My Journey with Cushing’s disease
At 30 years old, I was fit, healthy and naturally a size 8–10. I knew my body well, which is why, when it started to
Good quality sleep is a vital element of our health and wellbeing. It is arguably the most important of our pillars of health. There has been an increased interest in sleep and menopause, and the impact of our sleep on our health in general over the past few years. For women sleep is vulnerable at times of hormonal fluctuations and this includes menopause.
Menopause is the stage in life when a woman’s periods stop and her reproductive years end. Prior to menopause, women usually experience regular menstrual cycles when hormones rise and fall in set rhythms each month (pre-menopause).
As the menopause approaches these rhythms begin to lose their regularity, and hormone levels can rise and fall both erratically and dramatically. This is known as the perimenopause, and can last for many years. As sleep quality is impacted by these fluctuations, it can begin to suffer.
Sleep disorders are recognized as one of the most common problems associated with the menopause transition. The main hormones involved in sleep disruption during menopause are (o)estrogen, progesterone, melatonin, and cortisol.
Estrogen is involved in REM sleep which is important for memory, mood, and learning. It decreases the time it takes to get to sleep (sleep latency), and it decreases the amount of waking after sleep occurs. It also helps to regulate body temperature which is important for good sleep. Oestrogen regulates neurotransmitters such as serotonin that are important for controlling mood. As estrogen begins to fluctuate and decrease in perimenopause, sleep can be impacted.
Progesterone also has an important role in sleep. We only produce progesterone when we ovulate so as ovulation becomes less frequent in perimenopause, it can be the first hormone to decline.
Progesterone has a sedative effect as it modulates GABA transmission in our brain. This is a chemical that helps with sleep, anxiety, and restlessness. Progesterone is also involved with respiration improving breathing quality while we sleep.
Melatonin is known as our sleep hormone and is closely associated with our circadian rhythms. It is known to gradually decrease as we age, but this is particularly significant during the menopause transition.
Cortisol is often known as our stress hormone, and as levels increase, we can feel more anxious or stressed. During menopause, levels of cortisol have been shown to be higher at nighttime and we can often feel ‘on alert’ during the night making it difficult to fall back to sleep.
The hormonal changes occurring throughout the menopause transition can cause many symptoms throughout the body: Menopause-Symptom-Checklist.pdf
Symptoms such as hot flushes, night sweats, mood changes, needing to pass urine through the night, anxiety and low mood can impact sleep quality.
Lack of sleep – for example 4-5 hours a night instead of 7-8 hours can have a negative impact on how your brain functions. It can cause symptoms such as brain fog and memory difficulties. It can impact immunity, metabolic health and increase your risk of developing conditions such as heart disease and dementia.
Poor sleep can also impact your mental health and mood which is often vulnerable during the menopause transition. Women with poor sleep during menopause are 2-3 times more likely to experience depression.
Menopausal women also report higher rates of restless leg syndrome and obstructive sleep apnoea (OSA)– a disorder where breathing stops and starts during sleep. These are also due to hormonal changes occurring during menopause. OSA can lead to future health complications, and is important to address.
The years leading up to menopause are often busy with our career and family lives. Minor sleep issues that develop during this time can often gradually become more significant and sometimes result in sleep disorders such as insomnia.
Insomnia can be acute or chronic. Chronic insomnia is defined as occurring when you have persistent difficulty getting to sleep or staying asleep at least three times a week for a minimum of three months.
Levels of insomnia are higher in menopausal women than in the general population. Studies have also shown that there is a significant correlation between experiencing hot flashes and developing insomnia in perimenopause.
Good sleep hygiene can be very helpful. It is important to prioritize sleep to optimize wellbeing. Simple things you can do include:
Hormone replacement therapy can improve sleep quality as well as improving symptoms that disrupt sleep. Body identical progesterone acts as a sedative, and has hypnotic effects which often helps women with sleep.
Low dose antidepressants are also an option for some women, and can help with both hot flushes and restless leg syndrome.
Dietary changes, especially balancing blood sugar levels and avoiding insulin spikes helps optimize sleep quality. This also impacts energy levels throughout the day and improves long-term metabolic health which is also affected by menopause. Dietary supplements such as magnesium can also be helpful.
There is good evidence linking regular exercise with better quality sleep. Incorporating moderate intensity exercise earlier in the day with more gentle movement in the evening is beneficial. Yoga can also improve sleep quality in part due to its meditative properties which help us de-stress and relax our nervous system. Deep breathing exercises can increase melatonin production, facilitating relaxation and inducing sleep.
Cognitive Behaviour therapy for insomnia (CBT-I) can be very effective for menopausal insomnia. It helps improve sleep, depressive symptoms and emotional health, daytime function, quality of life and work performance. This can be done online or in person as well as 1:1 or in groups.
Although many women notice a change to their sleep in the years around menopause there is plenty that can be done to help. If you are experiencing issues with sleep, it may be beneficial to speak to a specialist with an interest in sleep disorders to find a plan that works for you.
Sleep is so important for our day to day well-being as well as our future health. It is something we should prioritize alongside diet, exercise, and lifestyle to feel as well as we can and live life to the fullest.
References:
de Zambotti, M., Colrain, I. M., Javitz, H. S., & Baker, F. C. (2014). Magnitude of the impact of hot flashes on sleep in perimenopausal women. Fertility and sterility, 102(6), 1708–15.e1. doi.org/10.1016/j.fertnstert.2014.08.016
Baker, F. C., Lampio, L., Saaresranta, T., & Polo-Kantola, P. (2018). Sleep and Sleep Disorders in the Menopausal Transition. Sleep medicine clinics, 13(3), 443–456. doi.org/10.1016/j.jsmc.2018.04.011
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