Menopause and sleep
For some, this natural stage of a woman’s life heralds a new, liberating phase. For others it brings a raft of difficult symptoms, including poor sleep and insomnia.
Many women will have experienced poor sleep well before perimenopause begins: around half of us experience insomnia at some time in our lives and women are 40% more likely to have insomnia than men. 78% of women experience insomnia when pregnant, and as they listen out for waking babies, a pattern of wakefulness and light sleep can become entrenched, and then worsen into chronic insomnia as menopause approaches.
This is a sorry picture, and very familiar to us at Zeez. Fortunately, we also know what it is to sleep well, throughout the years of perimenopause, and after menopause. One of Zeez’ founders, Anna, was a dreadful insomniac from early childhood, and learnt how to sleep well for the first time, during menopause. Oh the joy!
Let’s look at how menopause can damage sleep
What is menopause?
Menopause can be summed up as a state when a woman has not menstruated in a year. Her fertile life is behind her and her ovaries are no longer producing oestrogen. In the perimenopausal period, her body is scaling down production of oestrogen and progesterone, a process that usually begins in the mid 40s but can start earlier or later and naturally last for a period from six months to a decade. It can also happen abruptly following a hysterectomy or cancer treatment. There is a unique menopause for every woman.
How does menopause affect our sleep?
Oestrogen and progesterone support a raft of functions in a woman’s body, and as levels decrease, this can affect our sleep. How? Scientists don’t have a full picture, and things are complicated by the interaction of these hormones with each other, and with melatonin and testosterone (also declining during this period) and cortisol (increasing). Before perimenopause, our hormones are fairly steadily in balance, although this changes during the menstrual cycle. Once perimenopause starts, they can yoyo erratically, and we feel the impact in hot flashes, night sweats, mood swings, depression, anxiety, brain fog and sleep disturbance. Let’s look at some of the changes to our hormones during this time.
Hormones
The drop in oestrogen is linked with a reduction in REM sleep, during which we process emotions, store memories and learn. It increase the time it takes us to fall asleep, nighttime wakefulness, decreases time asleep, and impairs body temperature regulation. Hot flushes are a common signal of low oestrogen. Blood rushes to the skin’s surface, bringing the menopausal glow or – more irritatingly - a need to open a window or get outdoors quick. Hot flushes while you’re sleeping can become full-on night sweats. Hardly conducive to restful slumber. Changes in oestrogen may also contribute to the increased depression experienced by perimenopausal women.
The drop in our progesterone can make us feel less sleepy and impair sleep quality and breathing. (This time of our life is risky for the development of sleep apnoea). Along with oestrogen, it contributes to headaches, migraines and skin thinning, including vaginal thinning. Not only can this destroy the pleasure of sex, it also affects the urinary tract, bringing the increased urge to urinate. An apparently full bladder will wake you and traipsing to the loo in the night is a common contributor to poor sleep.
As for reduction in melatonin, that affects our circadian clocks, so that we may be less inclined to sleep and get up at the times which are good for our body, as well as affecting our immune system and our ability to handle inflammation.
And as if this wasn’t enough, our night time rise in cortisol can leave us anxious and panicky. Cortisol is the alertness hormone. Have you noticed how problems seem worse at four in the morning, when you wake suddenly? Cortisol raises the pulse and activates another network of hormones known as the hypothalamic–pituitary–adrenal (HPA) axis. The HPA is a deep rabbit hole to dive down, beyond the scope of this piece, but essentially, it is a network of neurotransmitters connected to mood, mental health, appetite, and sleep. Too much cortisol can affect its delicate balance.
What can we do?
Writing this, I feel really sorry for us, as women. It is an outrage that until recently the effects of menopause were ignored in workplaces. And a shame that employers haven’t understood how tough this can be, and have lost employees who needed flexibility whilst coping with menopausal symptoms. It is also sad that health issues that are particular to women tend to be understudied. As I write this, Nicola Bulley‘s body has just been recovered from the river Wyre. The experience of press coverage of her struggles has shocked many people. Her family said “ Due to the perimenopause Nikki suffered with significant side effects such as brain fog, restless sleep and was taking HRT to help but this was giving her intense headaches”. Could we know more about the menopause and what might alleviate symptoms? Shouldn’t we try?
