top of page

Your Sleep on Perimenopause

I thought I was tired because I had a toddler who was (is) still waking up frequently at night


I thought it was all in my head.

perimenopause and sleep
restorative yoga for perimenopause

My doctors did too.


Three o'clock and I were forming a bond. A toxic bond. A bond that was impacting my quality of life, my productivity, and my relationships.


But it wasn't in my head. And it's not in yours either.


Sleep disturbances are just ONE of 34 (YES, thirty-four) symptoms that can occur during perimenopause.

Current research shows that up to 60% of perimenopausal women will experience sleep disturbances, with the primary being nighttime or early morning waking or trouble falling asleep (insomnia). Sleep-disordered breathing and sleep disturbances from other medical concerns may also be experienced in higher ratios in this population (1).


Although there is no perimenopausal sleep disorder there are a variety of reasons sleep issues are thought to occur during this period of our lives such as changing hormones, vasomotor symptoms, depression, restless leg syndrome, and a variety of other medical problems and psychosocial factors.


While this short blog cannot possibly cover these topics in depth, I hope to help you understand what is occurring in the body during this period so that you can begin to grasp why and hopefully gain some insight into treatment options.


SO, WHY IS MY SLEEP SO MESSED UP DURING PERIMENOPAUSE?


HORMONE FLUCTUATIONS & THEIR EFFECT ON SLEEP

The changing hormones in a woman's body are thought to be the primary effectors of sleep, primarily progesterone and estrogen, both of which decline during these years.


Progesterone has a profound and straightforward effect on sleep it acts on GABA receptors, possesses a natural soothing quality, and has been used as a respiratory stimulant to treat mild obstructive sleep apnea so when it declines falling and staying asleep also becomes an issue (2).


Estrogen's effect on sleep is not as straightforward as progesterone's but it is no less important. Hot flashes occur when estrogen levels are low due to its impact on body temperature and core temperature during sleep. Estrogen increases the REM cycle and is involved in neurotransmitter metabolism that modulates sleep (norepinephrine, serotonin, and acetylcholine) and has also been shown to decrease night awakenings, increase total sleep time, decrease the number of sleep arousals, and decrease the trouble falling asleep; therefore a major factor in overall sleep quality (2).


Increased cortisol (via estrogen's effects), decreased melatonin, and testosterone changes have all been shown to affect sleep in perimenopausal women although, more research is necessary to understand their overall role.


VASOMOTOR SYMPTOMS

Vasomotor symptoms are another term for the hot flashes and sweating that can occur at any time of day and affect up to 80% of women during perimenopause (3). These symptoms are thought to occur due to a disruption in temperature regulation by the hypothalamus due to a decrease in estrogen. Vasomotor symptoms are a primary causative factor in perimenopausal sleep disorders however not all women who experience perimenopausal sleep disruptions blame or contribute this to hot flashes (3).


DEPRESSION

Research shows that perimenopausal and early post-menopausal women are two to four times more likely to develop a major depressive disorder, independently of other factors, primarily due to the decrease in estrogen. It has also been shown that women who have developed mood disorders during other reproductive transitions (e.g. premenstrual or postpartum periods) are more likely to develop menopausal mood disorders. These depressive symptoms have been directly linked to sleep disturbances. Additionally, in a longitudinal analysis, it was found that the presence of sleep problems at baseline significantly predicted major depressive disorders upon follow-up.(4-10).


OTHER MEDICAL CONDITIONS

Sleep-disordered breathing (e.g. sleep apnea), restless leg, medical conditions that increase in incidence with age, and demographics and psychosocial factors (e.g. the thought of aging, midlife stressors, and other health issues) in the menopause transition years have also been looked at and proposed to contribute to sleep disorders however, more research is needed to establish understanding and overall incidence and mechanism (11).


In summary, the primary cause of disordered perimenopausal sleep is due to hormonal changes that then affect other sleep mechanisms, depression due to changing hormones, other medical conditions that occur with increased age, or a combination thereof.


SO, WHAT ARE OUR TREATMENT OPTIONS?


MEDICATIONS & SUPPLEMENTS

There are a variety of treatment options ranging from prescription to over-the-counter to lifestyle factor changes. While it should not be your job to understand all the treatment options in-depth, it's always best to understand the basics. For more understanding of Menopause Hormone Replacement Therapy (MHT/HRT), I suggest reading Dr. Jen Gunter's Vajenda Substack HERE.


