Here’s why menopause is keeping you up at night^1,2

Menopause is the point in time 12 months after your last menstrual period. Perimenopause, also known as the menopausal transition, refers to the years leading up to menopause. After menopause, women enter postmenopause. The menopausal transition usually begins between the ages of 45 – 55 and can last from between 7 – 14 years. During this time, your body’s production of the hormones oestrogen and progesterone starts to fluctuate and then decline. As these hormone levels drop, symptoms of menopause start to emerge. These symptoms include hot flushes, sleep problems (e.g. insomnia), mood changes and vaginal dryness. Your symptoms can vary in frequency, severity and duration.^1,2,3,4

If you battle with insomnia, you may^2,4:

• Have difficulty falling asleep (taking 30 minutes or more to fall asleep)
• Have difficulty staying asleep
• Wake up too early, and then struggle to get back to sleep
• Get fewer than 6 hours of sleep on three or more nights per week
• Not feel rested or refreshed after sleeping
• Feel sleepy or tired during the day
• Worry about sleep continuously

Insomnia occurs frequently in women going through the menopausal transition (perimenopause) and menopause. As women age, rates of insomnia tend to increase. According to the Study of Women’s Health Across the Nation (SWAN), sleep problems (disorders) affect 16 – 42 % of perimenopausal women and 35 – 60 % of postmenopausal women.⁵

There are multiple factors of menopause and aging that can lead to insomnia including: hormonal changes, hot flushes, night sweats, mood disorders, stress, obesity, and poor health.⁶

Progesterone is thought to have anti-anxiety (anxiolytic) and sleep-promoting (sedative) properties. Declining levels may affect non-rapid eye movement (NREM) sleep, and your breathing drive (contributing to sleep apnoea and associated sleep problems). Oestrogen seems to decrease the time you need to fall asleep and the number of awakenings. Low oestrogen levels have been found to be associated with a greater severity of awakenings. Oestrogen also plays a role in the metabolism of serotonin and other neurotransmitters that affect your sleep-wake cycle, keeps your body temperature low at night (allowing for more restful sleep) and has an antidepressant effect. With less oestrogen, you may thus experience higher body temperatures, lower quality sleep, and poorer mood.

Hot flushes emerge as oestrogen levels decline and are reported by up to 80 % of women transitioning through menopause. A hot flush is a sensation of heat and flushing around the face and neck, sweating, anxiety, rapid heartbeat and chills that can last for between 3 – 10 minutes. They can occur during the day or at night (night sweats). The presence of self-reported hot flushes is consistently associated with poorer self-reported sleep quality and chronic insomnia, indicating that women link hot flushes with night-time awakenings. During a hot flush, the rise in your adrenaline level, caused by the rapid decrease of hormones, leads to a sudden burst of energy that makes it difficult for you to fall back to sleep. Data from SWAN show that women with moderate-to-severe hot flushes (6 - 14 days in a two-week period) are almost three times more likely to report problems of frequent night-time awakenings compared to women without hot flushes.

Menopause, mood disorders, and insomnia are tightly linked. Depression represents a risk factor for poor sleep and menopausal women are at increased risk of developing a major depressive episode, especially when hot flushes are present. The ‘domino effect theory’ shows that sleep is disturbed by hot flushes or other menopause-related factors, and multiple night-time awakenings (arousals) allow intrusive anxious thoughts to permeate several times during the night (also made worse by pre-existing anxiety or depression). In turn, waking up repeatedly offers plenty of opportunities for presenting anxiety throughout the night. In addition, sleep interruption (fragmentation) may contribute to daytime mood symptoms. In this context, insomnia follows sleep disruption and depression follows insomnia within a vicious circle.

Aging is typically associated with alteration of your circadian (sleep-wake) system and a decrease in melatonin secretion. Some study data suggests that differences in circadian regulation in postmenopausal women could contribute to sleep difficulties, particularly a more fragmented sleep or early morning awakening.

Many women will experience occasional bouts of insomnia, but menopause-related insomnia can last for weeks and months if not properly treated. If you’re experiencing insomnia, you should talk with your doctor to discuss your treatment options.

• Avoid nicotine, caffeine, and alcohol, especially in the late afternoon and early evening. These substances can disrupt sleep and reduce your sleep quality.⁷
• Use the toilet before going to bed to avoid waking up early or in the middle of the night. Avoid drinking any liquids a few hours before bedtime.⁷
• Reduce your stress as much as possible. Anxious and stressful thoughts can keep you up at night, making it harder to fall asleep. Regular massage, exercise, and yoga can help lower your stress levels. If you are feeling depressed or anxious, talk to your doctor or a mental health professional.⁷
• Develop a bedtime routine that cools you down and lowers your stress. Take a bath, listen to music, or read. Try some relaxation techniques, such as meditation or deep breathing.⁷ A deep breathing exercise to help you sleep⁸
• Develop a routine for falling back asleep if you wake up from a night sweat. Aim to stay in bed with the lights off and avoid doing anything that will wake you up further, like watching TV. Keep a change of clothes on your nightstand, or a glass of cool water to drink.⁷
• Dress in lightweight pyjamas to stay cool at night or sleep naked. Moisture-wicking exercise clothes are another good option. Likewise, swap out your bedding for cooler fabrics made from natural fibres like cotton.⁷
• Keep your bedroom temperature comfortably cool. Lower your bedroom thermostat to around 18 oC. Keep the air conditioning on at night or place a fan next to your bed to further cool the air and increase circulation.⁷
• Follow a regular sleep schedule, going to bed and waking up at the same time every day. Avoid napping during the day, especially for longer than 20 minutes, as that can interfere with your ability to sleep at night.⁷

Disclaimer
In preparing this article, every effort has been made to provide an objective overview. The content contained in this article contains medical or health sciences information as per cited articles for public information. The content of this article has been initiated and is brought to you by Sanofi South Africa.