Roxanne, a lady age 46 which is not in menopause yet, is seeking help for her sleep issues which has started recently. She has difficulty going to sleep and staying asleep. She wakes up many times during the night, tossing and turning until she falls asleep again or she become tired and get out of bed and does some errand around home, until she feels sleepy again and get back to her bed and sleep finally! This sleep issue makes her feel tired during the day. She asked "Is this happening due to menopause?" She feels exhausted at night but is not able to relax enough to sleep? Roxanne wants to know the reason for her recent nonstop worries and overthinking before sleep, which make her unable to let it go and fall asleep. As a result, when she wakes up in the morning, she feels like she hasn’t sleep at all and she feels so tired. This pattern of non-relaxing sleep is affecting her life, her relationship at home even her performances at work. She feels tired all day and her concentration has declined immensely. She is wondering if it is only her age and reaching to the so-called “menopause” or some other disease is happening. She tries to hide her worries!
How can menopause transition affect your sleep pattern?
Menopause is a process which starts about 10 years before your actual cease of menses. During these ten years which is called premenopausal transition, women have different types of experiences due to decline in function of ovaries and gradual hormonal imbalance. During this period women go through irregularity in menses, temperature dysregulation and hot flashes, mood fluctuations, wake-sleep pattern disruptions, skin issues and the list goes on and on! The last 12 months before cease of your menses is called perimenopause which all these symptoms become very prominent and noticeable and, in some cases, it has disruption in your daily living life and even your work performances. The twelve months after cease of your menses is called menopause and the years after that is called post-menopause.
Sleep disturbances are common in women age 40+ and become more difficult when it is associated with menopause transition symptoms like hot flashes, night sweats, mood swing, anxiety / depression, and respiratory changes like sleep apnea. There are other contributary factors in midlife sleep disturbance as well, such as medications, comorbid medical conditions, socioeconomic and behavioural factors, and poor relationships. Since there are many reasons for sleep disturbances for perimenopause/menopause women, the root cause of your sleep problem might be multifactorial. Therefore, a holistic methodology to assess sleep disturbances during menopause will be a reasonable goal-oriented approach for you.
Your countless responsibilities, your overbooked schedule and never ending to do lists do not let your brain switch off and as a result good sleep becomes a challenge for you. We all have nights when we can’t turn our brains off and find ourselves tossing and turning in bed. But if you’re having trouble falling sleep and/or staying asleep on a regular basis, you may have a condition called insomnia. While sleepless nights happen sometimes in your life, such as when you are overthinking because of a stressful situation, prolonged sleeplessness is not normal. It means, if this pattern occurs too often, and interfere with your daily performance, this can result in a health problem.
You spend a third of your life sleeping, and it’s one of the ways your body can recover from the stresses and replenishes. A good night’s sleep has impact on your overall health. Adults need about seven to nine hours of sleep a night to feel rested and be able to perform at their best during the day. When you don’t get enough sleep on a regular basis, you may feel stressed, tired, and less productive.
What are the impacts of poor sleep on your body?
It has the potential to lower immune system function, making you more prone to chronic diseases and getting infections. In a research by Mesarvi, Omar MD, they showed that sleep disorders can induce development of insulin resistance and obesity. It means the response of cells to insulin will be declined and as a result rise in blood sugar happens which ends up gaining weight and eventually obesity.
Leptin is the hunger hormone. It is a protein hormone produced mostly by fat cells, and its function is regulating metabolic activity among many other things. In a research they found that on Human studies the level of leptin was increased after sleep loss. Therefore, people sleep disorders because of imbalance and increased activity of hunger hormone, tend to not feel full after their meal, they crave for more food and even they feel they need to eat in the middle of the night. This explains why when you develop sleep disorders, you can easily gain weight.
A research done on Five hundred thirty-three individuals, published in 2020 in Frontiers in neurology showed sleep inconsistency has significantly associated with increased inflammation biomarkers. Which means that sleep has an anti-inflammatory property and inadequate sleep perceived as an inflammation by your body and your body eventually develops inflammation and inflammatory related diseases, if you continuously suffer from sleep irregularities.