Prescription options for sleep disruptions:

Hormone replacement therapy consists primarily of estrogen (estradiol), progesterone (Prometrium), and in some cases testosterone. Estrogen can lessen the factors contributing to sleep loss (hot flashes and night sweats) and progesterone can promote sleepiness when taken before bed due to its natural calming, sleepy properties. Both estrogen and progesterone come in a variety of delivery options including oral, transdermal (patch worn on skin), creams (vaginal and topical), sprays, implants, injections, and rings and your doctor will likely prescribe a combination dependent on your symptoms.


Other prescription medications consist of anti-depressant and anti-anxiety medications or prescription sleep medications.


Supplements for sleep disruption:

It should be said, that many supplements lack well-balanced and ample data to support their claims and they are not regulated by the FDA, meaning their labels may not accurately reflect their ingredients. Furthermore, of the scientific research available for many OTC supplements, the evidence is fairly limited and usually inconsistent. Please note, that I do not condone or promote any supplemental intake- I am merely providing information based on my reading and research. This is a short list of supplements promoted for sleep but is not comprehensive by any means. Additionally, please check with your medical team before ingesting a new supplement.


  • Ashwagandha

  • Melatonin

  • Magnesium

  • B Vitamins

  • L-Theanine amino acid

  • 5-HTP

  • Valerian root

  • CBD and THC



sleep and perimenopause
yoga for perimenopause


Lifestyle factors and other non-prescription treatments

It is not uncommon to be worried about HRT or unproven supplementation so, what are our other options or first-line treatments that can help promote healthy sleep habits? A LOT.


Cognitive-behavior therapy (CBT) is a type of talk therapy that can help you deal with negative thoughts and thinking so that you can more effectively react to the stressors of life and view/respond to challenging situations more clearly. (NOTE: MINDFULNESS & MEDITATION HAVE BEEN USED AS A TOOL IN CBT WITH SUCCESS).


Other therapeutic modalities such as clinical hypnosis and acupuncture have been shown to have effectiveness in the symptoms that accompany perimenopause which could be responsible for sleep issues.


And of course, but to no surprise, focusing on healthy lifestyle factors such as exercise, limiting alcohol intake, cessation of smoking, maintaining healthy body weight, and reducing stress, the same lifestyle factors that are recommended for most other health concerns are also recommended for the management of perimenopause symptoms.


WHAT CAN WE DO FOR OURSELVES UNTIL WE FIND HELP?

I know it's hard to explain to someone not IN IT (like postpartum). You may feel like you're going crazy (you are NOT) and likely you're experiencing a lot of different symptoms and don't know where to start.


FIRST and foremost, as exhausting as it is, find someone who specializes (www.menopause.org) and will LISTEN to your symptoms. Do not be blown off. Advocate hard. You know yourself best. if you are told you're too young or only offered anxiety/anti-depressant medications seek another opinion.

SECONDLY, work on changing your mindset and attitude toward rest expectations of yourself in this stage.


The emotional symptoms (increased anxiety, depression, panic, and worry to name a few) coupled with the extreme fatigue parallel that of postpartum depression and can even be to the extreme. Some days, you may not feel like doing much or being productive. Some days your depressive symptoms may be running the show. Let's not even talk about physiological changes.


When sleep is lacking, and until you can find someone to help, rest as much as possible. If you are home, this may mean a short nap. If you are working this may mean a midday 10-minute break like some breathwork at your desk or a walk listening to a guided meditation.


The best thing I've done for myself is taking intentional rest when I feel like I need a pause- mindfulness, meditation, even a restorative pose.


Mindfulness, meditation, and breathwork, much like CBT (cognitive behavioral therapy) have been shown useful in the treatment of both mental health issues/mood disorders and sleep disorders (12-14).


If you are interested in practicing yoga or starting a meditation practice, start here! I offer a free beginner's yoga series and a meditation and restorative yoga freebie. If you are still not sure if you're in perimenopause, grab my symptom tracker and start tracking. Click any of the links below to join me.






Please know there are so many women out there in the same boat as you and you're never alone. If you have any questions or need further information, please email me lauren@lganderson.com or reach out via social media. I'm always here.


