It’s 3 a.m. and you’re wide awake. How many times a week does this happen? Up to 60% of women in the menopause transition experience sleep disruption, according to the Sleep Foundation. It’s not just how much sleep you get, but the quality of that sleep. How often do you wake up and not feel rested? Let’s train your body for sleep with a sleep routine that works.
Menopause journey sleep problems
Even if you’re cruising through the menopause journey like a champ, sleep is likely one of the symptoms that’s a stumbling block.
In the pausitive health menopause journey survey, women who described menopause as “manageable” still described sleep disruptions as a symptom they needed help managing.
One woman said it felt like she didn’t sleep at all.
“I could go days without sleeping. Maybe a cat nap at night. I’d be exhausted and get into bed and fall asleep. And a couple of hours later, I was up. I did some of my best work then because I had nothing else to do…I would go a couple of days without truly sleeping.”
Sleep problems can include:
- Difficulty falling asleep or staying asleep
- Waking up in the middle of the night or too early
- Sleep apnea
- Waking up and not feeling refreshed
When those problems impact daytime functioning, it’s insomnia. According to researchers, sleep disturbances are severe enough in 26% of women undergoing the menopause transition that they meet the criteria for a diagnosis of insomnia.
Do over-the-counter (OTC) sleep solutions work?
At pausitive health, we understand many women are desperate for sleep solutions during their menopause journey.
In our survey, women talked about using Benadryl and Nyquil, even though these over-the-counter medications can create a “hangover” effect the next morning and are not meant to be used as sleep aids.
Melatonin is another popular over-the-counter dietary supplement. It’s a natural hormone the body produces, and it’s a vital part of the sleep-wake cycle.
But the American Academy of Sleep Medicine and American College of Physicians haven’t found strong evidence of its effectiveness for chronic insomnia. And taking too high a dose can exacerbate sleeping problems. Additionally, side effects can occur in some people, including nightmares, morning grogginess, irritability, and blood pressure issues. If you are taking blood thinners, melatonin can also increase the risk of bleeding.
Always consult your doctor before taking any supplement or over-the-counter medication for a use other than intended.
Over-the-counter sleep solutions won’t fix the underlying problems causing difficulty with achieving high-quality sleep of sufficient duration. Sleeping pills won’t either.
Should I use sleeping pills?
While sleeping pills may seem like a good solution, it’s just another “survival” tactic like over-the-counter sleep solutions. They’re for short-term use and don’t address the underlying causes of why you can’t sleep.
Prescription sleep medications have numerous side effects, including headache, change of appetite, nausea, fogginess the next day, nightmares, dry mouth, dizziness, and weakness, to name just a few outlined by the Sleep Foundation.
Some even come with black box warnings from the Food and Drug Administration (FDA), due to the seriousness of the side effects.
You can even become addicted to sleeping pills over time.
There are a number of alternative options that are safer and can offer better long-term results. Sleeping pills don’t address the root cause of your poor sleep. Ask yourself “why” you can’t sleep and address that issue.
Try alternative therapies. The American College of Physicians recommends cognitive behavioral therapy (CBT) as the first treatment option for people with insomnia because it’s than sleeping pills, with few side effects, if any.
With the menopause journey lasting a decade or more for some women, don’t try to “survive” the lack of sleep. Understand why you can’t sleep as knowing “why” can help you sleep better. Over time, sleep problems can impact your health, including raising your risk for conditions like heart disease, hypertension, obesity, and depression
There’s a healthier path to getting the recommended 7 to 9 hours of sleep each night.
Good sleep hygiene starts during the day
Your body goes through a sleep-wake cycle every day. What you do while awake can impact how well you sleep. Start a good sleep hygiene routine by taking steps during the day to improve sleeplessness at night,
1. Watch your caffeine intake even if you’re feeling exhausted.
When you’re exhausted, do you drink more caffeine to wake up in the morning? While this may jumpstart your day, it won’t help you kickstart a better sleep routine. And too much caffeine or caffeine too late in the day can exacerbate difficulties in falling asleep at the appointed hour.
Caffeine can cause problems at night. So, drink caffeine in moderation, even if you’re exhausted during the day. Otherwise, it’s hard to break into a better sleep-wake cycle.
