Menopause and Sleep Problems
Updated: 1 day ago
My Sleep Story
I started having sleep issues during perimenopause, about two years prior to menopause. I wasn’t too concerned about it in the beginning. I would just wake up around 5:00 AM feeling a little warm and have a hard time getting back to sleep. It wasn’t until I was actually in menopause that the sleep issues started to get severe. I would wake up in a sweat, radiating off my body. Heat coming from my back would heat up the bed and I would toss and turn, trying to find relief from the heat under me.
Sometimes, I would wake up every few hours. Other times, I was awake practically the whole night. I tried various supplements. Some would work for a while and then suddenly stop, or they would work but then have other unpleasant side effects, like waking up groggy or having nightmares. And I would be back to the drawing board, searching for a new remedy.
I did a lot of research. I wanted to know why I was waking up and how to prevent insomnia. I was constantly researching new ideas and connections between different body systems. Finally, after much research and experimentation, things started to improve. I began sleeping through the night again.
The annoying things is that so many sources were implying that insomnia during menopause is a mostly mental thing. I really felt like I was reading information from a hundred years ago when doctors believed in “hysteria” and that most of women’s problems were in our heads. For example, one site suggested drinking chamomile tea and limiting caffeine. Um, yeah. That doesn’t work. Another site suggested not to worry that good sleep would return after menopause was over. What?! I couldn’t wait that long. Menopause can last up to ten years! I needed real relief and I wanted to know what was actually causing the insomnia so I could find a cure.
I didn’t give up. I kept researching. What was it about falling hormone levels that caused so many problems? I knew the hormones estrogen and progesterone begin fluctuating in perimenopause and start falling after menopause. Apparently, estrogen regulates your body temperature and can decrease how long it takes to fall asleep, how often you wake up during the night, and increases total sleep time. Declining estrogen has been linked to hot flashes and can cause sleep-disordered breathing. Progesterone has a sedative and anti-anxiety effect and is often called a “feel-good hormone.” When progesterone levels fall, feelings of anxiety can increase, which can easily keep you up at night. And as progesterone is falling, another hormone, cortisol, may be rising.
Hot flashes started out happening just a few times a day. But, eventually it got so bad that they were almost back to back. When I lay in bed I would just toss and turn wishing for relief. I had to change to 100% cotton sheets, which helped a little. I tried a variety of supplements. What worked best for me was Black Cohosh. This herb cut the number of hot flashes down to almost none. This helped my sleep problems, but I was still waking up and sometimes unable to get back to sleep.
The Cortisol Connection
I knew that cortisol is a hormone often known as the ‘fight or flight’ or stress hormone, as it’s released when our brain senses danger. However, it’s not only a stress hormone. It also regulates your sleep-wake cycle, blood sugar levels, energy metabolism, blood pressure and more. The circadian rhythm of cortisol secretion has a waveform pattern. Usually, cortisol begins to have a rapid rise upon the first morning awakening and continues to rise for about 60 minutes. This phenomenon is called the awakening response.
The peak in cortisol is about 9 a.m. As the day continues, levels decline gradually. With the onset of sleep, cortisol continues to decline. The lowest point for cortisol occurs at about midnight. Cortisol levels start to rise approximately 2-3 hours after sleep onset and continue to rise into the early morning and early waking hours.
However, during menopause, the levels are off kilter. The hypothalamic-pituitary-adrenal (HPA) axis may be at fault. The HPA interacts with sleep in multiple ways, including cortisol release. Sleep is regulated by the HPA axis and a growing body of research suggests reciprocal associations between sleep and the activity of the HPA axis. Problems with the HPA can cause problems with sleep, and problems with sleep can also damage the HPA.
A cortisol releasing hormone (CRH) is secreted by a hypothalamic region. Dysfunctional HPA axis activity may play a role in some sleep disorders. HPA axis hyperactivity can lead to fragmentation of sleep, decreased slow-wave sleep, and shortened sleep time.
During menopause, levels of cortisol have been shown to be elevated at night-time, which can lead to increased feelings of stress and anxiety and also cause sleep disturbances. Additionally, cortisol levels spike just after a hot flash, which can leave a woman feeling ‘on alert’ during the night and can make it difficult to fall back asleep. The good news is that you can reduce menopause symptoms such as hot flashes, sleep disturbances and mood changes by balancing your cortisol levels.
