Midlife Wake-Ups, Hot Flashes, and Racing Minds: Your Guide to Better Sleep in Menopause
Chances are, if you’re in your perimenopausal or menopausal years, you’ve had your fair share of sleepless nights. I know I have. And most of my clients and patients have too. Sleep is critical for hormone balance. Hormones are made when we sleep. Hormones are detoxified when we sleep. Sleep affects ALL of our hormones, so we need to prioritize a good night’s sleep.
Now I know you might be saying, “But Jill, how can I sleep when I am waking up at night with hot flashes or multiple times per night to go to the bathroom?” Not to worry. I will share some sleep tips in a short while, so hold tight for just a second.
Perimenopausal and menopausal hormone changes impact our sleep. Progesterone, in particular, is our calming hormone. Since progesterone levels begin to drop in our mid to late 30s, we tend to experience an increase in sleepless nights as we age. Low levels of estrogen and testosterone can cause insomnia and affect our bladder health, causing frequent trips to the bathroom at night, which can prevent us from getting a good night’s sleep.
So, what can we do for a better night’s sleep? Let’s start with some of the basics that, when done consistently, can have a HUGE impact on sleep.
Foundational Support for Sleep
Cut out the processed foods. Sugar-laden, nutrient-devoid foods do nothing to support our hormones or our brain health, and they tend to wreak havoc on our gut health as well. Replacing them with a more nutrient-dense diet will go a long way toward promoting a good night’s sleep.
Limit caffeine intake, and avoid caffeine after 10 a.m. Some of us are very slow caffeine metabolizers, meaning we break caffeine down slowly. So that after-lunch coffee or mid-afternoon piece of dark chocolate that may not seem to be a problem is likely still in our system when we try to hit the sheets at night. Caffeine in some women may worsen hot flashes/night sweats.
Limit fluid intake before bed. While I am a big fan of staying hydrated, too many fluids before bed means lots of trips to the bathroom. Let’s try to drink the bulk of our fluids earlier in the day.
Reduce exposure to artificial light. It only takes one tiny pulse of light to disrupt our natural serotonin-melatonin seesaw (remember melatonin helps us sleep at night?), so we need to do our best to avoid artificial light exposure within two hours before going to bed. At the very least, we should turn our digital devices’ “Night Shift” settings on so that our digital device screen reduces its blue light emissions.
Use blackout shades on windows to make the bedroom dark. A bright room tells our bodies that it is time to wake up, which is the opposite of what we want our bodies to do come nightfall. A darkened bedroom signals to our body that it is time to go to sleep (and stay asleep). I’ve found a sleep mask helpful, and you might consider one, too! We want to do our best to tune into our body’s natural internal circadian rhythm.
Cover digital devices. If we use a digital alarm clock or our phone as an alarm clock, we should toss a towel over the face of the clock/phone or, better yet, plug it in away from our bed (we put ours in the master bathroom).
Go to bed when you are tired. If we push past our natural sleep cues to get one more thing done, we often end up with a second wind, making it difficult to fall asleep. Pushing ourselves to get one more thing done is NEVER worth it in the end. It’s important to listen to our body and hit the sheets when our body starts to signal to get tired.
Don’t go to bed with a full stomach, BUT don’t go to bed starving either. Some people sleep better if they have a little something in their tummy, especially those with digestive issues or those with a tendency for hypoglycemia (low blood sugar). But most of us tend to toss and turn if we go to bed with a full belly. Eating dinner earlier in the night can make all the difference.
Create a calm, cool, relaxing, sleep-inducing bedroom. Soft, cozy bedding in soothing colors, wooden bed frames, romantic artwork, and photographs that you love can be game-changers for a comfy bedroom. Dropping the temperature in the bedroom just slightly before hitting the sheets can also be helpful. Most people sleep better and find a deeper sleep in a cool room. Consider a Chili Pad if you need more cooling or cooling sheets. What you sleep in can also help regulate your body temperature during the night and promote better slumber. Try choosing sleepwear made from cotton, bamboo, or other moisture-wicking fabrics.
Set a bedtime routine. Most of us run around like a chicken with our head cut off all day and then wonder why we can’t fall right to sleep as soon as our head hits the pillow. If our nervous system has been in overdrive for 16 hours, it’s unrealistic to assume that it can switch into low gear in a matter of minutes simply because we want it to. Remember the days when you set a bedtime routine for your child? A lavender bath, rocking in a chair, maybe a bedtime story? Bedtime routines aren’t just for babies — adult women can also benefit from some type of bedtime routine! Routines help our body to understand what is coming next. Consider perhaps a warm bath with essential oils or an Epsom salt bath, a quiet meditation, a brief journal entry, or some gentle yoga poses to help wind down before bed.
