This is a guest blog post by Niki Bezzant, author of This Changes Everything. Be sure to check out the reviews on her book through the link.
Niki Bezzant: When I asked women to tell me about their experiences of perimenopause in the research for my book, one of the top 5 symptoms that came up in the list was sleep disturbance. As with most things related to perimenopause, the answer is not just one thing. It’d be wonderful if there was a magic solution, but usually it’s multi-factorial. We need to look at all the pieces of the puzzle.
So what's going on here?
What's the link between perimenopause and sleep?
What’s happening for people with ovaries at perimenopause is a bit of a hormonal rollercoaster. Oestrogen levels are fluctuating – going up and down in wildly unpredictable ways. This – as well as doing many other things – interferes with our brain’s internal temperature control and cause hot flushes and night sweats. They’re one of the main causes of insomnia in perimenopausal and menopausal women.
A flush at night causes an increase in heat and adrenaline that makes us sweat, which usually wakes us up, and can mean having to get up and change clothes and sheets. Flushes and sleeplessness are (unsurprisingly) linked; when women experience severe hot flushes, they are far more likely to have chronic insomnia.
That rollercoaster can interfere with sleep in other ways. Progesterone is another important hormone that’s also on the decline in perimenopause. One of its effects is as a calming sedative, so when it drops we might not sleep as well. It also helps keep our airwaves clear so we can breathe well at night.
What can we do about all this?
As with most things related to perimenopause, the answer is not just one thing. It’d be wonderful if there was a magic solution, but usually it’s multi-factorial. We need to look at all the pieces of the puzzle.
An important bit - and an easy one to address - is the sleep environment. Are you sleeping in a room that’s nice and dark, and cool enough? Sleep experts say a temperature of 18 degrees is ideal. Using natural fibres in your pyjamas and bed linen will help, too; they’re a lot more comfortable and are likely to be better at controlling temperature.
You might want to have a look at the content of your pillow and bedding, too.
I switched to a Cloud Wool Pillow (from Kind Face) recently, which I’ve found really comfortable through a sticky Auckland summer. It could be because wool has a natural wicking capability; absorbing moisture but keeping a layer of dry air at the surface.
This is something a pillow filled with polyester or feathers won’t do. (I’m also trying out a beautiful prototype bed cover made from wool from Kind Face, too, and the same applies – it’s been comfortable even on hot nights).
Another thing to get on top of: sleep hygiene. We all know these things, don’t we? Don’t look at screens right before bed; don’t drink alcohol or caffeine in the evening; don’t go to bed stressed or anxious; don’t eat too close to bed time.
They’re little things that can add up to a better sleep.
A couple of other quick ‘wins’ that could work if you’re not sleeping: exercise and morning light.
There’s evidence to suggest regular exercise is linked with better sleep and falling asleep faster. This may partly be because it helps regulate our body temperature, easing flushes. It’s also great for our mood and stress levels. If you can do it outside in the morning, even better, because exposing our eyes to daylight early in the day is key to better sleep. That morning light hits cells in our eyes, suppresses melatonin (the sleep hormone) and wakes us up. It also boost serotonin, which at night converts to melatonin and – voila – helps us get to sleep. Getting out for a walk or run first thing in the morning for at least 15 minutes, sans sunglasses, is the way to get that cycle going.
Once you have all that practical stuff sorted out, if sleep is still elusive, it might be time to seek more help and add in some extras (don’t abandon all the lifestyle stuff, though!)
If flushes and sweats are the problem, it’s worth knowing that HRT (hormone replacement therapy) or MHT as it’s now known, is a gold-standard treatment for these and is far more effective than anything else that’s been studied. It also has some big sleep benefits, in the form of progesterone; if you take micronized, body-identical progesterone (the form that’s usually recommended) you may find, as I do, that sedative effect really helpful for sleep.
Sleep – along with diet, exercise and stress – is one of the ‘big 4’ pieces of the health puzzle we need to spend time on throughout our lives.
At perimenopause it can be challenging, but it’s a key piece to get sorted; doing so can really ripple out into so many other areas of life.
Niki Bezzant is renowned for her pragmatic, no-nonsense approach to life. In her new book, This Changes Everything, she boldly addresses the challenges women encounter during menopause - particularly during perimenopause (the stage preceding menopause), which can be an emotionally demanding period to navigate.
You can also find Niki at nikibezzant.com