One thing that works quite well is using Roman Chamomile to reduce cortisol. Chamomile has been shown to reduce cortisol and Roman soldiers were said to have used Chamomile for courage during times of war. I have used Roman Chamomile oil before bed and it helps me fall asleep. The oil is super concentrated and one drop is like having 20 cups of chamomile tea. Roman Chamomile has a beautiful scent and it can also be diffused or inhaled straight from the bottle. I rub it on my arms or wrist before bed and I start to drift off.
Another condition that bothers menopausal women is Restless Legs. Restless Legs Syndrome is characterized by mostly nocturnal, uncomfortable sensations in the legs and an urge to move them to make the disagreeable sensation disappear. I have experienced this myself. It goes something like this: I would wake up in the middle of the night feeling warm, and toss off the covers. As I lie there, waiting for my body temperature to lower, I notice an itchy sensation in my legs and the desire to stretch them out and fold them back up again. I repeat the process until I decide to get out of bed altogether.
Dopamine acts as a messenger between the brain and nervous system to help the brain regulate and co-ordinate movement. Low dopamine levels are associated with muscle spasms. Dopamine transmission in the brain and spinal cord are involved, and an iron deficiency has been shown to be involved as well. Interestingly, both iron and dopamine levels dip during the evening and night time – due to the body’s natural body clock.
Iron-deficiency may be a cause of restless legs in some people. Including red meat or an iron supplement may help. If you think you may have low iron, it's useful to get your body’s iron stores checked by your GP. Magnesium plays an important role as well. In normal muscle function, getting adequate magnesium may help calm both body and mind. Research suggests that certain cases of restless leg syndrome may be caused by a magnesium deficiency, and that magnesium supplements can reduce RLS symptoms. I can attest to Magnesium working for restless leg syndrome. I take a teaspoon of Calm brand magnesium in water and almost instantly feel my body relax and I’m able to go back to sleep.
Hormone Replacement Therapy?
Several studies have evaluated the effect of HRT on sleep, however, findings are mixed and difficult to compare, given the heterogeneity in study populations, tools to evaluate sleep, and various HT preparations (formulation, dose and type of administration). According to a recent meta-analysis, HRT modestly improves subjectively evaluated sleep disturbance. However, in most studies, improved sleep quality has co-occurred with a reduction in hot flashes and HRT has been linked to cardiovascular disease and breast cancer. Therefore, trying to reduce hot flashes might be a better option given the risks associated with HRT. The official recommendation to doctors is to weigh out the odds before prescribing HRT.
Digestion and Insomnia
As if restless legs and hot flashes aren’t bad enough, digestive issues also may accompany menopause. And digestive issues can lead to insomnia. Decreasing amounts of estrogen and progesterone during menopause can slow down the process of food passing through the GI system. When the digestive process takes longer, more water is reabsorbed back into the bloodstream, which can lead to constipation, increased gas and bloating. And digestive issues can lead to insomnia.
However, this is an easy fix. Through trial and error, I found that when I take a digestive enzyme after dinner, I tend to sleep better. For the most part, when my digestion is good, my sleep is good.
There are a lot of different causes of sleep disturbance during menopause, including hormonal changes, hot flashes, restless leg syndrome, cortisol changes, and digestive issues. However, women don't have to suffer silently until menopause is over. There are plenty of easy, natural remedies available. Below are some that have worked for me. If you have any questions about menopause and sleep, feel free to comment below or email me privately.
Somnapure is a sleep supplement that has a combination of ingredients, which all support a good night’s sleep. I’ve used it and it is effective.
Calm is a powdered Magnesium supplement, which comes in a variety of flavors.
Black Cohosh is an herbal supplement which helps reduce anxiety, hot flashes, night sweats, and improves vaginal dryness.
Roman Chamomile is used to support relaxation and lower cortisol, allowing for restful sleep.
Iron supplements support proper dopamine functioning and helps reduce the occurrence of Restless Legs Syndrome.
*This is an affiliate site, meaning that I earn a small percentage when readers purchase products from the links found here. All products mentioned are from brands that I know and trust.