14: How to Sleep Better with Dr. Andrea Matsumura
EP. 14
For many women, poor sleep has become a normal part of life, whether due to pregnancy, menopause, family demands, or career pressures. In my twenties, I could fall asleep anywhere, but as I’ve gotten older, sleep has become much more elusive. So, how do we reclaim restful sleep as our bodies change, and how much sleep do we really need to feel refreshed?
Sleep issues during menopause are incredibly common, yet they often go unaddressed. As our hormones shift, so do our sleep patterns. The good news is, there are effective strategies to help us sleep better during this phase of life. In this post, we’ll explore how hormonal changes affect sleep, why sleep is essential for our overall health, and most importantly, how to improve sleep and reclaim rest in menopause.
If you're struggling with sleep during menopause, keep reading for practical tips and advice on how to sleep better and thrive through this season of life!
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Why Sleep is So Important
Sleep is often underestimated, despite its crucial role in our health. It’s the foundation that regulates everything from blood sugar levels to pain management. Without enough restorative sleep, managing chronic conditions like diabetes, high blood pressure, and chronic pain becomes much more difficult.
In fact, poor sleep doesn’t just impact these conditions individually; it has a cascading effect on nearly every aspect of our daily life. Whether it’s affecting our mood, our energy levels, or even our ability to focus, a lack of sleep can make us feel like we’re constantly running on empty. For women navigating menopause, these effects can be even more pronounced, as the body’s changing hormones complicate the quality of sleep.
How Hormonal Changes Disrupt Sleep During Menopause
During perimenopause and menopause, hormonal changes can significantly impact sleep. As estrogen levels decline, many women begin experiencing sleep disturbances, often in the form of wakefulness in the middle of the night. Hot flashes, which are caused by this drop in estrogen, also affect body temperature regulation and can disrupt sleep, making it harder to stay asleep through the night.
In addition to estrogen, progesterone also plays a role in sleep. While progesterone helps induce sleep, its levels also decline during menopause. The balance between estrogen and progesterone is key to maintaining restful sleep, and when this balance is disrupted, women may find it harder to fall asleep or stay asleep.
Moreover, the lack of sufficient sleep during menopause can have a cascading effect on other bodily functions. For instance, growth hormone, which is important for muscle repair and regeneration, is affected by poor sleep. The imbalance created by disrupted sleep can also lead to higher levels of cortisol, the stress hormone, further complicating sleep and overall health.
In short, as estrogen and progesterone levels decline during menopause, they directly impact sleep, and the resulting sleep disturbances can affect other systems in the body. Understanding this hormonal shift is key to finding effective solutions for better sleep during this time of life.
How Much Sleep Do We Really Need?
When it comes to how much sleep is necessary for feeling refreshed, there is no one-size-fits-all answer, but research provides clear guidelines. According to the American Academy of Sleep Medicine, most adults need between seven to nine hours of sleep each night to function at their best.
You may have heard people claim they can get by on five or six hours of sleep, but the truth is, those individuals are likely compensating in other ways. While they might think they're managing, studies show that consistently getting less than seven hours of sleep can impair cognitive functions, like memory consolidation and executive decision-making. Reaction times slow down, and overall mental performance suffers.
In fact, many people who think they’re just “fine” on fewer hours of sleep might only realize the consequences once their compensatory strategies—like caffeine or stimulants—stop working. Over time, these strategies fail to mask the underlying sleep deprivation, and that’s when the real challenges begin.
When we’re not getting enough sleep, it can manifest in various ways. Some people turn to caffeine or stimulants, trying to power through the day. In some cases, this can lead to misdiagnoses, like being told you have ADHD when the root cause of your symptoms is actually sleep deprivation. So, while it may seem normal to get by on less sleep, it's not ideal, and it often comes at the cost of long-term health.