Set a waking routine. A morning routine can be just as powerful as a bedtime routine. Melatonin quickly plummets when the retina of our eyes is exposed to sunlight, and as a result, our serotonin surges, which helps us get ready for the day. When we slowly wake or slowly wander out of bed, we don’t experience that same serotonin surge, and we tend to feel sluggish throughout the morning. So, when we wake up, we need to pull the curtains back and look out at the morning sun. This will naturally tell our bodies to wake up and prepare for the day.
Go to bed earlier. The bulk of our deep, restorative sleep naturally occurs between the hours of 11 p.m. and 3 a.m., so getting to bed well before midnight allows our body to do its essential repair work critical for healthy cell function and healing.
Cut back on the booze. Alcohol tends to interrupt our rapid eye movement (REM) sleep, the part of our sleep cycle when we are in significant repair mode. Red wine, which can worsen night sweats in some women, is often the cause of nighttime waking. I get it; alcohol is a nice way to wind down at night and can often help us fall asleep. But for many of us midlife gals, especially when we have multiple drinks, our body pays the price. I’m not suggesting a life without any alcohol, but it’s essential to listen to our bodies and to cut back on that extra glass of vino, especially if we experience disrupted sleep. Sorry, my sweet friend, I am just the messenger here! ;)
Check the mattress. People tend to keep their beds far too long, so pay attention to whether the mattress itself may be to blame for a poor night’s sleep. We can’t expect to have a good night’s sleep lying on a lumpy, lopsided mattress.
Hormone replacement therapy
Hormone replacement therapy is the gold standard treatment to address “pausal” sleep issues caused by a decline in hormones. Replacing declining hormones with bioidentical hormones will help reduce pausal symptoms and provide a whole host of other protective benefits too.
Estrogen. Estrogen replacement helps address sleep maintenance insomnia (i.e., waking at 2 or 3 a.m.) and can help reduce hot flashes that interfere with sleep.
Oral Progesterone is good for sleep because it converts to a sedating neurosteroid called allopregnanolone or ALLO, which soothes the GABA receptors in the brain (GABA is our calming neurotransmitter).
Transdermal testosterone can help to improve bladder/pelvic floor issues (which means fewer trips to the bathroom) and insomnia.
Nutrients & Supplements to Support Sleep
For perimenopausal and menopausal sleep issues
Flaxseeds. Incorporate ground flaxseeds (2 TBSP) into your daily routine for added fiber and phytoestrogen benefits. Flaxseeds contain weak plant estrogens to prevent erratic estrogen fluctuations (one of the suspected causes of hot flashes).[1] Always buy organic flax seeds in their whole seed form and grind them at home in a coffee grinder, storing them in the refrigerator to prevent them from becoming rancid.
Valerian may help with insomnia during perimenopause. Valerian has been used medicinally since early Greece and Rome to treat sleeplessness, nervousness, trembling, headaches, and heart palpitations. Several studies have shown that Valerian may improve sleep quality in pausal women with insomnia.[2], [3]Unlike sleeping aids that can cause grogginess in the morning, Valerian does not appear to affect alertness or concentration the following day. Valerian can take up to one month to see a noticeable benefit, but it may be worth considering if you suffer from sleeplessness due to low estrogen. Follow the manufacturer’s instructions for dosing.
Magnesium has been shown to reduce hot flashes in some studies. Magnesium glycinate is one of the most bioavailable forms of magnesium available. If you suffer from constipation or have difficulty pooping daily, you may prefer magnesium citrate, which not only helps with sleep issues but can help get those bowels moving! The typical starting dose is about 300 mg.[4]
Vitamin E has been shown to help with symptoms of low estrogen (including night sweats/hot flashes).[5] We always want to avoid DL-alpha tocopherol, a synthetic form of Vitamin E, and instead, choose a Vitamin E that contains mixed tocopherols and tocotrienols if possible. The typical dosing is 400-800 IU per day.
Maca is one of my favorite herbs of all time for overall hormone health. It has been shown to increase estradiol in menopausal women and help with insomnia, hot flashes, and much more.[6] MacaPause by Femmenessence is my go-to Maca for menopausal women. Follow the manufacturer’s instructions.
