Sleep problems and menopause: what you need to know

Sleep is a hormonal process, just like the menopausal transition. During perimenopause, your hormones start to fluctuate and then decline. This can affect the quality of your sleep. You may start having trouble falling asleep, feel restless at night, wake up at night and be unable to go back to sleep, or wake up very early in the morning. The relationship between progesterone and the stress hormone cortisol plays an important role in this respect. 

Known as the ‘relaxing hormone’, progesterone has a calming, mildly sedative effect. Like other reproductive hormones, progesterone levels decrease as you age and enter the menopausal transition phase. This can make it more difficult to fall asleep or stay asleep at night. Low progesterone can also affect the airways and cause disrupted breathing (sleep apnoea). Your blood oxygen levels can drop when you stop breathing, causing you to wake up.  

In addition, menopausal women often have low cortisol levels during the day (causing daytime fatigue) and elevated cortisol levels at night (causing difficulty with falling asleep). Cortisol is the enemy of a ‘sleep hormone’ called melatonin. Being under a lot of stress or going through a hectic time interferes with melatonin production. This can cause sleep problems or even insomnia, a condition where you try your best to sleep but are unable to.  

To make matters worse, when hormone levels drop during the menopausal transition, the levels of serotonin (the ‘happiness hormone’) also fall, which can trigger mood swings and depressive symptoms). Serotonin is converted into melatonin when it’s dark outside. Lower serotonin levels means less melatonin is produced which causes you not to sleep as well. 

When something that has always been effortless suddenly becomes difficult, it is bound to affect you. Especially when it comes to something as important as sleep. Many women complain of disturbed sleep during perimenopause and after menopause: almost 50 percent during perimenopause, and up to 60 percent during postmenopause. The closer to menopause women are, the more likely they are to rarely or never wake up feeling well rested.  

Note: poor sleep can also be caused by factors that may or may not be menopause related, such as nocturnal hot flashes, stress, lack of exercise or lack of exposure to sunlight.  

Sleep is important for many aspects of your health. It ensures that hormones and neurotransmitters can function properly, but also that you feel focused, happy and resilient. In fact, you can start to feel the effects of sleep deprivation after not getting enough sleep for just one night. You may feel gloomy or low, or find yourself more irritable than usual. Sleep deprivation can also negatively impact your energy level, mood, and in some cases, your sex drive. Lack of sleep may also affect appetite-regulating hormones, which can lead to an increased appetite. 

Does this mean you have to suffer needlessly? Of course not! By taking care of yourself, making minor lifestyle adjustments and prioritising good sleep hygiene, you'll see that it’s possible to improve your sleep. If you need a little extra help to get a good night's sleep, you can also consider trying supplements.  

To get a good night's rest, you need to lower your cortisol levels. This means you need to get your circadian rhythm, your daily cycle of sleep and wakefulness, back in balance. Some tips to get you back on track: 

• Expose yourself to natural sunlight in the morning: go outside no later than one hour after you wake up. 
• No alcohol and no coffee after noon. 
• Avoid exposure to blue-light screens (e.g., mobile phones, tablets, laptops) in the evening. 
• Dim lights in the evening. 
• Be physically active: exercise promotes sleep, but do it in the morning or during the day. You don't want your body temperature to rise too much before bedtime. 
• Take magnesium or saffron supplements.