Dr Barton shares her top tips on how to get better sleep during perimenopause and menopause

Our resident women's health and menopause expert, Dr Fionnuala Barton delves into the reasons behind these sleep disruptions and offers practical strategies to reclaim restful nights.

“Let her sleep – for when she wakes, she will shake the world” – Napoleon Bonaparte 

I often talk about Sleep as being one of the 4 Pillars of health and wellbeing in perimenopause and menopause, but I would argue that it is a priority regardless of gender, age or stage of life. Sleep difficulties are common across the population but are particularly prevalent in perimenopausal and post-menopausal women. The impact on which is far too often underestimated. Good quality sleep plays a pivotal role in our physical, cognitive, emotional health and thus overall health and well-being, and its significance becomes even more pronounced during this life stage.
In a workplace survey undertaken by The Fawcett Society 84% of women struggled with sleep making it the most reported difficulty amongst perimenopausal and menopausal women. This was very closely followed by brain fog, which can of course be impacted further by poor sleep.

So, in order for perimenopausal and menopausal women to wake up and “shake the world” we need to find solutions to the problem of poor sleep. To find the solutions, it is helpful to think about the “why”. 

Normal female sex-hormones oestrogen, testosterone and progesterone directly influence the parts of the brain responsible for initiation and maintenance of sleep as well as indirectly influence other hormone and neurotransmitter systems and the maintenance of normal “circadian rhythm”. Thus, when levels of these important hormones are fluctuant or insufficient problems manifest in several ways. 
Without sufficient melatonin we can lack sufficient “sleep pressure” to get off to sleep with ease. With serotonin, noradrenaline, adrenalin, cortisol, and dopamine off-balance we can experience more extreme emotions and anxiety, our perception of fear and threat changes and the integration and processing of inputs can be impaired making it harder to switch off and remain switched off throughout the night. 

We may find ourselves in a hyper-vigilant state where we are only able to access shallow sleep and thus wake more easily to external stimuli such as the snoring partner, physical aches and pains, the need to pass urine or the neighbourhood foxes squabbling in the street. This is an important evolutionary advantage that many women develop if they become mothers. 

Our cardiovascular system is more reactive and internal thermostat less refined making it more likely we might wake in the middle of the night with hot flushes, drenching sweats and even palpitations. Many women experience panic attacks that wake them from troubling dreams. 

Our ability to move reliably through the normal cycles of sleep is less reliable and as a result we may access less of the deep restorative sleep that is so important. Many people consider sleep to be a rather uneventful and inactive part of the day, but on the contrary, our bodies are working hard to maintain our metabolic, emotional, cognitive, and physical health when we sleep: provided we get enough of the good quality stuff.

Metabolic Health

One of the key concerns during perimenopause and menopause is the potential for weight gain and shifts in metabolism. Sleep deprivation can exacerbate these issues because when the body doesn't get sufficient rest, it can lead to hormonal imbalances, particularly in insulin and cortisol. These imbalances contribute to increased fat storage, insulin resistance, and heightened stress levels. Ensuring a good night's sleep becomes crucial in maintaining a healthy metabolic balance, supporting weight management, and reducing the risk of metabolic disorders like Type 2 Diabetes.

Cognitive Health

Short term memory issues, difficulty with verbal recall, focus and concentration are common complaints during perimenopause and menopause leading to a general lack of clarity and “fog”. Sleep plays a vital role in cognitive processing, including memory consolidation and problem-solving skills and thus promote sharper cognitive abilities. 

Psychological Health

Circadian Rhythm

The body's internal clock, known as the circadian rhythm, regulates sleep-wake cycles, hormone production, and various physiological processes. Disruptions to this rhythm can exacerbate symptoms of perimenopause and menopause. It can feel like being jet-lagged every day. Creating a consistent sleep schedule helps regulate the circadian rhythm which in turn, can alleviate some of the other challenges we face and contribute to a smoother transition.

What are the solutions?

Limit Screen Time

Avoid Alcohol:

While it may seem like a nightcap is a good way to unwind, alcohol can disrupt sleep patterns and contribute to night sweats and palpitations. Limit alcohol consumption, especially in the hours leading up to bedtime, drink plenty of water before to reduce blood alcohol concentrations and support prompt liver processing. Keeping a symptom diary can help identify if alcohol consumption is part of your sleep difficulties and if so can be a powerful tool to motivate reducing intake or even abstaining. Consider your relationship with alcohol and consider a trial of 2-4 weeks without it to monitor how much better your sleep can be. 

Moderate Caffeine

Caffeine is a potent stimulant that blocks the effect of melatonin in the body. It has a long half life so sticks around for several hours after consumption: even 6hrs after consumption caffeine can reduce quality sleep by an hour. So, diarise your caffeine intake and timing and aim to stop drinking caffeine 6-8 hrs before your intending sleep time. It is also a potent diuretic (it promotes urine production) so capping caffeine at lunchtime may also avoid the need to wake to pass urine in the middle of the night!

Keep the Room Cool

Reducing your core body temperature and maintaining a cooler ambient temperature in the bedroom can help reduce the intensity of nocturnal flushes and sweats. Consider taking a hot bath or shower before bed to reduce core body temperature and aim for around 16 degrees in the bedroom with breathable clothing and bedding and a fan to enhance comfort. Consider the materials that your mattress and duvet are made from as these may contribute to temperature dysregulation also.

Practice Mindfulness and Meditation

Both can be powerful tools for managing stress and promoting relaxation if you are able to find the time, space and motivation for them. It does not need to be arduous or prolonged. Start by taking just a few moments of purposeful pause to reflect inward, deepen and slow your breathing, foster positive thoughts and practise gratitude. Consider thinking of 1 thing that you have achieved, 1 thing that has had a positive impact on you and 1 thing you are grateful for. There are so many examples of these to consider and incorporate into your bedtime routine to calm the mind and signal to your body that it's time to wind down. 

Journalling

You can even take this one step further and write things down before bed to “empty” busy thoughts and big feelings to provide a sense of closure before attempting to sleep. 

You are not alone. Seek Help

If you are finding sleep difficult, I invite you to get curious and explore some of these strategies. They can be effective alone, in combination with each other and alongside lifestyle optimisation. Seeking relief from sleep difficulties can be unrelenting, exhausting and progressively more stressful over time, but starting somewhere and building on this at whatever pace is possible, can foster a sense of empowerment. If it is all too complex and overwhelming, please speak to a healthcare professional for a detailed assessment and individual plan.