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Part 1: Why You Maybe Losing Sleep & Why You Can't Afford to!

 

"I'm not sleep-deprived; I'm just in a committed relationship with my snooze button. We're going through a rough patch."

Are you finding it random if you get a good night's sleep? Sleep issues impact over 47% of women of perimenopausal age. This increases to 60% in postmenopause (1). The main driver of direct sleep change is progesterone. As ovulation declines, there is less progesterone which is a hormone that helps with create a state of sleep induction or a hypnotic effect (2).  In addition, women suffering from night sweats or hot flashes, restless leg and other perimenopause symptoms can have issues with sleep due to namely estrogen. 

The inability to sleep is one of the most difficult issues for women in perimenopause. Insomnia and sleep disturbances have a major impact on quality of life and health, including increasing your risk of chronic diseases, impacts your cognitive functioning, and decreases your overall ability to function during the day. Women face challenges with their mood, patience, body weight, exercise training, sexual wellness, and a host of other issues. According to the Centers for Disease Control and Prevention, more than 50% of perimenopausal women do not get at least seven hours a night. By contrast, the level for premenopausal women is over 70% (3). 

Before we start diving into menopause, let's take a moment and assess if you already are experiencing sleep risk factors. The below list encompasses major influencers of sleep:

  1. Family members with sleep or psychiatric disorders
  2. Prior history of being a poor sleeper
  3. Chronic pain
  4. Light sleeper
  5. Sensitivity to hormone changes
  6. A busy, active brain, especially at night
  7. Anxiety, worry, rumination
  8. Depression or bipolar disorder
  9. History of trauma
  10. Being a ‘type A’ person
  11. Shift work or a spouse that works shift
  12. New medication, stopping a medication
  13. Stress: financial insecurity, divorces, others

What You Used To Do Won’t Help

Women typically spend night hours finishing chores, working, or are up so late doing ‘life’ they do not get to unwind with television or entertainment until the time they should go to bed. We know all the ‘don’t look at screens before bed', but really? It is the one time of the day when we can have peace and tune out reality and relax. Are we really going to put our screens away? Maybe you super motivated women will do it, but for some of us, this is not helpful information.

As women, we power through sleeplessness and don’t consider getting help for insomnia or other sleep disorders like restless leg syndrome given other priorities. This takes a toll, however, on our health year after year, and perimenopause represents a time where we need to be proactive about our sleep and recognize it as important as our physical activity, nutrition, and mental wellness. We can’t continue to be sleep-deprived zombies feeling groggy and lethargic, just ‘getting through the day’ versus taking charge with energy.

Do You See Yourself in Helen?

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Meet Helen. Helen is a 47-year old woman who has always cherished the time when everyone is in bed to relax and unwind. Unfortunately, as her children got older, this time period pushed later and later into the evening. She has gotten into the habit of going to bed at an hour that never allows her to achieve even seven hours of sleep. She uses the time to catch up on chores, work, and to spend time in another world watching her favorite reality television shows. By the time Thursday arrives, she is a complete zombie and can barely get through the day. Each weekend, she says she is going to be earlier but each week passes and she has yet to tackle her sleep hygiene. Does this sound like you?

Why Is Sleep Impacted During Perimenopause?

Sleep issues such as insomnia, an inability to fall asleep, stay asleep, racing thoughts, sleep apnea, or wake disturbances, which are issues with the quality, timing, and amount of sleep or sleep apnea where breathing stops and starts make it difficult to take life by the ovaries. For some premenopausal women, the period before menstruation can be a time of insomnia due to the increase and drop of estrogen and progesterone. In perimenopause, which on average spans 4 to 5 years but can last over 10 years, hormone levels are like a roller coaster, swinging back and forth. Typically, a woman’s period spaces out further and further until it stops due to these hormonal fluctuations. Progesterone appears to have the most impact on sleep given its properties to induce calm and restfulness. Melatonin, the hormone that helps with sleep, also declines slowly during menopause, impacting sleep.

Sleep is also impacted by perimenopausal symptoms such as hot flashes, night sweats, restless leg syndrome, and minds that won’t turn off. There are often also high levels of stress related to a period of self-reflection and redefining who we are. For example, learning how to be an empty nester or parenting adolescents, caring for aging parents, struggling with career performance.

References

  1. Salari N, Hasheminezhad R, Hosseinian-Far A, Rasoulpoor S, Assefi M, Nankali S, Nankali A, Mohammadi M. Global prevalence of sleep disorders during menopause: a meta-analysis. Sleep Breath. 2023 Oct;27(5):1883-1897. doi: 10.1007/s11325-023-02793-5. Epub 2023 Mar 9. PMID: 36892796; PMCID: PMC9996569.

  2. Andersen ML, Bittencourt LR, Antunes IB, Tufik S. Effects of progesterone on sleep: a possible pharmacological treatment for sleep-breathing disorders? Curr Med Chem. 2006;13(29):3575-82. doi: 10.2174/092986706779026200. PMID: 17168724.

  3. Vahratian, A. Sleep duration and quality among women aged 40-59, by menopausal status. National Center for Health Statistics Data Brief. No. 286, September 2017, https://www.cdc.gov/nchs/products/databriefs/db286.htm.

  4. Women’s Guide to Overcoming Insomnia. Dr. Shelby Harris. The Women's Guide to Overcoming Insomnia Combination of therapeutic touch and music key to a better night’s sleep during menopause. The Menopause Society. October 25, 2023. Accessed October 25, 2023.

  5. KeskinTore F, Yagmur Y. The effects of therapeutic touch and music on sleep quality, menopausal symptoms and quality of life in menopausal women. Menopause. 2023, doi:10.1097/GME.00000000002269.

  6. Vaillancourt R, Gallagher S, Cameron JD, Dhalla R. Cannabis use in patients with insomnia and sleep disorders: Retrospective chart review. Can Pharm J (Ott). 2022 Apr 15;155(3):175-180. doi: 10.1177/17151635221089617. PMID: 35519083; PMCID: PMC9067069.; Corroon J. Cannabinol and Sleep: Separating Fact from Fiction. Cannabis Cannabinoid Res. 2021 Oct;6(5):366-371. doi: 10.1089/can.2021.0006. Epub 2021 Aug 31. PMID: 34468204; PMCID: PMC8612407.


 

 

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