Midlife- The Great Sleep Bandit... Tips for a Better Night's Sleep
If there’s one thing I took for granted when I was younger, it was the ability to sleep through the night. And while I definitely experienced insomnia periodically in those younger years, once I did fall asleep I was out until morning. And I could sleep-in easily on the weekend, long past my usual wake-up time without a problem. Those were the days!
Sometime around my mid-40’s, that started to change. At the time, I knew very little about perimenopause (or menopause for that matter), and honestly, I thought I was too young to have to think about it at all. I wasn’t sure what was going on, but I was waking several times a night. Sometimes my heart would race. Sometimes I was just super hot. Sometimes there was no accompanying physical symptom- I was just wide awake at 3am for no apparent reason. And for me, there is no more frustrating feeling than lying awake in the middle of the night. Invariably, if my heart wasn’t racing, my mind was, and I had a very difficult time shutting down as I worried about, well, everything. Because for some reason, issues and problems always have a way of feeling magnified in the wee hours of the morning.
I also don’t remember a whole lot being written about the topic at the time. I just knew that I felt tired all the time, and I didn’t know how to fix it. Occasionally, I would take an Ambien when I got desperate, but it always made me feel like I had a hangover in the morning, so that kind of defeated the purpose.
Why do so many of us start to experience sleep issues as we enter midlife? Is there a simple explanation? The answer, like so much else in life, is that it’s complicated. There are the sociological, psychological and cultural aspects of being a midlife woman in today’s world with it’s confluence of pressures (I highly recommend Ada Calhoun’s “WHY WE CAN’T SLEEP- Women’s New Midlife Crisis” to explore these factors); there’s also the physiological impacts of wildly fluctuating hormones and the havoc they can wreak on us as we move into perimenopause and beyond, which I’ll focus on below.
Let’s start with the basics- what is perimenopause?
Perimenopause
Perimenopause means “around menopause” and is marked by the physical changes that take place in the years leading up to a woman’s final menstrual period. Among the signs and symptoms are sleep problems, irregular periods, mood changes, hot flashes and night sweats, vaginal dryness, reduced sex drive, forgetfulness, heart palpitations, dry skin and hair, increased urinary problems and weight changes. As if that were not enough, there are also some more “silent” issues, such as changes in cholesterol levels and loss of bone density. Something tells me that if this list of symptoms impacted men, we would have a lot more options in the way of treatments, but that’s a different topic for a different day! Most women will notice some combination of these changes (but thankfully, not necessarily all of them) beginning in their 40’s, and this phase can last from anywhere from 4-8 years and in some cases as many as ten (the average age for menopause is 51 years old). While there are some lucky ones who coast through without any issues, most of us will not get out unscathed!
Hot Flashes/Night Sweats, and Strategies to Manage
If you have ever been awakened in the middle of the night drenched in sweat, then you need no explanation here! Suffice it to say that is pretty difficult to get back to sleep when you wake up feeling like you are on fire. Research indicates that the decreasing estrogen levels we experience with perimenopause mess with our internal thermostat, or more specifically, the hypothalamus, making us more sensitive to changes in body temperature. Translation- when the hypothalamus thinks that you are too warm, it sends a signal that you need to be cooled down, resulting in the hot flash. Hot flashes affect approximately 75% of women during this transition, and they can last anywhere from 1-5 minutes and can occur anywhere from a couple of times per day to multiple times per hour.
Fortunately, there are several strategies to help address these nightly episodes. For me, having a fan next to my bed at all times has been a life-saver. I even take it with me when I travel. You can find very inexpensive personal fans like the one I have here. Also, while I don’t love a cold room during the day, I set the thermostat to 68 degrees every night, which has also been a big help (as has having an understanding husband who wears layers to bed!). Additionally, sleeping in light cotton clothes (for me, it’s just a light, loose-fitting tank top) and on cooling cotton sheets can also help to mitigate the issue. Keeping a cold glass of water (you can use an insulated cup or just let the 68 degree room work for you) is also helpful when you wake up hot.
Alcohol can also play a role in sleep disturbances generally, but specifically, red wine is said to be a common trigger of hot flashes. I used to love a nice glass of burgundy at the end of the day, but found that it was really screwing with my sleep, so I rarely drink red wine anymore. Other triggers may include spicy foods, hot beverages or even a warm bath before bed. Everyone is different, so the best way to track and connect the dots is to keep a journal to help you recognize and eliminate triggers. By heightening your awareness and employing some of these simple strategies, you can greatly improve the quality of your sleep.
Perimenopause, Menopause and Midlife- A Perfect Storm for Anxiety and Depression
While I’m dealing more with the physiological here, no article on sleep in midlife would be complete without addressing how complex and intense this phase of life can be. Many women in their 40’s have young kids/teens at home and are simultaneously helping to care for aging parents. Add to this the demands of work and career for many, and consider the stressors of the past year with the pandemic. It’s no wonder so many feel completely overwhelmed in the face of unrelenting pressures and responsibilities, with little time to focus on self. Here at Patina, we talk a lot about the freedoms that come once you get past these demands, but the fact is that many women are dealing with perimenopausal symptoms while performing the biggest juggling act of their lives. (Again, check out Aida Calhoun’s book for a deeper dive into this area)
Those life circumstances alone would be enough to make the most stoic and stable among us anxious and/or depressed. Now factor in the concurrent hormonal shifts taking place at this stage, and you really do have the conditions for a perfect storm of anxiety, depression and psychological upheaval, which can obviously be very detrimental for restful sleep.
