Ah – is there anything better than waking after a night of deep, restful sleep? You start the day with a clear head, feeling energized and ready to take on the world. Yes, I promise it is possible. However, if you are anything like most women struggling with the joys of perimenopause, that restful type of sleep seems like a thing you can only dream of (no pun intended).
In this article, we will discuss the reasons why our sleep is disruptive, the importance of quality sleep for women in midlife and some tips to bring you closer to feeling refreshed after a night’s slumber.
Why Can’t I Sleep?
The standard advice is to aim for 7-8 hours of sleep per night. But 1 in 3 women in perimenopause reported they get less than seven hours and 1 in 2 say they don’t feel rested when they wake in the morning. Women are under a lot of stress at home and at work. Add to that the hormonal changes that take place as we enter perimenopause and menopause and it is easy to see that many things can contribute to our collective lack of sleep.
Teenagers. They also cause gray hair. Just kidding…kind of. Women start to experience disrupted sleep the minute they become moms. Between night time feedings, the endless trips to make sure the baby is breathing and the early morning cries for more food, becoming a mom forever changes your sleep. Women tend to become lighter sleepers as a result – ready to jump whenever necessary. As children grow, the reasons for lack of sleep change slightly – the early morning practices, last minute school projects and then waiting up until midnight to make sure they get home safely. Raising children is such a blessing — but your sleep pays the price.
Hormonal changes. The decreasing estrogen and progesterone in your system can cause sleep disruption and insomnia. Progesterone is our anti-anxiety, pro-relaxation hormone, so the decline of this hormone can contribute to overall stress and anxiety. Estrogen, in turn, plays a role in our circadian rhythm signaling which may cause our body to feel like we aren’t ready for bed at such a reasonable hour (and so, we proceed to stay up bingeing Netflix way beyond our normal bedtime). Estrogen also contributes to our bodies’ melatonin production. This chemical is necessary for inducing sleep. Less estrogen equals less melatonin and conversely more cortisol, the stress hormone.
Perimenopausal symptoms. Waking up drenched in sweat from the night sweats that accompany midlife changes is incredibly disruptive to a good night’s sleep. Again, declining estrogen levels are to blame as it helps to control the body’s ability to regulate temperature. As it declines, we can become more sensitive to even slight changes to temperature and in the body’s attempt to cool down, we experience a hot flash. Night sweats are just hot flashes that occur at night. Obesity and smoking can increase the risk of severe hot flashes.
Other causes. As we progress through to full menopause and further hormonal decline, frequent nighttime urination, restless leg syndrome and sleep apnea can also become a barrier to restful sleep.
Why Is Sleep So Important?
Sleep is not only the time where our bodies rest and recover, but a time of regeneration and restoration in nearly every system in the body. Here are a few specific examples of why is it so important:
It protects the brain. This is a time when your brain compresses all of the information it took in for the day. An ongoing lack of sleep has been associated with cognitive decline as we age.
It positively affects mental health. Fluctuating hormones and life’s stressors can affect our mental health. This is exacerbated when sleep is lacking. Many studies have looked at the bi-directional effect lack of sleep and depression/anxiety have with one another and have reinforced the importance of quality sleep.
It may help to regulate blood sugar and metabolism. Sleep deprivation and continued nighttime awakenings leads to greater fluctuations in blood glucose. The result can be a tendency towards insulin resistance and the potential for developing Type 2 diabetes.
It may help with weight loss. Weight gain is a major concern for many midlife women. A lack of sleep is thought to disrupt our appetite control hormones, ghrelin and leptin, which can affect our hunger cues throughout the day.
It is cardioprotective. Heart disease is the leading cause of death in women in the U.S. Poor sleep or a general lack of sleep is associated with increased systemic inflammation, high blood pressure, elevated cholesterol and the development of atherosclerosis.
Tips to Reclaim a Restful Night’s Slumber
All of the following tips fall under the category of good Sleep Hygiene. Sleep hygiene is simply the healthy habits you can add to your routine that set you up to get the best night’s sleep possible.
- Establish a consistent sleep schedule. Of course, this is easier said than done. However, humans are creatures of habit and if you do your best to stick to the schedule you have set – even on the weekends – you will feel your body start to get used to the pattern. Over time, you will feel yourself naturally start to wind down a few hours before the bedtime you have set.