Before considering what might help, I think it is important to appreciate that the effects of menopause are far from universal. Some people have no adverse symptoms. I didn’t have a single hot flash, nightsweat, or migraine. There are great differences in women’s experiences in different cultures. American and British women experience the worst symptoms, and the Japanese have such an easy time that there is no translation for “hot flash”. The few studies that have been done show that stress worsens symptoms, but otherwise the reasons for difference are unclear. Most commentators attribute differences to cultural attitudes towards ageing, but I suspect that diet plays a large part.
There are safe and simple additions that can be made to our diet and lifestyle which are not prohibitively expensive. With the onset of peri-menopause, we need higher levels of nutrients than before, since our ability to absorb nutrients is affected by the changes to the body.
Vitamins B6 and B12 may help ward off menopausal depression by boosting serotonin, the mood enhancer hormone. B vitamins may also help with insomnia by calming down the hot flushes. Zeez users will already know how beneficial a breakfast containing tryptophan (e.g. eggs) can be in boosting serotonin.
Magnesium helps relax muscles and promotes a more restorative sleep, while also balancing blood sugar levels. Click here to read our article on ‘good’ magnesium.
Calcium levels may drop during perimenopause and affect bone density. This is quite likely to be caused by a vitamin D deficiency or low magnesium rather than by a low intake of calcium. We need Vitamin D and magnesium to absorb calcium and most of us are very low in these, whereas calcium itself tends to be plentiful in a western diet.
Omega 3 is found in oily fish, grass-fed meat, eggs, olive oil, nuts, seeds, avocado, organic butter, ghee or coconut oil. Tests have shown that taking omega 3 decreases the frequency of hot flushes and the severity of night sweats.
Studies have shown that foods high in the amino acid glycine (found in milk and cheese, beans, legumes and tofu) can aid deep sleep for menopausal women.
You will find suggestions for good well-priced brands here.
Meanwhile, love your gut! An out of balance gut microbiome can result in oestrogen being reabsorbed. The gut is also responsible for making and managing neurotransmitters such as serotonin, dopamine and melatonin, all of which influence mood and sleep.
If you are suffering from menopause - linked poor sleep, remember that alcohol affects our REM sleep. If struggling, I would avoid alcohol in the evening and confine nicotine and caffeine to the morning. All of these raise the ‘flight or fight’ state that can get between us and a good sleep.
Using Zeez tech to help with menopause-linked poor sleep
Some people imagine that the Zeez help during perimenopause and menopause because problems are hormonal. Nor so. Zeez users range from teenagers to people in their 90s with an almost even gender split. Lots of young men. And perimenopausal and menopausal women are our biggest user group. We help them to fall asleep, stay asleep, and wake up rested, with far fewer trips to the loo. We help them to relax, so that their cortisol reduces. By helping such women to sleep, we help balance hormones so that they are likely to wake up with energy at 7 or 8 am (high morning cortisol) rather than at 4 am with relentless, raging worries. When people respond to the Zeez, deep sleep and REM sleep increase. Quite often, Zeez users dream more intensely, as they catch up on REM sleep. It can take more time for perimenopausal and menopausal women to respond to the Zeez, and sometimes they need additions to their diet and changes to lifestyle. I haven’t counted, but I suspect that fewer menopausal women have an instant response to the Zeez. Not surprising, given the complexity of our hormones at this time. How does this help? Our users have found that anxiety dissolves, they are able to go back to work, to return to jobs they enjoy, having recovered energy as sleep returns. They have new pleasure in their children and grandchildren, more energy to do what they love and be who they are meant to be. It can be wonderful to witness.