Practical Tips for Improving Sleep During Menopause
When it comes to improving sleep during menopause, establishing a solid sleep routine is key. Here are some tips that can help you set yourself up for better rest:
Wind Down Before Bed: Just like we prepare food before eating, we should prepare our bodies and minds for sleep. Don’t just go, go, go, and then expect to fall into bed. Give yourself a wind-down period where you engage in calming activities to signal to your brain that it’s time to sleep.
Establish a Sleep Plan for Middle-of-the-Night Wakefulness: If you wake up in the middle of the night, avoid the instinct to reach for your phone. Looking at the clock or checking your phone can worsen sleep disturbances. Instead, have a plan. This plan is called stimulus control, and it involves creating an environment and routine that helps your brain relax and reset:
Get Out of Bed: If you can’t fall back asleep after about 15 minutes, leave your bed.
Engage in Relaxing Activities: Go to a quiet, comfortable chair and do something boring and relaxing, like reading a dull book or practicing imagery work or meditation. Make sure the lighting is indirect, and avoid screens. This gives your brain the chance to calm down without any overstimulation.
Don’t Work or Exercise: Avoid any mentally or physically taxing activities like cleaning, working, or exercising during this time. Your goal is to unwind, not to stimulate your body or mind further.
Return to Bed When Sleepy: Once you start feeling sleepy, return to bed. Over time, this can help reduce the amount of time spent lying awake and eventually help you fall back to sleep faster.
Consider Cognitive Behavioral Therapy for Insomnia (CBT-I): If you find that you’re waking up in the middle of the night more than three times a week for over three months, you may be developing a neurological pattern of wakefulness. In these cases, cognitive behavioral therapy for insomnia (CBT-I) can be helpful to address the root causes of sleep disturbances and break the cycle of wakefulness. For issues that haven’t persisted for three months, trying sleep hygiene practices can be a good first step before moving into therapy.
Improving sleep during menopause is a gradual process, and like other health changes (such as weight loss), it takes time. Stick with these strategies, and over time, you should notice an improvement in your sleep quality.
Addressing Root Causes of Sleep Issues
The key to improving sleep isn’t always relying on supplements or medications, but rather focusing on the root causes of sleep disturbances. In the context of menopause, many women experience sleep issues due to underlying conditions like sleep apnea, restless leg syndrome, or musculoskeletal pain.
Sleep Apnea: Up to 90% of women with sleep apnea may not be diagnosed. Since many of the symptoms of sleep apnea are not visible (especially if the partner doesn't notice), it’s critical to seek diagnosis if you're experiencing frequent nighttime awakenings, choking, or gasping for breath.
Restless Leg Syndrome & Iron Deficiency: Sleep disturbances related to restless legs can sometimes be linked to low iron stores (ferritin levels). Addressing these iron deficiencies can significantly improve sleep quality.
Musculoskeletal Pain: Many women report waking up every couple of hours due to pain, often in the form of joint or muscle discomfort. Addressing menopause-related pain (e.g., joint stiffness, musculoskeletal syndrome) through hormone therapy may alleviate these sleep disruptions.
Hormone Therapy and Sleep
For women experiencing sleep disruptions due to menopause, hormone replacement therapy (HRT) can play a pivotal role, particularly estrogen and progesterone, which have been linked to improved sleep.
Hormone Therapy: Many women see marked improvement in sleep after starting HRT. However, if significant improvements aren't seen within a month, it may be necessary to adjust the dosage or consider alternative treatments.
Testosterone's Role: While testosterone is often considered for other menopause symptoms, there is currently no direct evidence that it improves sleep. In contrast, estrogen and progesterone are more likely to have a positive impact.
Reclaiming restful sleep during menopause is not only possible but essential for overall health and well-being. While hormonal changes can disrupt sleep patterns, there are effective strategies to improve sleep quality, from establishing a solid bedtime routine to addressing underlying health issues like sleep apnea or musculoskeletal pain. It’s important to prioritize sleep and take small, consistent steps to create a restful environment. With patience and persistence, you can regain the restorative sleep your body needs to thrive during this phase of life.