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  • Susan Horgan

Why does perimenopause have you lying awake at night?

Updated: Jan 17, 2023

How hormone changes at a busy life stage are the perfect storm for a good night’s sleep.

We’ve all been there. Feeling exhausted, hop into bed, lights out. And then, nothing. You’re lying there looking at the minutes tick by, unable to doze off. Or, if you’re lucky, you get to sleep fine, but then something wakes you (usually needing the loo in my case!) and you can’t get back to sleep. The brain kicks in and you’re going through the monstrous to-do list you have to try to get through tomorrow.

And these types of nights can happen to anyone, at any time. But research shows that women report higher incidence of sleep problems than our male counterparts, and these sleep issues become more common as we transition through perimenopause to being post-menopausal. It’s reported that sleep disturbance is the 2nd most common symptom of perimenopause (definitely one I’ve experienced already), with up to 60% of women being affected. To look at some numbers, the research suggests that “the prevalence of sleep disturbance varies from 16% to 42% in pre-menopause, from 39% to 47% in perimenopause, and from 35% to 60% in post-menopause”.

The most common symptoms of sleep issues that occur during the menopause transition are difficulty falling asleep, frequent night waking and waking early in the morning. Other signs of disordered sleep include snoring, sleepwalking and talking in your sleep.

“It’s not a problem – I only need 5 or 6 hours sleep anyway”. I regularly hear from clients that they’re “used to” poor sleep and they can manage on less sleep. And it’s true that we condition ourselves to be able to function on less sleep and being tired just becomes the new norm. If you’ve had young children, you can certainly remember the days when you used to function on only a few hours. But there’s a difference between just functioning and functioning well. Adults need at least 7 hours of good quality sleep for their body and brain to rest, detoxify, repair and be ready to take on another day.

Consistently getting too little sleep, or too little good quality sleep, can have negative consequences on many aspects of anyone’s health – from your appetite, to your immune system, to your cognitive function, heart health and more.

When you’re also experiencing the hormonal rollercoaster of perimenopause, these effects can magnify some of the symptoms that so many women experience – mood swings, brain fog, weight gain, anxiety, memory loss and your ability to cope with stress.

So why does perimenopause affect sleep?

There’s lots of factors that can impact on your ability to get a good sleep and not all of them are specific to women. However, our sex hormones play a significant role in our sleep so when we get to perimenopause and our hormones are little more erratic, sleep can be one of the first things to be affected. So why is this?

In the early stages of perimenopause, usually in your early to mid-40s, you start to produce less progesterone. This is thanks mainly to the fact that the number of eggs you have left is lower so you may not ovulate every month (no ovulation = no progesterone) and, even when you do ovulate, the amount of progesterone you do produce may be lower.

Progesterone has a powerful sedative effect, helping you to get to sleep easily when you go to bed and supporting more deep sleep – helping to keep you asleep all night.

It’s also has a really calming effect on the brain, helping to reduce anxiety and support your ability to cope with stress - all of which is beneficial when it comes to trying to get a decent sleep.

To add more fuel to the fire, your oestrogen is also fluctuating from higher-than-normal highs to really low. High oestrogen can trigger high histamine levels, which can impact on your sleep quality.

Drops from high to low oestrogen levels may trigger hot flushes and night sweats that can disrupt your sleep.

Low oestrogen levels affect your body’s ability to utilise magnesium effectively, the sleep centres of the brain and alters your circadian rhythm making it really hard to sleep well.

To top it all off, the amount of melatonin (our sleep hormone) we produce naturally declines as we age and this decline is continuing throughout the menopause transition too. Melatonin is produced by the pineal gland in your brain and is associated with the control of your sleep-wake cycle. It’s production is triggered by the dimming light of the evening time and is stopped by daylight exposure. Less melatonin can make it harder to get to sleep or harder to stay asleep throughout the night.

Plus, if you suffer from other perimenopause symptoms like anxiety, depression, restless legs, palpitations, body aches or joint pain, you may find that these can interrupt your sleep too.

But it’s not just about your hormones

Like I said already, there are lots of things that can stop you from getting enough sleep. Your hormones are almost certainly playing a role but it’s really important to take a look more broadly to see whether there are other lifestyle factors that could be at the root of your problem. Most of these things are well within our ability to control, as opposed to our hormones that are a little more complex to reign in. So what sort of things am I talking about?