How much can the Zeez help alleviate menopause symptoms? It is clear that peri-menopausal and menopausal women can do well with the Zeez, even if it takes a little more work. Our users have much better sleep, massively reduced anxiety, more energy, and less pain. We would like to do more trials but do get lots of feedback from our users. Perimenopausal and menopausal women are likely to need MORE nutrients, MORE daylight and MORE sunshine than they needed pre menopause to live their best life.
Zeez can’t take the menopause away, but relaxation and good sleep make us far more resilient to the effects of changing hormones.
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Our users say:
“After years of poor sleep that got worse due to perimenopause, I was desperate. Already doing everything I could…Good sleep hygiene, no tech in the bedroom, getting light in the morning, exercising, eating well …I felt like there was nowhere for me to turn. I decided to try the Zeez. It IS the answer!
I always get to sleep quickly but wake after around 4 hours. After using the Zeez for a few months, I still wake most nights, but am sleeping much more deeply and find it much easier to get back to sleep again. Zeez isn’t a miracle cure…you really must treat it as part of a good routine…but if you are doing everything else right, then this might just be the cherry on the top. Rachel
“I had menopause related insomnia for 12 years. I wanted to give the pebble a try, as everything else had failed. I was often able to fall asleep quickly, but always woke in the night, several times, sometimes lying awake for many hours..
After about 6 weeks I started to notice a positive difference. I still wake in the early hours of the morning, but I now manage to get back to sleep quicker and I can also sleep for longer.
The pebble alone probably won’t cure a chronic sleep problem, but combined with other lifestyle changes, including in my case meditation, it helped me to manage an awful situation, where often I would get no more than 3 hours of sleep a night. After over a decade, I was desperate to find a solution and the pebble is the best thing I’ve found..” Elaine
“3 years ago, my sleep had deteriorated to virtually none. I felt lucky if I was achieving 3 hours of sleep twice a week. More often, I was sleeping 1 hour a night and often none at all. My sleep issues started years earlier, with the onset of peri-menopause. I put this down to stress at work, I reduced the stress, but my sleep patterns regressed further. I truly felt like my brain had 'forgotten' how to fall asleep. By the time I contacted Anna at Zeez, I was beyond desperate, trying not to become addicted to sleeping medication. I was a danger on the roads and felt helpless and depressed. I purchased the Zeez on a trial basis, as I had bought so many other sleep aids. I thought it wouldn't work.
The first night, I felt relaxed and drifted off for a few hours. The second night I slept longer, and entered a deep sleep. The third night I slept six hours. It was wonderful to sleep and wake feeling like my brain had rested. I took advice from from Anna about nutrition, as my sleep is still not perfect and at my age and in full blown menopause I need extra nutrients.
I tend to use the Zeez for around two weeks, and then feel like I don't need it for a few weeks. It helps 'reset' my brain into sleep mode. I cannot be without it. On a bad night I now sleep 6 hours with some waking. On a good night, I sleep for 8 hours without waking. I feel like the Zeez has literally saved my sanity.” Mariane
“Zeez is helping as few things have. I did not have a sleep problem until menopause 28 years ago. Since then, although I was falling asleep easily and generally going back to sleep easily, I was waking up up to 6 times a night so was not rested to say the least, with consequences for mood and activities. Several things have helped: Ativan, [Lorazepam, unlikely to be prescribed in the UK] which I still take, but rarely, for fear of habituation, an herbal supplement containing phenbut, an altered form of an amino acid, which lost effectiveness with time and was withdrawn and in 2019 an herbal supplement which worked very well but was also withdrawn. I was struggling for hope that good sleep was possible. I am so lucky to have found Zeez which made withdrawal from the herbal supplement bearable even in the midst of the pandemic. I am persuaded that without Zeez I would not have resumed my pre-menopausal pattern of waking 2-3 times and falling quickly back to sleep. “ Nancy [Miami]
References
https://www.academia.edu/25779906/Sleep_and_menopause?email_work_card=view-paper
https://www.medscape.com/viewarticle/983113?src=mkm_ret_221210_mscpmrk_psych_womens-health&uac=373577BZ&impID=4965044#vp_1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245250/