Common Sleep Struggles During Menopause:
How Get Your Zzzzzz’s Back
by Dr. Val Cacho
Are you one of the 40-60% of women that has difficulty sleeping through menopause transition? If so, keep reading to discover potential reasons why you are waking up tired and what to do to restore your sleep and energy.
Sleep and Aging
As we grow older there are normal age-related changes to our sleep stages. Our sleep is comprised of four distinct stages: stage 1 and stage 2 are light sleep, stage 3 also known as slow wave sleep or deep sleep, and REM. With time we have less stage 3 and REM sleep and more light sleep. We can also develop chronic medical conditions as we age that affect our sleep quality such as arthritis, diabetes mellitus, and heart disease. Sometimes the medications we are given to treat these chronic conditions can keep us from sleeping and cause insomnia.
Hormone Fluctuations
With aging comes the decline in our hormones of reproduction, estrogen and progesterone. As these hormones fluctuate, we can experience a laundry list of symptoms including hot flashes, night sweats, mood swings, insomnia, muscle and joint pain, vaginal dryness, and low libido. Waking up frequently at night due to hot flashes and night sweats tops the list of sleep disruptors during menopause. However, women in menopause can also wake up for reasons unclear to them and have difficulty returning to sleep once they do awaken. Some studies show that these awakenings can improve with hormone replacement therapy.
Obstructive Sleep Apnea (OSA)
OSA is a medical sleep condition that occurs when the muscles of the upper airway, typically the tongue and soft palate relax during sleep and close off the airway which results in snoring, gasping or choking for air when asleep or witnessed pauses in breathing. When this happens, our brain wakes up and our muscle tone increases as a protective mechanism to help us breathe. Multiple cyclic episodes of difficulty breathing followed by an awakening is disruptive to our sleep quality. Daytime symptoms of OSA include morning headaches, unrefreshed sleep, fatigue, and problems with memory, focus, and attention. OSA happens 2-3x more frequently in women in menopause as compared to those in pre-menopause. Additionally, women are often under diagnosed for OSA and are sent to a therapist to treat depression (as symptoms may overlap with that of OSA). Other times women are advised to have their blood checked for hypothyroidism instead of having a sleep study ordered. If you suspect you have OSA talk to your doctor about getting a sleep study.
Sleep and Stress
Life tends to get complicated as we grow older, and our stressor may compound leading to poor sleep. There may be more demands at work as we move into manager or director positions. Or we may be contemplating retiring after working for 25-30 years. An additional stressor can be the strain of caregiving for elderly parents while still caring for our own children. Uncontrolled stress is a big factor that causes difficulty falling asleep, especially if we have ruminating or anxiety provoking thoughts at night. Sometimes stress can also lead to early morning awakenings with the inability to relax and fall back asleep.
What To Do
If you have had difficulties with your sleep for more than two weeks or if you are experiencing symptoms of excessive daytime sleepiness, difficulty focusing at work, or find yourself driving drowsy, please seek out care from your doctor. If your sleep disruptions are due to fluctuating reproductive hormone levels and hot flashes ask your physician if you are a candidate for hormone replacement therapy. Studies show low dose estrogen or progesterone (alone and when combined) improves sleep quality in women who experience hot flashes. Additionally, if you think you may have undiagnosed OSA ask for a sleep study (you don’t have to snore to have OSA). A sleep study can be performed easily in the comfort of your own home, and it is readily treated with positive airway pressure therapy, changing in body position such as side sleeping or sleeping with your torso elevated, or oral appliances made by dentists. If stress is the culprit for your struggle with sleep, make sure you are taking time for yourself. Also don’t hesitate to reach out for help. There are many qualified mental health professionals that focus on women in midlife. To find a licensed sleep therapist in your state, the Society of Behavioral Sleep Medicine’s directory just follow this website: https://www.behavioralsleep.org.
Dr. Val Cacho, aka Dr. Val, is an expert integrative sleep medicine physician. She’s a board-certified internal and sleep medicine doctor, author, and entrepreneur. She started @sleephoria.health after seeing an increase in menopausal women in her medical practice who were struggling with sleep.
For more information visit www.sleephoria.com. Be sure to sign up for our weekly newsletter for the latest expert insights on sleep and women’s wellness delivered right to your inbox! Subscribers will also receive The Guide to Sleep and Perimenopause.
November 2022