's why so many midlife women suffer from overactive bladder, either in the form of having to go all the time or having to go suddenly and without warning. Lack of estrogen also can cause the pelvic muscles to weaken, resulting in poor bladder control.

What to do

  • Beware bladder triggers. Cut out irritants like caffeine, chocolate, citrus, alcohol, and spicy foods at least four hours before you go to bed.

  • Prepare for bed with an empty bladder. Don't drink liquids for several hours before you go to sleep.

  • Hydrate early and often. Stay well hydrated by drinking plenty of water, particularly during the first half of the day.

  • Boost bladder health. Take a probiotic supplement to control any possible yeast overgrowth and promote general bladder health. If you're prone to urinary tract infections, drink cranberry juice or take a cranberry supplement.

  • Do Kegel exercises to strengthen the bladder muscles. If you don't know how to do these, ask your doctor to refer you to a physical therapist who specializes in pelvic floor strengthening.

Melanie Haiken

Melanie Haiken discovered how important it is to provide accurate, targeted, usable health information to people facing difficult decisions when she was health editor of Parenting magazine. See full bio