Knowing what’s happening with our hormones during this time is important to help with understanding symptoms (such as sleeplessness, among many others). As we enter perimenopause, our hormone levels can fluctuate pretty wildly, and toward the last couple of years of this phase, our estrogen levels begin to reduce sharply. By the time we are in menopause, our estrogen production is only about 1/10th what it was before. I’m focused on estrogen here because it plays such an important role in our feelings of well-being. It is estrogen, in part, that helps to stimulate serotonin production, and serotonin, also known as the body’s “feel-good” chemical, works to regulate mood, social behavior, memory and sexual desire, and importantly here, is also thought to influence sleep. So when estrogen levels are low, serotonin levels are impacted, which can impact so many of the functions that make us feel human, leading to increased anxiety and depression, and in turn, more sleepless nights.
Additionally, melatonin (aka, the sleep hormone) serum levels also decrease as we age, and this may also play a role in decreased sleep quality.
While this sounds like a lot, I think it’s incredibly important to understand that this it’s all a normal part of the aging process, and there are ways to manage and mitigate the discomfort of the transition, and to get more and better sleep. Many women start to feel like they are going crazy during this time, and sleep deprivation can compound this feeling by multitudes. This is why we have to talk about these issues more openly, because the more we talk about it, the less we have to suffer. Menopause and the surrounding issues are still a bit taboo in this country, although fortunately, I think that is starting to change. So let’s keep talking, continuing below with some strategies to combat sleeplessness.
How to Sleep Better- Tips and Tricks
We talked earlier about some strategies to address night sweats, but I’ll repeat them here and add some other tips for a more restful night’s sleep.
ADDRESS NIGHT SWEATS:
Sleep in a cool room (I set my thermostat to 68 degrees at night), and keep a small fan on your nightstand (this has saved me many a night!)
Wear loose cotton clothes to sleep, and sleep on breathable cotton sheets
Keep a journal to figure out your hot flash triggers (such as alcohol, spicy foods, etc.) so you can avoid
Keep a glass of cold water next to your bed (insulated cups keep it cool!)
DON’T FIGHT THE MELATONIN!
Melatonin is the hormone that helps regulate our sleep/wake cycle, and our levels of this hormone rise in the evening to help prepare us for sleep, and drop in the early morning hours to prepare us to wake.
Make your room as dark as possible, and use a sleep mask to help the cause if necessary. I love this one and wear it every night. It’s silk, which has properties that can benefit the gentle skin around your eyes as an added bonus!
Limit blue light exposure before bedtime. Sources of blue light include televisions, smartphones, tablets, light bulbs (fluorescent and LED) and computer monitors. Blue light can seriously mess with your body’s ability to produce melatonin, so try avoid or limit exposure in the 2-3 hours before you go to sleep. I have a hard time with this one as I like to read at night, so I use readers that block blue light- I am currently loving these, but there are many widely available options out there that offer this protection.
TARGETED SUPPLEMENTS /AROMATHERAPY
Studies have shown certain supplements can help with quality and quantity of sleep. Below are some of the things I take, but as always, speak with a health care provider before incorporating supplements into your routine.
Magnesium Glycinate- Some people refer to magnesium as nature’s chill pill, and it’s been a real game-changer for me. It works to activate the parasympathetic nervous system, which is the system that helps to keep you calm. It also helps to regulate melatonin production. There are various forms of magnesium, but glycinate is said to be the best absorbed and the most gentle on the stomach. I take 250 mg before bed.
Melatonin- the sleep hormone is widely available, and comes in 1-10 mg doses. While you might think more the better, that is not the case with melatonin. Research suggest that lower doses are more effective, in the range of 0.5 to 3mg.
Zinc- An essential micro-nutrient, zinc has been shown to help regulate sleep. Research has shown that having adequate levels of zinc in the blood can shorten the time it takes to fall asleep and help you get more and better quality sleep. I take one 20mg zinc glycinate pill nightly before bed.
Lavender Aromatherapy- Some studies have shown that lavender can help to promote sleep and relieve anxiety. One easy way to try it is via a beautiful diffuser like this one.
The suggestions listed here are not meant to be exhaustive, and while I always prefer taking a natural, holistic approach wherever possible, there are times when medical intervention may be necessary and more effective for some women. Hormone replacement therapy (HRT) can be helpful in addressing severe symptoms. There is controversy about HRT and safety, and there are some conflicting studies out there, so before deciding to take it’s important to do the research and ask a lot of questions to see if it is right for you. Some doctors will also prescribe low-dose birth control pills to help women through the perimenopausal phase. There are also pharmaceuticals such as anti-anxiety meds and anti-depressants that can make a big difference for those who are suffering. This is where it becomes very important to have a doctor that you feel comfortable with and trust, and one who is knowledgeable about these issues. Unfortunately, doctors do not receive much in the way of menopause training in medical school, so it can be helpful to seek out a practitioner who specializes in the area. You can search for a provider on the North American Menopause Society web page to find a doctor near you.
Getting quality sleep can be a real challenge during midlife, but knowledge is power, and understanding your body and the natural changes occurring during perimenopause and menopause can help you to address the issues and wake up feeling rested and ready to take on another day!