How to get a better night's sleep in perimenopause

Why is sleep important?

Sleep allows the body to rest, recover and repair and is important for our productivity, health and longevity. Over the past few decades, the overall average number of hours we sleep each night has decreased but we should ideally be aiming for between 7-9 hours of sleep each night.

A lack of sleep (defined as 6 hours or less per night) is associated with a shorter life span and worse health outcomes, including increased risk of mental health issues, obesity and cardiovascular disease. We all know how rubbish we can feel after a bad night’s sleep, experiencing symptoms such as poor memory, difficulty concentrating, low mood and increased irritability.

Poor sleep can disrupt hormones associated with weight control leading to weight gain, which is often already an issue in perimenopause. Ghrelin (known as our hunger hormone) increases after a night of less sleep. This is why you feel hungrier the day after a bad night’s sleep and craving that carbohydrate-rich sugary treat (doughnut anyone?) Levels of Leptin (the satiety hormone, released after eating to tell us we’re full) also decreases with a lack of sleep, causing us to eat more. A lack of sleep also affects the body's blood sugar control, increasing the risk of insulin resistance and triggering the release of our stress hormone cortisol, which causes more fat to be deposited around the tummy.

Why is sleep disrupted in perimenopause?

Poor sleep is often reported by women in midlife and is usually caused by many different factors. Whether its difficulty falling asleep or staying asleep, poor sleep quality is a commonly reported symptom in perimenopause and menopause and can make you feel even worse at a time when you’re already struggling. But why is this?

Stress is a big contributor and stress levels tend to be high in women during perimenopause and menopause. Stress affects sleep and lack of sleep raises the stress hormone cortisol, resulting in a vicious sleep/stress cycle. Cortisol levels are designed to be highest in the morning, to help us get out of bed ready to start the day, and then slowly taper off through the day to low levels at night, to help us relax and fall asleep. When chronically stressed, cortisol levels can remain high, resulting in that ‘tired and wired’ feeling at bedtime, when you just can’t switch off to fall asleep.

Anxiety is another common menopausal symptom which can contribute to early morning waking. You wake up, start thinking about your ‘to-do’ list, and before you know it, you’re wide awake at 4am and can’t get back to sleep.

And let’s not forget hormones!! Declining oestrogen levels and imbalances between oestrogen and progesterone at perimenopause can cause night sweats, increased urination, restless legs and sleep apnoea, which are all going to disrupt your sleep.

Did you know that oestrogen is needed to make serotonin (our happy hormone) which is needed to make melatonin (our sleep hormone). We need sufficient melatonin to fall asleep and stay asleep, it’s therefore easy to see how low oestrogen levels in perimenopause and menopause can lead to lower levels of melatonin and poor sleep.

And then there’s progesterone, our calming hormone, known as our natural sedative. Progesterone binds to and acts on our gamma-aminobutyric acid (GABA) receptors in the brain. GABA slows down your brain by blocking specific signals in your central nervous system, helping you to calm down, relax and fall asleep. Therefore low progesterone can contribute to lower levels of GABA, affecting sleep quality.

So, what can be done to improve sleep?

Here are my top diet and lifestyle recommendations to support sleep:

• Go to bed and wake up at the same time every day – routine is key!

• Establish a regular relaxing bedtime routine, which might include a hot bath or reading. The natural fall in the body’s core temperature after a bath can help you to fall asleep.

• If you have cold hands or feet in bed, try wearing gloves or socks.

• No laptops or devices in the bedroom and ideally no screen time at least 90 minutes before bed. Screens emit blue light which blocks melatonin. If using devices in the evening, consider wearing blue light blocking glasses.

• Spend time outdoors in the morning to get sunlight, increase melatonin levels and improve your circadian rhythm (your body’s natural sleep/wake cycle)

• Do some form of exercise every day, but not too late at night which can be too stimulatory.

• Ensure the bedroom is dark and cool. The best temperature for sleeping is 18 degrees Celsius. Blackout blinds and eye masks can be helpful.

• Reduce or eliminate alcohol which reduces restful REM sleep and can contribute to hot flashes.

• No caffeine after midday. Caffeine is a stimulant and having caffeine too late in the day can disrupt sleep.

• If you have to get up in the night to pee, reduce fluids in the evening.

• Try not to eat within 4 hours of going to bed. If your body is still digesting food, it’s going to disrupt your sleep. However....

• Don’t go to bed hungry! If sleep quality has worsened after beginning a low-carbohydrate diet, you may need to add carbs back in at the evening meal to calm the nervous system. A carbohydrate/protein rich snack before bed can be helpful to prevent blood sugar dips, cortisol release and early-morning waking.

If you want to learn more about sleep and its importance for physical and mental wellbeing, I highly recommend the book ‘Why We Sleep’ by Matthew Walker.