How to Enjoy Better Sleep After Menopause
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Health

Secrets to Better Sleep After Menopause

Here are some great recommendations from the experts.

Sleep mask with "ZZZ" bubble
Getty Images

According to the results of my sleep chronotype quiz, I am a dolphin, which is surprising. My kids would classify me more as a bear — at least until I’ve had my first cup of coffee in the morning.

“Everyone has a different biological clock … that sets your day’s hormones, energy levels and has an incredible influence on your daily success,” explains Michael Breus, a clinical psychologist and a fellow of the American Academy of Sleep, in his video on the dolphin chronotype.  “At what time your clock runs is called your chronotype,” he adds, which can be classified into four categories — dolphin, lion, bear and wolf. Knowing which you are can help you understand how to work with your body to get a good night’s sleep, rather than fight against it.

But even if I do everything that might help me as a dolphin, a light sleeper, statistics around sleep problems aren’t encouraging. According to The Study of Women’s Health Across the Nation (SWAN), sleep disturbances range from 16 to 42 percent in premenopausal women and then climb to 35 to 60 percent when we’re postmenopausal. These sleep difficulties postmenopause run the gamut — from problems falling asleep, to staying asleep, to waking early and not feeling rested. Insomnia can wreak havoc on our lives, causing problems with everything from memory to increased risk for cardiovascular disease, to greater anxiety and irritability, to lower quality of life.

However, the good news is that it doesn’t have to be this way, In fact, “There is recent data to show if you are not sleeping well as you get older, it is more of a sign of your health status than your sleep status,” according to Breus, speaking in his master class, “Why Am I So Exhausted? How Your Sleep Has Changed and What You Can Do About it.” In other words, as we age “we should not be sleeping poorly,” he continues.

However, there are more challenges as we age, particularly for women. The reason for women’s postmenopausal sleep problems include, in large part, the fact that estrogen and progesterone hit rock bottom after menopause, and the ratio of these two hormones to testosterone is also thrown off balance, says Abhinav Singh, M.D. medical director of the Indiana Sleep Center. This imbalance may be one of the reasons that sleep apnea (a sleep disorder in which breathing stops and starts), tends to become more common in postmenopause, and closer to its prevalence in men.

This is also a time when snoring and weight both tend to increase. Hot flashes (or sudden intense heat in the upper body) and night sweats (the ones that occur at night) are also linked to insomnia as we age.  It’s not clear whether it’s the hot flashes that trigger the night waking, or the other way around, says Singh, although likely hot flashes cause the sleep disruption early in the night, during deep sleep, while later in the night, during REM sleep, it’s more likely that the sleep disruption happens first and then the hot flash.

I can certainly attest to the ravages these hot flashes have on my sleep. I often wake in the night drenched, and end up hyperalert at 3 a.m., reading a novel with my phone light under the covers in what my husband refers to as our “humid bed.” This can be very anxiety-provoking.

“Mood disorders and sleep disorders are good friends,” explains Singh. But which comes first is hard to say. He believes that any discussion of medication therapy with your doctor should incorporate a discussion of both sleep and mood issues, rather than treating each one separately. For example, symptoms of restless or twitching legs can be exacerbated by medications such as SSRIs, or selective serotonin reuptake inhibitors, the antidepressants often prescribed to treat depression and anxiety.

Fortunately, we can improve both the quality of our sleep and the length of time we get shut-eye.

Here are some recommendations from the sleep experts.

Get into good daytime habits. Exercise is good for many things, and that includes sleep. Do about 20 minutes of cardio per day, but avoid vigorous exercise late in the day. Eat around the same time each day. And cut down on coffee and alcohol! If you drink coffee, stop by 2 p.m.

Prepare yourself for bed. This is what Singh refers to as sleep 4-play. He divides the hour before bed into four parts, each 10 to 15 minutes:

  • Have a warm shower to dilate the skin, which will facilitate heat loss and in turn cool down your core.
  • Journal or write down anything that you need to stop circulating in your brain, whether it’s worries or a to-do list for the next day.
  • Read something relaxing.
  • Meditate or do yoga to anchor the mind and calm your breathing. There are many free meditation apps, such as Insight Timer, that you can use.

You also need to dim the lights well before bed. Bright lights suppress the production of melatonin, a hormone that helps us sleep. In his master class, Breus recommends wearing blue-light-blocking glasses when we’re using smartphones and online devices in the evening to help protect us from the harmful effects of blue wavelength light.

If you wake in the night, with a hot flash, and are feeling stressed, use a cognitive-behavioral approach to calm yourself down, says Kate Panter, M.D., a gynecologist and obstetrician in the United Kingdom. So instead of freaking out about being tired the next day, you can use more positive self-talk. For example, you could ask yourself, “What would my best friend or someone I love say? “You’ll get back to sleep. Millions of people around the world struggle with this.” 

Start your morning right. “If I could give everyone one tip, it would be wake up at the same time every single day,” Breus says. He then recommends that you take five deep breaths to wake up the respiratory system, and have 20 to 30 ounces of room temperature water next to you when you sit up, because sleep is very dehydrating. Then “get light into your eyeballs.” Ideally, getting outside into sunlight is optimal, but if it’s still dark outside, artificial light (such as a light box) will help to get rid of the brain fog. Also, get blood tests to check that you are not deficient in iron, magnesium, Vitamin D or melatonin.

Finally, Singh suggests minimizing the use of sleep aids (over the counter or prescription) in favor of behavioral and cognitive approaches to improving sleep. “Making changes to how you prepare and think about sleep will be the best approach over the long term,” he says.

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