Why Menopause Disrupts Your Sleep

Understanding How Sleep Changes During Menopause

Menopause, simply put, is the end of a woman's menstrual cycle. But underneath this simple concept is a rollercoaster of hormonal changes accompanied by a host of symptoms.

The average age of menopause is 50–51, but first symptoms might start as early as our 30s.

Every woman's experience with menopause is unique. While some may sail through it with minimal disruptions, others might find it more challenging.

Over the years working as an OBGYN, I've journeyed with countless women through this stage of life. It can look different for each of them, but most women have one thing in common: sleep disruption.

One of my patients in the Menopause clinic summarized it well. She recounted her nights as if she were a "jumping Mexican bean," thanks to the hot flashes. She was having trouble falling and staying asleep. Her anxiety got so bad that sometimes she woke up feeling "like a black dog was sitting on her chest". Even when she managed to get more hours of sleep, she still woke up feeling tired.

If you or your friends have ever experienced something similar, you will understand the gravity of the situation.

It's not just about counting sheep. It's about the domino effect sleep disruptions have on every facet of life, from mood to health to productivity.

But before we jump into solutions, let's first understand why menopause affects our sleep. Understanding is the first step to healing.

Why is getting enough sleep important?

"A good laugh and a long sleep are the two best cures for anything." — Irish Proverb.

How many times have you sacrificed sleep only to find yourself sluggish the next day?

It's a familiar tale: the decreased energy, the insatiable appetite, the wavering commitment to fitness. Sleep, however, is more than a mere time of rest. It's a central part of our overall health.

In my clinical practice today, discussions about sleep form a cornerstone of most consultations. And here's why:

1. Cognitive Wellness

Adequate sleep is pivotal for our brain's optimal functioning. It sharpens memory and enhances problem-solving capabilities. On the other hand, sleep deprivation can blur attention, alertness, and concentration, leading to reduced cognitive efficiency. Even our fine motor skills are affected.

Diminished attention can elevate the risk of accidents — be it while driving or even simple household chores.

A lack of sleep is also a known risk factor for developing Alzheimer's disease and dementia.

2. Immunity's Gatekeeper

A regular sleep cycle ensures optimal immune function. There's a reason you're more susceptible to colds after pulling consecutive all-nighters. But even less than seven hours of sleep affects your immunity significantly. A rested body equips you to fight viruses and many other threats more effectively.

3. Balancing the Scales

Sleep plays a crucial role in regulating appetite. Ghrelin (the hunger hormone) increases with sleep deprivation, which causes those late-night cravings. Sleep also improves insulin sensitivity and stabilizes blood sugar levels, which reduces your risk of diabetes.

4. Heart Health

Our heart and vessels undergo repair and maintenance during sleep. Regular disruption of this can lead to long-term cardiovascular issues. Chronic sleep deprivation is linked to various health complications: heart diseases, high blood pressure, and diabetes, to name a few.

Did you know that turning the clocks back by one hour in spring increases the events of heart attacks by 24% the next day? And that is just one hour of lost sleep.

Given that heart disease is the number one cause of death for both men and women, sleep should be our top priority for good health.

5. Mood and Stress

Brain changes during sleep are crucial for mood stabilization and memory consolidation. No wonder brain fog and mood swings are other common symptoms of menopause.

Lack of sleep can also spike cortisol levels, the stress hormone, making us more irritable and prone to other health conditions.

6. Libido

Hormones are not the only thing that affects our desire and intimacy. Consistently poor sleep is considered a risk factor for sexual dysfunction.

This study found that longer sleep duration predicted better next-day sexual desire and arousal in women. Additionally, each extra hour of sleep increased the likelihood of sexual activity with a partner by 14%, independent from other factors. And we are less likely to be 'in the mood' if we're always tired.

7. Longevity

This study performed a systematic review and meta-analysis on sleep duration and all-cause mortality. They found both short and long duration of sleep were associated with various health issues and a greater risk of death.

Other factors can also play a role, and the relationship between sleep and health is complex.

But in essence, sleep is not just about recharging for the day ahead. It's about clear minds, long-term health and happy relationships.

So what is a good sleep?

For many women, especially those between 26 and 64 years of age, the National Sleep Foundation recommends an ideal duration of seven to nine hours.

However, sleep isn't a one-size-fits-all affair.

Genetics, daily activities, personal health, and age shape our unique sleep profiles. And while duration is essential, the quality of sleep — its depth and consistency — plays a pivotal role, too.

The statistics from the Centers for Disease Control and Prevention (CDC) are alarming: about half of postmenopausal women sleep less than seven hours daily.

I often hear from patients who believe they can thrive on just five or six hours of sleep. It's like the body getting used to carrying a heavy backpack daily; the weight is unhealthy, even if we feel adapted to it.

Finding that 7 to 9-hour sweet spot, adjusted for individual needs, is key. While age does influence our sleep patterns, it shouldn't dictate our sleep quality.

How does menopause affect sleep?

So, what exactly happens to our sleep when menopause sets the stage?