- Turn off the electronics. We tell our kids to shut everything down, yet sit on our phones or in front of the television to “unwind” in the evenings. The reason this hurts our sleep is that all of these devices emit blue light which tricks our brain into thinking it is still daytime. This suppresses our bodies production of melatonin. If you aren’t quite ready to shut everything down, a good idea is to use the blue-blocking mode on your phone or try some Blue Blocker glasses.
- Practice yoga, light stretching or meditation. These activities promote a relaxation response in the body that relieves stress and calms the mind. And although this can be done before bed, incorporating these at any time of day can have beneficial effects that reduce stress and increase sleep quality. 
- Exercise. Adding regular exercise to your daily routine has been found to help you fall asleep faster and experience higher quality sleep. In one study published in the journal Sleep Medicine, individuals with a usual sleep time of less than 6.5 hours completed moderate-intensity workouts (think walking, riding a stationary bicycle, or jogging on a treadmill) four times a week for six weeks. At the end of the experiment, they reported getting an extra 75 minutes of sleep per night.
- Get Outside. Fresh air in your lungs and sunlight on your face first thing in the morning is a fabulous way to start the day and it is scientifically proven to improve your sleep quality. Go for a short walk first thing upon rising, drink your coffee or tea outside with your face in the sun, or if these aren’t possible, consider purchasing a light box to use at your desk during the morning hours.
- Consult your provider regarding supplements that may help. While there are many sleep-aids on the market, consider talking with your provider about alternatives. Many turn to melatonin for help in falling asleep because it is readily available and “safe.” For temporary needs, it may be a good choice. A word of caution, however, melatonin has a negative feedback loop. This means by giving your system a melatonin supplement, the pineal gland then believes there is enough melatonin in the body and reduces production. After a while, we can become dependent on it because the body isn’t making enough, disrupting our sleep in the long run. And while it may help you fall asleep, the data is limited as to whether it has any effect on the sleep disturbances faced by menopausal women. Consider instead a cup of decaffeinated herbal tea, or simply a magnesium supplement. Magnesium has many benefits and numerous studies have shown its association with significant improvements in sleep quality.
Sleep is critically important to overall health and well being especially as we transition into menopause. With all of the challenges women face during midlife, preserving sleep quality has to be at the top of the list of priorities. As with most things, consistency is the key to results. So, try to incorporate a few of these tips into your routine and enjoy a good night’s sleep.
 Strickland, A. Women in midlife aren’t sleeping enough, study finds. CNN Health. 2017. https://www.cnn.com/2017/09/07/health/women-sleep-menopause/index.html
 Gersh, F. Menopause: 50 Things You Need to Know – What to Expect During the Three Stages of Menopause. California: Rockridge Press. 2021.
 Beccuti, G; Pannain, S. Sleep and obesity, Current Opinion in Clinical Nutrition and Metabolic Care: July 2011.14:4. 402-412. doi: 10.1097/MCO.0b013e3283479109. https://journals.lww.com/co-clinicalnutrition/Abstract/2011/07000/Sleep_and_obesity.16.aspx
 Grandner, Michael A et al. “Sleep: important considerations for the prevention of cardiovascular disease.” Current opinion in cardiology vol. 31,5 (2016): 551-65. doi:10.1097/HCO.0000000000000324. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5056590/
 Newsom, R. How Blue Light Affects Sleep. Sleep Foundation Website. 2021. https://www.sleepfoundation.org/bedroom-environment/blue-light
 Corliss, J. Mindfulness meditation helps fight insomnia, improves sleep. Harvard Health Blog. 2020.
 Reid, Kathryn J et al. “Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia.” Sleep medicine vol. 11,9 (2010): 934-40. doi:10.1016/j.sleep.2010.04.014 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992829/
 Blume, Christine et al. “Effects of light on human circadian rhythms, sleep and mood.” Somnologie : Schlafforschung und Schlafmedizin = Somnology : sleep research and sleep medicine vol. 23,3 (2019): 147-156. doi:10.1007/s11818-019-00215-x. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751071/
 Schwalfenberg, Gerry K, and Stephen J Genuis. “The Importance of Magnesium in Clinical Healthcare.” Scientifica vol. 2017 (2017): 4179326. doi:10.1155/2017/4179326. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5637834/