Sleep has a direct effect on the level of growth hormone. As the name implied, growth hormone is involved in growth of human tissues. In a research published in 2020, they discussed how the hormonal axis of growth hormone and insulin like growth factor involved in learning and memory in addition to the growth in bone and repair in muscles. In other words, this axis does its neuroprotection activity at the central level in addition to its peripheral actions. This explains why you feel tired, fatigued and you have brain fug when your sleep is disrupted.
Good sleep has positive impact on muscle regeneration and repair. In a research published on 2021 on the role of sleep on recovery from exercise induces muscle injuries, they found out the deleterious effect of sleep irregularities on muscle tissue and the biological responses and the benefits of sleep improvement on the regeneration and repair of muscle in athletes.
The last and the most important is the effect of resting sleep on your brain function and cognition. Sleep affects cognition, concentration, memory, and mental stability. The evidence in a study on 1683 participants in 2020, shows that poor sleep quality is consistent with higher risk of late-life poor brain function and dementia.
Sleep modulates release of many hormones and irregularity in your sleep-wake pattern results in hormonal imbalance. Among all hormones role of estrogen, progesterone and melatonin is well studied both on sleep and during menopause.
Menopause happens when your ovaries cease production of estrogen and progesterone due to stop ovulation. These hormones are related to whole body functions such as mood, sleep, metabolism, hunger, sexual desire, cognition, and many others.
Estrogen - main female sex hormone - encourages a good quality sleep, keeps continuity of your sleep and decrease the number of your awakenings during the night. In addition, estrogen reduce your latency period for falling asleep which means the time you need to finally fall asleep. Approximately 10 years before you cease your menses, the level of estrogen starts to decline in a fluctuating manner. This fluctuation of estrogen levels continues during the perimenopause through menopause and has a great role in further sleep issues. Low estrogen is also responsible for your hot flashes, night sweats, feeling of distress and anxiety and even migraines and headaches. All of them can interfere with your circadian rhythm (your internal 24-hour clock which regulates your sleep wake cycle and your body temperature). It explains why during the perimenopausal phase your accompanied hot flash and night sweats, contribute to you poor sleep.
progesterone is another important female sex hormone which promote feeling good, keeps you calm by decreasing perception of stress and feeling of anxiety. In addition, it decreases symptom of depression as well. Progesterone at normal levels, keeps sleep latency phase short, so you fall asleep easier in a shorter period of time. You stay relaxed during your sleep and the number of waking stays low. However, during perimenopause as the number of ovulation declines the amount of progesterone decrease accordingly. Reduction in progesterone level has another back lash too. As progesterone has positive effect on your airways and helps you breathing easier, decline in level of progesterone may contribute to an increased probability of sleep apnea and in turn the problematic breathing disrupts your smooth sleep during the night.
Melatonin – the so-called- sleep hormone is main messenger of your circadian rhythm. Circadian rhythm is your natural internal clock that regulates your bodily response to your surrounding 24 h light-dark cycle. In mammals, this central clock is located inside of your head, and it does this regulation through secretion of a hormone named melatonin. There is a neath interconnection in your hypothalamus between pineal gland and other light receptive areas that in congruent and balanced hormonal activity, let the circadian cycle work seamlessly. In a simple word, daylight suppresses secretion of melatonin. With the gradual decrease of light in the afternoon towards the evening, the part of hypothalamus, which was inhibited by light from secretion of melatonin by light, start sending message of darkness to produce melatonin and induce night related physiological functions like sleep metabolism, sleep blood pressure regulation, and relaxation.
