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How to overcome sleep problems during perimenopause

| MAR 4, 2022

Disrupted sleep can be one of the first signs of perimenopause. Many women put insomnia down to stress, work strain or the sheer overwhelm of life, not realising hormones play a major part. We have over 50 hormones in all, but let’s take a look at three in particular that play a role in sleep. 

The three key sleep hormones

Progesterone is known for its calming qualities and helps with melatonin production. When it starts to decline (it’s usually the first sex hormone to deplete during the transition into menopause), women can feel its effects quite significantly. 

Low estrogen is another sign that perimenopause is kicking in. This can cause night sweats, muscle aches, joint pain and bladder issues. 

Thirdly, the effects of the stress hormone cortisol are felt more around this time but, unlike sex hormones, there’s no shortage of cortisol. In fact, many women are very aware their levels are rising.

It’s important not to catastrophise. A few nights of bad sleep is to be expected but when it continues over weeks or months, insomnia impacts our health. It can have a detrimental effect on our weight, mood, energy and work performance. All is not lost though. I’ve included plenty of strategies to add to your sleep toolkit. Before we get to them, it’s a good idea to explore the foundations of what makes a good night’s sleep.

How much sleep do we need?

Not everyone needs the often quoted eight hours sleep a night. Some people function perfectly well on seven, while others might need closer to nine. It’s also worth remembering that requirements change and people find that, as they age, they need less sleep. As with so many other aspects of health, it really is individual. Try to focus on what works for you, rather than worrying that you’re not meeting the population level quotas that are often mentioned in research. 

How to naturally increase the need for sleep

The fundamental key to a good night’s sleep is to build up your appetite for it throughout the day. As soon as you wake up, look to insert as many drivers as you can that increase the need for sleep at bedtime. These include: 

  • Exposing your eyes to early morning daylight to set your body clock (ideally within 30 minutes of waking).
  • Making sure you’re moving your body/exercising each day. 
  • Getting plenty of fresh air. 
  • Avoiding naps, particularly long ones taken later in the day. 
  • Trying to go to bed at the same time each night (even after a bad night’s sleep). 
  • Avoiding caffeine after noon. 
  • Finding coping mechanisms to manage stress. 
  • Dimming your evenings (turning off glaring, overhead lights and avoiding blue light from devices).

What can you eat to improve sleep?

There isn’t a magic food guaranteed to send you into a deep slumber but foods that contain tryptophan might help. Tryptophan is an amino acid that helps stimulate the production of melatonin, which is our sleep-inducing hormone.

Foods that aid sleep:

  • Turkey
  • Bananas
  • Salmon
  • Milk
  • Yoghurt
  • Oats

To increase the likelihood of these foods making you feel sleepy, try combining them with a carbohydrate before bed. Good combinations include Greek yoghurt with banana, apple with almonds, or an oat cake and peanut butter. I generally advise people finish their last meal around three hours before bedtime to help with digestion but a small snack, like those mentioned above, might help some people - definitely worth a try. 

Foods that harm sleep:

  • Sugar
  • Alcohol
  • Caffeine 

We need to make a conscious effort to avoid stimulants like sugar, smoking, caffeine and alcohol before bed. Lots of women use a glass or two of wine as a crutch to numb their perimenopause symptoms or to take the edge off a stressful day.  Alcohol is a sedative so it can bring on sleep, but it’s not conducive with deep, restorative REM sleep (which you need for learning and concentration) and it tends to fragment the sleep you do get. It also raises your core body temperature so it’s very likely to bring on a night sweat. It can also increase your resting heart rate which in the middle of the night can feel like a racing pulse or palpitations - this exacerbates the stress-insomnia cycle. 

Some people are incredibly sensitive to caffeine and studies into those who think they’re not affected have found that caffeine can reduce sleep quality. When it comes to sleep, quality is perhaps more important than quantity. As a good rule of thumb, try to avoid caffeine after noon and remember that green tea, energy drinks, some cold and flu remedies, chocolate and even decaffeinated coffee contain some caffeine. If you’re getting that heavy-lidded feeling in the afternoon, try getting up and walking around or going outside. It’s surprisingly good at re-energising and avoids the need for a caffeine fix. In the evening many women find sleepy teas helpful. Look out for things like valerian root, passionflower, lavender, lemon balm and chamomile – but try to finish fluids by 7pm to prevent having to get up in the night to go to the toilet. 