Rhubarb has been shown to help ease menopausal symptoms.[7] Estrovera by Metagenics contains an extract of rhubarb and is used for menopausal night sweats and hot flash relief.
For trouble winding down at night or falling asleep
High nighttime cortisol (our long-term stress hormone) can cause women to have trouble winding down at night to fall asleep.
Adaptogenic herbs. The combination of Ashwagandha AND Magnesium in the evening can often help reduce cortisol levels and relax the body.
Melatonin. You might consider a melatonin supplement if you are not falling asleep because of low melatonin production at bedtime. Experts recommend starting low around 0.5 mg or so 30 minutes before bedtime and increasing as needed.
For trouble staying asleep
You might opt for a sustained-release or time-release form of melatonin, which may help sleep duration.
5-HTP. The body makes melatonin from serotonin. Serotonin is made from an amino acid called 5-HTP (5-hydroxytryptophan). Instead of taking melatonin before bed, you might opt for a 5-HTP supplement. Once taken, the body will convert 5-HTP to serotonin within just a few hours, which should help to ensure a steady and continuous supply of melatonin to get you through the night. Follow the manufacturer’s instructions for dosing.
Warning: Remember that 5-HTP is contraindicated if you take any SSRI or SNRI (or other serotonin-enhancing) antidepressant or sleep medications such as Zoloft, Trazodone, Wellbutrin, Ambien, or you may end up with a toxic surplus of serotonin.
If you have a racing mind
Remember earlier when I mentioned the calming neurotransmitter GABA? Well, its counterpart is glutamate, which is considered an excitatory neurotransmitter. For various reasons, some women have too much glutamate at night when they should have GABA.
Adaptogenic Herbs. Ashwagandha or Holy Basil before bed can be helpful (along with magnesium).
NAC. The amino acid NAC (N-acetyl cysteine) suppresses the brain’s glutamate synthesis and promotes conversion to GABA.
Amino acids. Two other amino acids — L-theanine and Taurine- have a calming effect on the brain. L-theanine is an amino acid found in green tea. Taurine is an amino acid that reduces cortisol levels and increases GABA production, a major inhibitory neurotransmitter—our bodies’ natural “off” switch.
Teas and Bedtime Elixirs that May Be Helpful
Bedtime Teas (avoid drinking before bed if you tend to wake at night to use the bathroom)
Bedtime elixirs
Essential oils for sleep and relaxation
Meditation Apps for Sleep
Other supplements that may be helpful.
References
[1] Pruthi, Sandhya, et al. “Pilot Evaluation of Flaxseed for the Management of Hot Flashes.” Journal of the Society for Integrative Oncology, vol. 05, no. 03, 2007, p. 106., doi:10.2310/7200.2007.007.
[2] Taavoni, S., et al. “Valerian/Lemon Balm Use for Sleep Disorders during Menopause.” Complementary Therapies in Clinical Practice, vol. 19, no. 4, 2013, pp. 193–196., doi:10.1016/j.ctcp.2013.07.002.
[3] Taavoni, Simin, et al. “Effect of Valerian on Sleep Quality in Postmenopausal Women.” Menopause, vol. 18, no. 9, 2011, pp. 951–955., doi:10.1097/gme.0b013e31820e9acf.
[4] Park, Haeseong, et al. “A Pilot Phase II Trial of Magnesium Supplements to Reduce Menopausal Hot Flashes in Breast Cancer Patients.” Supportive Care in Cancer, vol. 19, no. 6, 2011, pp. 859–863., doi:10.1007/s00520-011-1099-7.
[5] Ziaei, S., et al. “The Effect of Vitamin E on Hot Flashes in Menopausal Women.” Gynecologic and Obstetric Investigation, vol. 64, no. 4, 2007, pp. 204–207., doi:10.1159/000106491.
[6] Depypere, Herman T., and Frank H. Comhaire. “Herbal Preparations for the Menopause: Beyond Isoflavones and Black Cohosh.” Maturitas, vol. 77, no. 2, 2014, pp. 191–194., doi:10.1016/j.maturitas.2013.11.001.
[7] Dietz, Birgit M., et al. “Botanicals and Their Bioactive Phytochemicals for Women’s Health.” Pharmacological Reviews, vol. 68, no. 4, 2016, pp. 1026–1073., doi:10.1124/pr.115.010843.