Therefore, melatonin production and release is directly bounded to your circadian rhythm and the decline in the amount of light that your eyes receive in the evening makes you drowsy. melatonin stays elevated through the night and starts falling with sunrise when the light start increasing. It explains why during the daylight melatonin is barely detectable and should give you a clue that if you are not making enough melatonin in the evening, you may have difficulty falling asleep. Finding of an study about association of level of melatonin and night-shift work indicated that night-shift work was associated with suppression of melatonin production. So, keep in mind if your environment is too brightly lit in the evening, your sleep center is not receiving message of darkness and stays inhibited by your surrounding light. As a result, you will have a difficult time going to sleep and staying asleep.
Perception of amount of light through age may have impact on sleep pattern. Therefore, in healthy adult who stay active and have nutritious food, low melatonin or a disrupted release of melatonin may not be attributed to the age. Instead, there are other root causes such as exposure to too much bright light at evening and night, lack of exposure to natural light during the daytime, overthinking and stress, and nutrient deficiencies are factors that should be addressed.
What can you do for helping your insomnia during menopause?
For many women, menopause is distressing. The symptoms are uncomfortable and even debilitating. The fluctuation in hormone level and hormonal imbalance has impact on sleep pattern and smoothness of sleep. Menopause cause you to wake up in the middle of the night for many reasons. From night sweats to hot flashes, your brain overthinking and hassle of middle life responsibilities and the decline in estrogen and progesterone -your patience and calmness hormones all together affect your sleep at all levels.
You need to have a strategy to help yourself with your menopausal sleep disorders. There are many steps that you can take to help improve your sleep before you start medications which I will briefly list few of them and I leave the remained to our one on one session for further exploration according to your special condition.
What is a naturopath's take on sleep health?
Practicing naturopathy is based on the principle of determining the root cause of events and conditions. For this reason naturopathic doctors spend a significant amount on your first visit taking a comprehensive medical history from you. Then to rule in or out underlying aetiologies, functional tests are usually quite useful. For instance, there are comprehensive lab tests for Oxidative stress analysis, metabolic analysis, cardiovascular profile, hormonal health assessment and female hormone profile, melatonin profile, among other things, are very helpful in determining e the root causes of your current concerns.
As always we do not wait for the lab results to come out and we start our naturopathic recommendations by introducing pertinent lifestyle adjustment strategies.
Four essential habits for combating sleep issues
1) Dedicate yourself to a sleep time habit
The first and most important practice to help with your sleep is setting a sleep time habit and hold on it. Sleeping at the same time every night, let your body adjust and accept the transition to sleep relaxation. To start the transformation, I usually recommend my patients to use a sleep diary for a week or two t to find out your own present sleep pattern and your present set point for optimal timing to cool down. Then we can start to work on your mal-adapted routine and optimize it to a healthier pattern that not only works better for your present condition, but also assists you to achieve your future healthy goals easier.
2) Boost your innate Melatonin
The second step to improve your sleep problem is boosting your natural melatonin production and secretion. It means that you need to avoid bright light starting two hours before your bedtime and stop watching screens before sleep including turning off your mobile devices and social media before even going to bed.
3) Adopt ONE sleep ritual.
Another important step is getting your mind and body ready to sleep by a time bounded sleep ritual. My all time recommendation is go out to the nature for a 10-15 minutes, short slow pace, meditative walk. Breath fresh air, pay attention to trees, stars or whatever your mind can calm down with. Keep your thoughts short and simple, as the healing secret of nature comes out of its simplicity.
4) Practice sleep mindfulness.
The fourth step is to practice sleep mindfulness. I need you to understand that in order to going from daytime activity and its alertness to nighttime relaxation and its tranquil, you need to pass through a transitional zone of acceptance and cooling down. The ritual routine gives your mind the opportunity to finish the evening activities and let your body shift to the bedtime calmness. Sit in your bed quietly, while your multiple screens and all social media are turned off, close your eyes, and focus on your breathing. Pay attention to your own physical sensations, feel the air while it is going in and out and how your body parts respond to this deep breathing. When you allow yourself to observe your own thoughts and feelings, you will find many points of blessing and reasons for gratitude.
Fifteen short solutions for insomnia.