So MUCH love,

lauren






References


  1. Baker, F. C., Lampio, L., Saaresranta, T., & Polo-Kantola, P. (2018). Sleep and Sleep Disorders in the Menopausal Transition. Sleep medicine clinics, 13(3), 443–456. https://doi.org/10.1016/j.jsmc.2018.04.011

  2. Eichling, P. S., & Sahni, J. (2005). Menopause related sleep disorders. Journal of Clinical Sleep Medicine, 1(03), 291-300.

  3. Archer, D. F., Sturdee, D. W., Baber, R., de Villiers, T. J., Pines, A., Freedman, R. R., Gompel, A., Hickey, M., Hunter, M. S., Lobo, R. A., Lumsden, M. A., MacLennan, A. H., Maki, P., Palacios, S., Shah, D., Villaseca, P., & Warren, M. (2011). Menopausal hot flushes and night sweats: where are we now?. Climacteric : the journal of the International Menopause Society, 14(5), 515–528. https://doi.org/10.3109/13697137.2011.608596

  4. Bromberger, J. T., Matthews, K. A., Schott, L. L., Brockwell, S., Avis, N. E., Kravitz, H. M., Everson-Rose, S. A., Gold, E. B., Sowers, M., & Randolph, J. F., Jr (2007). Depressive symptoms during the menopausal transition: the Study of Women's Health Across the Nation (SWAN). Journal of affective disorders, 103(1-3), 267–272. https://doi.org/10.1016/j.jad.2007.01.034

  5. Bromberger, J. T., & Kravitz, H. M. (2011). Mood and menopause: findings from the Study of Women's Health Across the Nation (SWAN) over 10 years. Obstetrics and gynecology clinics of North America, 38(3), 609–625. https://doi.org/10.1016/j.ogc.2011.05.011

  6. Cohen, L. S., Soares, C. N., Vitonis, A. F., Otto, M. W., & Harlow, B. L. (2006). Risk for new onset of depression during the menopausal transition: the Harvard study of moods and cycles. Archives of general psychiatry, 63(4), 385–390. https://doi.org/10.1001/archpsyc.63.4.385

  7. Steinberg, E. M., Rubinow, D. R., Bartko, J. J., Fortinsky, P. M., Haq, N., Thompson, K., & Schmidt, P. J. (2008). A cross-sectional evaluation of perimenopausal depression. The Journal of clinical psychiatry, 69(6), 973–980. https://doi.org/10.4088/jcp.v69n0614

  8. Soares C. N. (2014). Mood disorders in midlife women: understanding the critical window and its clinical implications. Menopause (New York, N.Y.), 21(2), 198–206. https://doi.org/10.1097/GME.0000000000000193

  9. Borrow, A. P., & Cameron, N. M. (2014). Estrogenic mediation of serotonergic and neurotrophic systems: implications for female mood disorders. Progress in neuro-psychopharmacology & biological psychiatry, 54, 13–25. https://doi.org/10.1016/j.pnpbp.2014.05.009

  10. Studd J. W. (2011). A guide to the treatment of depression in women by estrogens. Climacteric : the journal of the International Menopause Society, 14(6), 637–642. https://doi.org/10.3109/13697137.2011.609285

  11. Baker, F. C., Lampio, L., Saaresranta, T., & Polo-Kantola, P. (2018). Sleep and Sleep Disorders in the Menopausal Transition. Sleep medicine clinics, 13(3), 443–456. https://doi.org/10.1016/j.jsmc.2018.04.011

  12. Gothe, N. P., Hayes, J. M., Temali, C., & Damoiseaux, J. S. (2018). Differences in Brain Structure and Function Among Yoga Practitioners and Controls. Frontiers in integrative neuroscience, 12, 26. https://doi.org/10.3389/fnint.2018.00026

  13. Niazi, A. K., & Niazi, S. K. (2011). Mindfulness-based stress reduction: a non-pharmacological approach for chronic illnesses. North American journal of medical sciences, 3(1), 20–23. https://doi.org/10.4297/najms.2011.320

  14. Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., ... & Hofmann, S. G. (2013). Mindfulness-based therapy: a comprehensive meta-analysis. Clinical psychology review, 33(6), 763-771.




Comments


Commenting has been turned off.
Let's Be Friends
  • Facebook - Grey Circle
  • Instagram - Grey Circle
  • Pinterest - Grey Circle
bottom of page