Sleep Disturbance and Menopause - Healthy Balance Nutrition Sleep

Sleep disturbance during the menopausal years is a very common complaint by women, in fact, it is reported by 25% of women between the ages of 50-64 years. It can include not getting good quality sleep, difficulty falling and staying asleep, waking during the night and waking too early in the morning.

We all know how that makes us feel, don’t we?

Tired, fatigued, no get up and go, lack of energy and generally struggling through the day, only to do it all again the next night. The compounding effect can be debilitating on our quality of life if it continues for too long.

There are many factors that contribute to sleep quality and quantity in menopause, including hormonal changes, menopause symptoms, lifestyle factors, and the exacerbation of other conditions that affect sleep.

Let’s first look briefly at the biology of sleep……….

The Biology of Sleep

Sleep is a fundamental biological process that is required for good health and well being throughout our life. The benefits of sleep include stress reduction, improved mood, memory and immunity, lowered risk of chronic health conditions such as diabetes, heart disease and weight stability, just to name a few.These fantastic health benefits are the result of the important functions that occur while we sleep, allowing recovery and repair, improved brain and heart function, our metabolism is supported as well as hormone regulation such as those involved in appetite regulation and blood sugar control.

Sleep is primarily influenced by two biological processes:

Sleep pressure (homeostatic sleep drive)
Body clock (Circadian rhythm)

Both of these processes work together to promote good quality sleep. Sleep pressure is basically our need to sleep, the feeling of wanting to sleep, which increases the longer we are awake. Body clock is a 24-hour cycle that regulates sleepiness and wakefulness, and is regulated by the brain responding to dark and light throughout a 24-hour period.

So it would be fair to say that sleep is pretty important, but what happens in menopause if we are having recurring nights of little sleep caused by night sweats and hot flushes, or waking in the middle of the night after a few good solid hours, and then can’t get back to sleep?

Understanding sleep in menopause

Most of us will remember when we were younger, that getting a good night’s sleep wasn’t an issue. You could say that, our body clock and sleep pressure worked pretty well in harmony, and then we hit midlife and all of a sudden, the restless nights began.

Let’s have a look at what influences good quality sleep…….

Hormonal Changes

Hormones that play a role in sleep include human growth hormone (GH), prolactin, cortisol and melatonin. When the levels of these hormones change, our sleep will be affected.

Human growth hormone (GH) is released while we sleep and is associated with promoting healthy muscles and bones to keep us strong, it also regulates our metabolism. It is secreted intermittently by the pituitary gland, occurring in 6-10 pulses in every 24 hr period. Each pulse is different in length of time and the amount of GH released. Exercise has been shown to influence production and in fact, research has shown that exercise and sleep are the two key factors involved in its production. Lifestyle factors such as nutrition, stress and age also play a role.

Research has found that GH secretion is lower in post menopausal women compared to younger women. The decrease in oestrogen at menopause is strongly correlated with this difference. The mechanisms involved that affect sleep patterns in menopause has not been determined though.

Prolactin is more widely known for its role in breastfeeding, it does, however, have many other functions, including sleep. It is more involved in the onset of sleep and rises during the night to keep you asleep, also working closely with the circadian rhythm.

Like GH, it is secreted from the pituitary gland and levels have been found to be lower in post menopausal women compared to younger women due to decreasing oestrogen levels. Aging dampens prolactin production at night, resulting in wakefulness.

Cortisol is well known as the stress hormone, but it has many other functions in the body including its role in the sleep-wake cycle. It is produced and secreted from the adrenal glands into the blood, and works closely with the circadian rhythm. It stimulates waking in the morning by increasing throughout the night (starts around 2-3 hours after going to sleep), peaks at around 9am and as the day continues it keeps you alert until around bedtime, when levels start to decline.

Cortisol levels begin to rise with age, which may have an effect on sleep patterns, however there are many other factors that also influence sleep and cortisol during menopause, including the involvement of many other hormones, stress levels, menopausal symptoms and overall health status.

Melatonin is produced and released from the pineal gland in the brain, into the bloodstream. It is often referred to as the sleep hormone, as it is involved in the sleep-wake cycle, having the opposite effect of cortisol. When melatonin is high, cortisol is low and vice versa. Melatonin starts to be released in response to darkness (typically night time) and exposure to light (typically morning) halts its production, regulating the circadian rhythm.