Off note! These short-cuts work for every reason of insomnia including menopausal transition
1- Have your supper earlier and stop eating about two hours before bed.
2- Avoid stimulating food in the dinner.
3- Avoid having heavy meals at night.
4- Reduce amount of liquid intake from two hours before sleep.
5- Reduce alcohol intake particularly in the evening.
6- Avoid smoking.
7- Avoid caffeinated beverages like coffee, black tea, colas in the afternoon.
8- keep your bedroom clean as sanitary bedroom promote healthy sleeping.
9- Turn off all screens, cellphone, social media, etc. at least two hours before bed.
10- Avoid bright light from two hours before sleep to help with circadian rhythm.
11- Sleep in a dark room to help with melatonin.
12- Avoid noisy environment to keep your sleep un-interrupted.
13- Keep your body cool during night by not wearing tight sleep dress.
14- Maintain a cool room temperature during night by turning on air-conditioner or using a fan.
15- Avoid harsh discussion or holding grudge before sleep. Forgiveness is the most effective tranquilizer!
Herbs and natural health products for Natural Insomnia Relief
In my practice, I tend to use primarily herbals and botanical medicine to address different health issues. In addition to herbs, nutritional supplements are my second to go in case of finding deficiency in my patient presentation and In combination, most of the time they address many different health issues including sleep disorders and insomnia.
Menopause by itself and sleep in particular are two distinct but quite interrelated conditions which can be helped profoundly by use of herbs, botanicals and nutritional supplements. I will list briefly a few of the herbals and nutritional supplements that can help with sleep problem in menopause, and I leave the rest and details for your in person one on one visits to be able to tailor a well researched individualized treatment according to your special need and condition.
Melatonin : It helps prevent deterioration of neuronal cells and delays the cognitive decline in menopausal women
L-Theanine: It helps with relaxation, decrease stress and anxiety and enhance the sleep quality.
Magnesium: An essential mineral for a relaxing sleep and a healthy life overall.
Iron: To help with restless leg syndrome, promote smooth sleep.
Vitamin D: Vitamin D in addition to help for bone health, it has a hormonal role in many different biochemical/hormonal pathways in your body including smooth sleep.
Vitamin B complex: These vitamins such as vitamin B6, Folate and Vitamin B12 are important cofactors in many different hormonal-biochemical pathways. Their adequate serum level is crucial for overall health and in sleep as well.
Valerian is a flowering plant which as a herbal remedy is well known by its odor of unwashed socks, is widely used as a sleep aid that many people find it quite helpful.
Lavender is a flowering plant which is well known by its pleasant fragrance and is widely used in perfumery. Lavender has antioxidant, antidepressant, and sedative properties and contains compounds that decrease stress hormones, making it easier to relax and fall asleep.
Passionflower is a beautiful flowering plant that in ancient Persia it was known as “flower of clock”, as it modulate your innate circadian rhythm. Passionflower has a mild sedative effect and is often used to promote sleep and reduce anxiety.
Mint is a perennial herb with pleasantly scented leaves. It helps with gastric bloating. Therefore, if your insomnia is due to your maldigestion, mint may help with your sleep by reducing gas production and bloating of your stomach. Caution is warranted for use of mint in patients with GERD, as it may worsen the gastroesophageal reflux.
Chamomile is a flowering plant with a mild and pleasant flavor, it has soothing effect on digestive system in addition to its characteristics of improving sleep quality.
Take home note:
Sleeplessness, stress, anxiety, mood swings are common at menopause. Try to adopt a healthy lifestyle in order to get quality sleep. Natural helps are available. Do not wait until changes internalize in you and you get fixed with those maladaptive habits.
Disclaimer: The information in this article is the property of Dr. Masoumeh Shayesteh Manesh ND, and is not intended to diagnose, treat, or cure any diseases or promote any services or products mentioned on the website. Naturopathic medicine is not to be used as a replacement or as a replacement for prescribed medications. Please talk to your health care provider before starting any supplements or natural therapies.