By Rachel Davies, Nutritional Therapist

Menopause is a natural transition in a woman’s life that marks the end of her reproductive years.  It occurs when a woman's ovaries stop releasing eggs, and is marked by the absence of a menstrual period for 12 months. In the UK, the average age for women to go through menopause is 51 years old, although it is typically anywhere between 45 and 55 years old. The perimenopausal stage, the stage prior to the last period where hormones are fluctuating and declining, can last from 2-12 years and symptoms and severity will vary from woman to woman. 

By 2030, 1.2 billion women worldwide will be menopausal and 85% of these women will experience symptoms be they mild or more severe. Menopause is a natural and inevitable transition but for many women it is overwhelming and debilitating to their quality of life. 

The transition into menopause brings a range of hormonal changes that impact many areas of health including hot flushes and low mood, to weight gain and fatigue. Sleep disturbances are a common feature for many women and can include finding it harder to fall asleep, stay asleep, or feel rested upon waking. In research led by the British Menopause Society, up to 60% of the women interviewed mentioned sleep problems.

The connection between hormones and sleep

So what is going on during menopause that affects sleep? Firstly it is helpful to understand a bit more about our hormones and the mechanisms through which they may impact our sleep. 

Hormones are chemical messengers in the body that help to regulate various bodily functions, including metabolism, growth, mood and reproduction. During the menopausal transition it is the fluctuating, and ultimately declining, levels of oestrogen and progesterone that impact sleep disturbances. 

The role of oestrogen

Oestrogen has a protective effect on sleep by supporting serotonin production which is a precursor for melatonin, the sleep hormone. As oestrogen levels drop during perimenopause, the brain’s ability to regulate the sleep-wake cycle can become compromised. This relationship between oestrogen and serotonin can also impact mood. Low mood in turn is often a feature in sleep disturbances. 

Declining oestrogen also impacts the thermoregulatory centre of the brain and contributes to body temperature fluctuations, leading to night sweats and hot flushes, two common culprits in nighttime waking. Oestrogen also has an anti-inflammatory effect on the body so declining levels can lead to higher levels of inflammation and joint pain which can be a troublesome factor in disrupting sleep. 

The role of progesterone

Progesterone has a calming, sedative effect on the body. The drop in progesterone that occurs in perimenopause and continues into post menopause can lead to increased anxiety and restlessness, which impacts the ability to fall and stay asleep.

The yoyoing of hormones during menopause also impacts the body’s ability to handle stress which can lead to higher levels of cortisol, one of our major stress hormones. Cortisol works in opposition to melatonin to regulate your sleep-wake cycle. So higher overall levels of cortisol can suppress melatonin resulting in elevated levels of arousal in the evening, insomnia, and fragmented sleep. 

The combination of low oestrogen and progesterone plus often higher levels of cortisol leaves many women feeling stuck in a cycle of poor sleep, increased stress and daytime fatigue.

Other key sleep issues during the menopausal transition

1. Sleep apnea: Sleep apnea is a condition which causes a person to repeatedly stop breathing whilst they are sleeping, impacting quality of sleep and daytime energy levels. Sleep apnea prevalence increases during and post menopause. Although the exact mechanisms are not fully understood, weight gain, hormonal shifts, and changes in muscle tone can increase the risk of developing sleep apnea. Have a read of our blog about sleep apnea here. 
2. Night sweats: One of the most well-known and troublesome symptoms of menopause is night sweats. Night sweats can result in waking up drenched in sweat, heart racing, and unable to cool down. This frequent disruption not only breaks up sleep cycles but also makes it difficult to return to restful sleep after waking.
3. Restless Legs Syndrome: Restless Legs Syndrome is a neurological condition that causes an irresistible urge to move the legs, especially at night, making it hard to relax and fall asleep. Research suggests this becomes more prevalent during menopause. 

Supporting sleep through the menopausal transition

So with all this change going on, what can we do to optimise the sleep we are getting? Here are my top tips: 

• Optimise your sleep environment: Make sure your bedroom is cool, dark and quiet. Run a fan, if you need one, and keep a glass of water nearby to help manage hot flushes if and when they occur. 
• Manage stress: Elevated cortisol can add an extra layer of complication to menopause and exacerbate hormonal imbalances. Consider incorporating stress-reduction techniques, such as mindfulness, breathwork, stretching, journalling or meditation, into your bedtime routine and throughout the day. 
• Commit to a healthy, balanced diet: Supporting your body with a whole-food based diet can help to mitigate some of the symptoms of menopause and manage those hormonal fluctuations. In particular, ensuring your have adequate protein, plenty of fibre and colourful plant foods in every meal supports the body with key nutrients and helps to reduce risk of longer term health risks associated with menopause
• Avoid alcohol, caffeine and tobacco: These substances can all interfere with sleep and intensify hot flushes.
• Exercise regularly: In addition to helping you sleep better, regular exercise supports heart health, prevents the loss of bone and muscle mass, helps reduce stress and supports better mental health.

Don’t give up hope! It is very possible to support better sleep through menopause by being consistent with these strategies. Plus, Extracted have created the perfect sleep-supporting blend of 11 natural ingredients in their formula for Sleepee - to help you achieve a more restorative night’s sleep during this chapter of your life, and beyond. 

If you are struggling with menopause, do speak with your GP who can help you in finding the right support. This article is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

www.racheldaviesnutrition.com

This blog is written by Nutritional Therapist Rachel Davies. Rachel is registered with the BANT (British Association of Nutrition and Lifestyle Medicine) and the CNHC (Complementary and Natural Healthcare Council). She continually attends CPD training to further her expertise and keep abreast of the fast moving field of nutritional science.