During menopause, melatonin levels begin to decrease, having an effect on initiating and maintaining sleep, accompanied with frequent waking in the night and/or waking too early, disrupting the circadian rhythm.

Menopause symptoms

If you are experiencing menopause, I don’t need to tell you that some of the symptoms cause sleep disturbance! These include vasomotor symptoms such as hot flushes and night sweats, restless legs or restlessness in general, headaches, anxiety, palpitations and joint pain. Then there is waking in the middle of the night to go to the toilet more often than you used to, as bladder and urinary problems become an issue. These are all very common symptoms, some women will experience all of them, others will experience a few and some none at all. The main reason for these symptoms is fluctuating levels of oestrogen, and for most women they settle once they reach post menopause.

Lifestyle factors

Lifestyle factors are the one thing we have control of, to either worsen our sleep quality and quantity, or improve it. Lifestyle factors including how we manage our stress, how often we exercise, when and what we consume, along with sleep hygiene and routines can have a direct impact on how the hormones involved in sleep regulation behave, and can also improve our menopause symptoms that impact negatively on our sleep.

As mentioned earlier, the stress hormone cortisol will result in low quality sleep as it stimulates waking. Being aware of your stress triggers and finding ways to manage stress so that cortisol levels remain low will be key to improving sleep quality. If cortisol is low, the sleep hormone melatonin will increase, helping you to have a good night’s sleep. This may also have a positive effect on feelings of anxiety and palpitations.

Regular exercise will not only make you tired at the end of the day, but it is involved in the production of GH, and can alleviate hot flushes and night sweats. In regards to food, it is best to eat meals at least 3 hours before going to bed to allow for food to be digested, as going to bed with a tummy full of food is uncomfortable and can keep you awake. Decreasing coffee consumption as caffeine keeps you alert as it increases cortisol production. It is recommended that you have your last coffee of the day in the early afternoon, also avoid alcohol as it worsens vasomotor symptoms.

Some other things you could try to get a good night’s sleep include:

Turning off all your screens (phones, laptops, tv) at least an hour before going to bed
Have a relaxing bath with essential oils such as lavender to promote relaxation
Dim the lights or light a candle
Meditate to relax and promote sleep
Try journaling to de-stress or show gratitude
Breathwork – diaphragmatic breathing relaxes the nervous system
Keep to the same bedtime routines every day, going to bed and waking at the same time
Aim to get 7-9 hours of sleep per night
Cotton is breathable, so is best to wear cotton bedclothes and use cotton sheets to help alleviate hot flushes/night sweats
Read a good book
Drink a herbal tea like chamomile to promote relaxation

Getting a good night’s sleep can be a challenge during menopause, but having an understanding of the factors involved in promoting good sleep and what can hamper it, will arm you with the information to set a good routine in achieving good sleep and good health and wellbeing during this time.

This article is for information purposes only, as each individual’s circumstances are unique. If you are concerned by your symptoms and they are worrying you, always consult your doctor for further advice.

References

1 Australian Menopause Society, Sleep Disturbance and the Menopause, September 2018.

https://www.menopause.org.au/hp/information-sheets/949-sleep-disturbance-and-the-menopause2

2 Fugate Woods N et al, Cortisol Levels during the Menopausal Transition and Early Postmenopause: Observations from the Seattle Midlife Women’s Health Survey, Menopause,2009, 16(4):708-718 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2749064/pdf/nihms119444.pdf

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11 National Sleep Foundation, Understanding your body’s internal clock or circadian rhythm – is the first step to better sleep. https://www.sleep.org/articles/circadian-rhythm-body-clock/

12 Shazia J et al, Sleep, Melatonin, and the Menopausal Transition: What Are the Links?, Sleep Science, 2017;10(1):11-18 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611767/

13 Sleep Help, Sleep and growth hormone, 7 June 2019. https://www.sleephelp.org/hgh-and-sleep/

14 Sleepio, What controls our sleep pattern? https://www.sleepio.com/articles/sleep-science/what-controls-our-sleep-pattern/

15 The Sleep Doctor, Cortisol and effects on your sleep, Dr Michael Breus https://thesleepdoctor.com/2020/03/24/cortisol-and-its-effects-on-your-sleep/