Common sleep issues
Insomnia, characterised by problems getting to sleep, staying asleep or early morning waking affects about 50% of women during perimenopause. This may be due to changes in hormones which play a direct role in sleep but also due to changes in neurotransmitters (chemicals in the brain that transmit messages), mood and body temperature during this time, together with increased stressors.
Sleep apnea, a sleep-related breathing disorder, also becomes more common during perimenopause because of lower levels of progesterone. This can lead to poor quality sleep and daytime fatigue, a symptom that can easily be confused with symptoms of the menopause itself. If you or your partner notice heavy snoring or pauses in breathing followed by gasps during sleep, speak to a doctor.
Perimenopausal women have a higher risk of having sleep-related movement disorders. These include restless leg syndrome where there are uncomfortable feelings in the legs with an overwhelming urge to move, and periodic leg movement disorder characterised by repetitive movements of the legs during sleep, often undetected by the individual experiencing them. Both these disorders can lead to poor sleep quality and problems falling and/or staying asleep. Again, if you or your partner notice any unusual leg movements before or during sleep, speak to a doctor.
How to sleep better during the menopause transition
Hormone Replacement Therapy
For most women the benefits of hormone replacement therapy far outweigh the small risks (read here for more information), with improvements in sleep, menopausal symptoms, mood and quality of life. Speak to a doctor about your options and for understanding your own risk profile.
Improve your sleep hygiene
The good news is there is a lot women can do, outside of medication, to improve their sleep during this time but there is unlikely to be one solution. First, consider your sleep hygiene and make changes to your activity levels, diet, alcohol and caffeine consumption. You might know this, but are you actually doing it? Some things you can do to improve your sleep hygiene include:
- Cut out caffeine eight hours before bedtime
- Reduce alcohol consumption
- Stop smoking
- Avoid hefty meals before sleep
- Put screens away an hour before bedtime
- Exercise more
- Get out in the natural daylight
- Relax in the hour before going to bed.
Consider your sleep environment
Is your bedroom conducive to sleep? Is your mattress comfortable, do you have the right type and number of pillows? Choose bedding made from natural fibres as these are much more effective at regulating body temperature and managing hot flushes. Wear less in bed, reduce the thickness of your duvet and blankets. Keep your bedroom as a place for sleep, not a place for work or “nesting.”
De-stressing
Think about your stressors and what you are carrying in your stress bucket. Are you taking on too much? What resources can you make use of to help you cope? What helps to relieve your stress besides unhealthy habits such as alcohol, smoking and sugar? Consider yoga and mindfulness – science shows there is good evidence they help with stress reduction, sleep problems and managing the menopause transition (read here for more information). Build in down time to your life, away from electronic devices, especially and crucially in the evening.
