Hot flushes, hormones and stress. Lots of factors related to menopause can impact our sleep. Vhi Clinical Lead for Women’s Health, Dr Fiona Belton, speaks to us about the cause of insomnia during menopause, how our lifestyle and diet can play a role, HRT and alternative treatments, and when you should seek professional help.

How is insomnia defined?

It’s common for us all to have a bad night’s sleep every now and again, and this is especially true for women during menopause. But where do a few nights of poor sleep venture into insomnia? Dr Belton starts by explaining the difference between having a couple of nights’ bad sleep and having insomnia. Insomnia is classified as difficulty sleeping for at least three days in a week for a prolonged period, such as a month or more. Importantly, insomnia will cause significant distress to how you function during the day. There are different ways insomnia can present: difficulty getting to sleep, waking up during the night and having difficulty getting back to sleep, or sleeping but not feeling refreshed the next day due to the quality of sleep you’ve gotten.

The causes of insomnia and difficulty sleeping during menopause

A decline in oestrogen is a significant factor in insomnia and sleep disturbances during menopause. Oestrogen is a female hormone that plays an important role in many functions of a woman’s body. The area of the brain that controls our sleep is responsive to oestrogen, so when there is a drop or fluctuation, our sleep-wake cycle can be affected.

The area of our brain that controls our body’s thermostat is also impacted by changes in oestrogen levels, causing hot flushes. Hot flushes can also impact sleep because they cause night sweats and wake us up due to being too hot in bed.

A certain number of women suffer from mood disturbances during menopause and this can affect your sleep. Anxiety may cause problems getting to sleep or back to sleep if you’re waking up during the night. Depression can cause similar issues. Snoring and obstructive sleep apnoea (OSA) are more common in perimenopause and menopause. OSA causes disrupted and poor-quality sleep and fatigue. It can be precipitated by weight gain, which can occur around menopause.

Restless Leg Syndrome is another sleep disorder that is more common around and after menopause. It may be precipitated by fluctuating hormone levels.

Dr Belton says that approximately 40-50% of women will notice some impact on their sleep due to perimenopause or menopause. Here are four ways you can work toward improving your sleep during menopause:

1. Focus on lifestyle factors

Lifestyle factors that can positively affect sleep during menopause include diet and other day-to-day efforts:

Diet

• A diet of foods with a low glycaemic index (GI): GI refers to the rate at which glucose (sugar) is released from digested food, affecting your blood sugar levels. Foods with a low GI include whole foods like wholegrains, fruit and vegetables, chickpeas, lentils and oats.
• Cooking meals from scratch: Rather than buying processed foods or pre-made meals, using fresh ingredients as much as possible is also advisable during menopause. This means you know exactly what you’re putting into your body and getting lots of nutrients.
• Following a Mediterranean diet of beans, pulses, seeds, fish, lean meats, and olive oil is also recommended.

Day-to-day lifestyle

• Daily exercise will also help people sleep better, but Dr Belton advises avoiding vigorous exercise in the couple of hours before you go to bed. 
• Caffeine is a stimulant and can lengthen the time it takes to get to sleep. Minimise caffeine intake after lunch if sleep is an issue for you.
• Alcohol can worsen insomnia as well as the quality of sleep experienced, so it’s advisable to minimise alcohol consumption if sleep is an issue.

Try to avoid smoking for at least two hours before bedtime. Nicotine in cigarettes is a stimulant so it will affect sleep. It is also present in e-cigarettes, nicotine gum and patches so these can also have a negative impact on sleep.

2. Practice good sleep hygiene

Sleep hygiene refers to our sleep environment and behaviours, and it plays an integral role in our sleep quality. Dr Belton explains that the bedroom would ideally be a place for sleep and intercourse, and we should try to use other rooms for things like watching TV or scrolling on our phones. Other good sleep hygiene habits include:

• Making sure your bedroom is at a comfortable temperature ― not too hot or too cold. If you suffer from hot flushes, keep a window open and ensure your bedding and pyjamas aren’t overly heavy.
• Keeping clutter to a minimum in your bedroom. This helps to maintain a peaceful space.
• Ensuring the room is dark and quiet before you try to sleep.
• Reducing your screen time in the couple of hours before sleep.

3. Speak to your healthcare provider about hormone therapy

Menopausal hormonal therapy (MHT), also known as HRT, is a medicine-based treatment that is used to relieve symptoms of menopause. Dr Belton explains that when it comes to prescribing hormone therapy, there are specific guidelines that healthcare providers follow.

After discussing your symptoms, your healthcare provider will help you to decide whether HRT is the best treatment for you. Dr Belton discusses that the goal of HRT treatment for sleep disturbances isn’t to get someone to a perfect night's sleep every night ― an unrealistic goal as most people don’t have perfect sleep every night ― but to achieve a quality and quantity of sleep that is sufficiently restorative, so your quality of life isn’t negatively impacted. 

When you combine the positive impacts of hormone therapy with healthy lifestyle choices and good sleep hygiene, Dr Belton said some women can feel very noticeable improvements in their overall menopause symptoms, “Hormone therapy can have a transformative role for some women. Even if they improve by only 50% with HRT, it can then make it easier to put the other bits and pieces ― the lifestyle factors ― in place. When you combine the improvement from hormone therapy with the improvement from healthy lifestyle changes, you can see a very significant improvement in your quality of life.”

4. Consider the alternatives to HRT

Some people may not want to use hormone therapy, or they might not be a suitable candidate for it, but there are alternative treatments you can try. There are many supplements and herbal preparations marketed to women going through menopause, and specifically those with sleep disorders. It’s important that you speak with a healthcare provider who is familiar with these products so they can advise you on what may or may not be helpful.

Mindfulness and meditation can help some women get better sleep, especially if they are under stress or experiencing anxiety. Cognitive Behavioural Therapy for Insomnia (CBTi) has been shown to result in an improvement in sleep quality, as well as daytime functioning, energy, work performance and overall quality of life in post-menopausal women who experience insomnia.

At what point is it advisable to see a doctor about sleep issues?

It’s important that you speak to a healthcare provider before your sleep disturbances or insomnia become “a problem that is affecting your daily functioning and general wellbeing.” Dr Belton remarks that, if you feel in good enough health to do so, you can at first put in place the good sleep hygiene habits and lifestyle practices discussed to see if they help with your sleep. If you don’t feel well enough to take these steps you should speak to your healthcare provider for further advice.

Hopefully, this guide has offered you useful advice and tips to help overcome your sleep disturbances during menopause. It’s important to remember that although difficulty sleeping is common during menopause, professional help is waiting as soon as you feel you’re struggling to cope ― you’ll find the best treatment for you and improve your quality of life.
 

This content is for information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Always seek advice from your GP or an appropriate medical professional if you have concerns about your health, or before commencing a new healthcare regime. If you believe that you are experiencing a medical emergency call 999 / 112 or seek emergency assistance immediately. 

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