The blue light police

The first, and probably most obvious one, is your use of devices in the evening time. Most of our beloved devices – phones, tablets, laptops etc – give off blue light at a

frequency that affects our body’s ability to produce melatonin. And we’re spending more and more time on them, especially in the evening time, as a means of relaxing or switching off. This is definitely one that I’m guilty of at times and have to take conscious steps to manage my exposure. How about you?

The caffeine hit

Did you know that the half-life of caffeine (the time it takes your body to remove half the amount of caffeine from your blood) is around 5-6 hours? This varies based on many factors including your genetics and ethnicity, but 5-6 hours is a good average.

That means that half the caffeine from a coffee you drink at 3pm is till floating around your blood at 8/9pm, when you should be winding down for bed. And even if you’re one of the lucky ones that can have a coffee after dinner and still get to sleep, it may not be the great sleep that you think it is due to the effect on your sleep quality and ability to get into a deep, restorative sleep. I know my ability to handle caffeine has reduced in the last couple of years and can’t drink caffeine late in the afternoon or I won’t be able to sleep that night. When do you have your last coffee or tea?

The daily grind

Perimenopause hits at one of the busiest stages of a woman’s life. There are so many plates that need to stay spinning, it can feel overwhelming sometimes. There’s all the day-to-day commitments like work and career, raising your children (if you have them) and keeping the house from looking like a total rubbish tip. Maybe you’re also caring for elderly or sick parents. Not to mention the pressure to be doing “all the things” that social media places on us – dress a certain way, eat a certain way, do a certain type of exercise etc.

Stress plays havoc with our health. Cortisol, our stress hormone, is designed to make us alert and ready for that “fight or flight” response. Which is why, when everything is working well in the body, our cortisol naturally peaks in the morning and gradually declines as the day progresses to it’s low point in the evening. But when we’re constantly under pressure, our poor adrenals keep pumping out cortisol to support our stress response and we don’t get that nice low in the evening. And it’s this that is like a wrecking ball for your sleep. Not only that but cortisol is also like kryptonite for your hormones. When it comes to stress, we can’t easily remove some stresses from our lives – work, money, grief are things that we can’t necessarily control – but we can control our reaction to them and the things we do to support our ability to cope with these stresses when they do crop up. Anything you can do to reduce cortisol levels before going to bed is going to be a good thing in terms of improving your chances of a good sleep.

Location, location, location

We don’t often think about the impact our bedroom has on our ability to sleep. But the body benefits from certain environmental conditions in order to support healthy sleep. Things like the temperature of the room, how dark it is, the clothing and bedding you choose can all set the scene for whether you get a good or bad night’s sleep.

What’s your poison?

Alcohol is another big sleep killer. While we think a few drinks knocks us out, it is actually having the opposite effect, making it harder for us to get into a deep sleep. Alcohol also triggers more waking during the night – some for the loo and some so short we hardly notice. But the end result is a poor sleep, leaving you exhausted the next day.

Other things like not maintaining a regular sleep and wake time, as well as eating late, especially when it’s something sweet or carb-rich can also negatively affect your ability to get a good sleep.

So what's the point?

There’s so many things that can impact your sleep, it might seem like you’re doomed to poor sleep for the rest of your days. But trust me, that’s not the case. So many of the things we’ve looked at above are things that are easily changed and controlled by you. It’s not about changing everything all at once – let’s be honest, there’s not many that could succeed with that approach. But if you slowly start to work through them, you’ll find that some of them are really simple and massively effective.

Of course some of you may find that, even after making lots of changes, your sleep is still really bad and absolutely, you should speak to your doctor about whether some form of hormone therapy or medication might be appropriate, but at least you know you’ve worked through everything else and are confident that they are not driving your sleep problems. Never be afraid or ashamed to ask for help. Sleep keeps you sane and benefits both you and the people around you so make sure you’re being heard and get the support you need.

Need some help?

At the end of January, I’m going to be running a free challenge for anyone who feels they are perimenopausal and would like some support to make some changes that will improve your sleep. You can check out all the details here or sign up by entering your details in the form below.

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