Top tips for a great night’s sleep

Sleep is not a passive process. There's an incredible amount of work being done internally when you’re in the land of nod. So it’s important for both physical and mental health to get good quality sleep. Here are some key tips to help get you ready for a good night’s rest.

  • Your body needs to drop its core temperature by about one degree to initiate sleep and to stay asleep throughout the night. The optimal bedroom temperature is 16-18 degrees. Try keeping your bedroom window open in the run up to bedtime. Having a bath can help because your body temperature drops when you get out.
  • Invest in blackout blinds or add blackout material to your existing curtains. Or try wearing an eye mask. 
  • Make sure you have a firm end time to your working day and separate your workspace from your relaxing space.
  • Keep gadgets out of the bedroom if possible. They can encourage you to wake in the middle of the night for a quick scroll and often cause an onslaught of stress if they’re the last thing you look at before you turn the lights out.
  • Try wearing blue-light-blocking glasses in the afternoon if much of your day is spent in front of a screen. Overexposure to light, in particular electric lighting, late at night delays melatonin release meaning we feel less tired, which delays sleep onset and disrupts quality sleep.
  • Weighted blankets exert a hug-like pressure which might be helpful in reducing anxiety. In a study in Occupational Therapy and Mental Health, 63% of participants reported lower anxiety after sleeping with a 14kg blanket.
  • Having a sleep routine can help train our circadian rhythms for sleep, so it pays to be consistent. A regular wind down routine conditions the part of our brain called the suprachiasmatic nucleus (SNC) to bring on sleepiness.

An alternative to sleeping pills: CBT therapy

Cognitive Behavioural Therapy for Insomnia (CBT-I) is an evidence-based approach and is said to be as effective as sleeping pills for ongoing sleep issues, without the side effects. There are lots of online courses from reputable providers and most say you’ll see a difference in just 4 weeks. CBT-I is NHS backed and works by tackling the behaviours sufferers have around sleep. It helps people increase the sleep drive that I mentioned above, but it also addresses people’s thoughts and beliefs around sleep and tries to make those more positive. Insomniacs usually have very negative thoughts about sleep and their ability to cope. CBT-I works to reframe these thought patterns.

Supplements linked with better sleep

Supplements are rarely the quick fix people expect them to be. Your first port of call should always be to get all the other sleep foundations in place first - alcohol, caffeine, building up your sleep drive, staying off devices, having a regular routine etc. That said, here are some ideas to consider, but choose one and try for at least two months before deciding whether it’s effective or not. Always check with a healthcare provider first, especially if you’re taking prescribed medication.

  • L-theanine: this has been linked with better sleep in people with anxiety. One study used 450–900mg daily for eight weeks.
  • Glycine: this has many roles in the body, one of which is making serotonin and melatonin that work to calm the brain. It has been linked with falling asleep faster and having better-quality sleep. Try 3g before bed.
  • Magnesium: low levels can impact sleep and a whole raft of related perimenopause symptoms including anxiety, palpitations, restless legs and fatigue. Magnesium works by supporting GABA (which calms the brain), reducing glutamate (which stimulates the brain) and lowering the stress hormone cortisol. Try starting with 300mg magnesium glycinate, which combines the calming action of glycine, an hour before bed. You can build up your dose as needed but ask a professional for guidance. 
  • Taurine: the therapeutic dose for sleep is 3g taken before bed. 
  • Montmorency cherry (or tart cherry) juice: this contains tryptophan and melatonin and is often touted as a sleep aid, although robust research is scant. If you want to try for yourself, look for sugar-free versions and aim to take 300–400ml in the evening. Here's an easy sleep smoothie recipe.

For a much deeper insight into taking control of perimenopause symptoms via diet, lifestyle and medical interventions, read my best-selling book The Perimenopause Solution, written in conjunction with a menopause doctor.

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