Multiple factors come into play, from the predictable hormonal roller coaster to the often overlooked aspects like circadian rhythm shifts, mood disorders, existing health conditions, and even our daily life choices.

1. Hormonal Disruption

When it comes to understanding sleep disturbances during menopause, hormones play a key role.

"Hormones are like a symphony; everything needs to be in balance for the music to sound just right." — Dr. Christiane Northrup.

The decline in estrogen and progesterone, both pivotal for sleep, can directly impact sleep quality.

Progesterone, a natural sleep promoter, drops during menopause. Lower levels can make falling and staying asleep more challenging. It's also crucial for our breathing function and can cause worsening issues such as sleep apnea.

Estrogen, on the other hand, helps maintain the architecture of sleep. Its decline can lead to more frequent awakenings. Another significant function of estrogen is ensuring our body remains cool at night, which is essential for uninterrupted sleep. It's also a key player in serotonin regulation, a neurotransmitter responsible for our mood.

So, as estrogen wanes, we are left with night sweats, heat sensitivity, insomnia, mood swings and sometimes even unsettling dreams.

2. Mood Disturbances

Menopause can come with mood swings, anxiety, and even depressive episodes for some. These emotional shifts can hamper the ability to fall or stay asleep. Moreover, the ongoing lack of sleep can further intensify these mood disturbances, creating a vicious cycle.

3. Changes in Circadian Rhythms

As we age, alterations in our circadian rhythms can lead to earlier sleep and wake times. This shift might clash with lifestyle habits established over decades, leading to bedtime restlessness and early morning awakenings. Notably, as we age, there is a natural drop in melatonin, the body's sleep-inducing hormone, further adding to sleep disturbances.

4. Underlying Health Conditions

As we get older, our health conditions may worsen, or new ones may arise. Often, multiple medications are necessary to manage these conditions, and they can disrupt sleep on their own.

5. Lifestyle and Habits

Alcohol, caffeine, and certain habits can exacerbate sleep issues. Though a glass of wine might feel like it's aiding in relaxation, alcohol interferes with the deep stages of sleep. Additionally, life's myriad challenges — like adapting to a suddenly silent home when kids leave or caring for ageing parents — can add weight to a restful night.

Common Sleep Challenges During Menopause

As you can see, for many women, the menopausal transition isn't silent at night.

The five most common sleep disruptions during menopause are these:

1. Sleep Issues Due To Physical Symptoms

Research in the American Journal of Epidemiology estimates that around 80% of women suffer from hot flashes and night sweats. They disrupt sleep by causing sudden wakefulness, often accompanied by heavy sweating.

In addition, a decrease in estrogen levels can cause dryness and irritation in the vagina and bladder, resulting in more frequent nighttime urination.

On top of that, muscle and joint pains commonly experienced during menopause can also disturb your sleep.

2. Challenges in Initiating Sleep

The onset of sleep, once an effortless transition for many, can become elusive during menopause. This is mainly due to decreased melatonin and progesterone levels, both of which facilitate our sleep.

3. Struggle in Maintaining Sleep

It's not just the act of falling asleep but sustaining it that becomes an ordeal for some. Recurrent awakenings result in fragmented, non-restorative sleep. Factors like declining estrogen levels and increased stress or anxiety are usually responsible for these nocturnal disruptions.

4. Sleep Apnea

While menopause doesn't directly instigate sleep apnea, it can worsen its symptoms. Obstructive sleep apnea presents differently in women, making it challenging to diagnose.

The symptoms may not always align with the typical heavy snoring but instead show up as frequent night awakenings, daytime fatigue, or mood disturbances. That's why women are less likely to seek assessment for sleep apnea, and doctors are less likely to recognize it as a possibility.

The ramifications of sleep apnea go beyond just disrupted sleep. It can increase the risk of cardiovascular disease, type 2 diabetes and even cancer.

5. Insomnia

While occasional sleep disturbances are expected during menopause, chronic insomnia stands apart in its intensity and persistence.

Insomnia is defined by consistent sleep challenges lasting over three months and occurring multiple times a week. Disrupted sleep that leads to insomnia followed by depression is a common "domino effect" noted in various scientific articles.

True insomnia requires specialized attention and intervention, as it can lead not only to depression but also other health issues.

Sleep is complicated

Sleep isn't just about resting our eyes. It's a complex, essential process that significantly influences our health.

Understanding why our sleep changes during menopause gives us a sense of power and control. It's like getting the remote control back when life's TV seems to be playing its own shows.

Remember the lady I talked about at the start? After our consultation, she returned four months later, telling me she was sleeping well and feeling great. The magic of knowing what's happening makes it easier to implement the needed lifestyle changes.

So, stick around for part two of this article. We dive deep into the practical tips for better sleep I discuss in my clinic and how to conquer your 'black dog' of sleepless nights.

With knowledge and the right strategies, peaceful nights are within reach, regardless of age.

Get ready to move from knowing to doing. Sleep can be complicated but as one of the most famous sleep scientists Matthew Walker, PhD simply put it is "the greatest healthcare insurance policy that's freely available to society".

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