2. Moderate your alcohol intake.
Alcohol is a sedative and makes some people feel sleepy, but that effect may be only temporary. Drinking alcoholic beverages can diminish your sleep quality and duration.
While you may fall asleep faster, and even that varies by person, alcohol may cause you to wake up in the middle of the night because of what’s known as the rebound effect. As the alcohol metabolizes and the effects are eliminated, your body bounces back from the depressant effect and disrupts your sleep cycle. Your body transitions from deep to lighter sleep during the rebound.
Plus, alcohol can have a diuretic effect, which may awaken in the middle of your sleeping period to go to the bathroom.
Women typically feel the effects of alcohol faster and sometimes at lower doses than men, so it doesn’t take as much to disrupt sleep.
Remember, CDC dietary guidelines regarding alcohol use indicate moderation means one drink per day for women. A drink is considered to be one of the following:
It is also important to note that alcohol use can increase your risk of high blood pressure, liver disease, dementia, and cancer (e.g., breast, colorectal).
Secondly, alcohol during menopause can exacerbate symptoms like hot flashes.
3. Eat nutritious meals.
Avoid large meals, especially before bed. They can increase the likelihood of heartburn from GI reflux, which in turn can cause discomfort and difficulty sleeping.
When you’re tired, you may be more inclined to grab junk food and high-fat foods. That can perpetuate a poor sleep cycle.
Studies show changes in sleep patterns can alter hunger sensations and appetite, leading to increased body mass.
4. Don’t eat before bed.
Researchers found eating too much at night can negatively impact sleep, especially for women.
Women who ate high calorie, high-fat and carbohydrate meals 30 to 60 minutes before bed, had higher sleep latency (the amount of time it takes you to go from being fully awake to sleeping; normal = 10 – 20 minutes).
Try to eat several hours before bed, and consider several small meals throughout the day rather than one large one if you find yourself eating too late at night or snacking all evening.
5. Exercise
A high-energy activity like aerobics can also help you get a better night’s sleep.
Try to get your heart rate up several hours before bedtime. Being very physically active right before going to bed can actually make falling asleep more difficult.
6. Get outside
If you work indoors, find time to go outside and get some sunshine.
Melatonin researcher, Russel J. Reiter of the University of Texas Health Science Center said, “The light we get from outside on a summer day can be a thousand times brighter than we’re ever likely to experience indoors. For this reason, it’s important that people who work indoors get outside periodically, and moreover that we all try to sleep in total darkness. This can have a major impact on melatonin rhythms and can result in improvements in mood, energy, and sleep quality.”
Studies have found morning light is most helpful in producing natural melatonin at night.
7. Find a way to unwind during the day and night.
If you have a stressful job or are dealing with a stressful personal situation, those worries can wake you at 3 a.m. or make it difficult to unwind when you’re trying to sleep.
Find time each day to relax your mind and body, even if it’s just five minutes of mindful meditation. It’s a natural remedy to help you get more sleep.
8. Structure your day according to your chronotype.
There is science behind why this happens and understanding that science can help you adjust your day to reduce stress, which can cost you sleep.
Whether you’re an early bird or night owl, that consistent regulation of your sleep and wake times are identified by your chronotype. It’s typically a permanent identification of when you sleep and wake.
There are three different chronotypes:
- Morning-types
- Evening-types
- Neither-types
About 60% of the population is classified as a neither-type, meaning you have no preference.
If you’re a night owl, you’ve likely been that way all your life. It doesn’t mean you can’t wake up at 7 a.m. for work, but early morning productivity may be more difficult for you.
Conversely, if you’re an early bird, you may be most productive first thing in the morning. By 3 in the afternoon, you may feel sleepy and less energetic.
These cues that your body sends you are linked to your chronotype.
Your chronotype also controls other body functions, and it’s difficult to change. For that reason, it can impact how well you feel, especially during menopause.
For example, early birds have an academic advantage in school. They typically earn higher grades. It makes sense if you think about it because most schools start early in the morning. If you’re a night owl, waking up and being productive is not as easy.
There are even trends that show one’s activities are impacted by chronotype. For example, night owls can be angry, depressed, impulsive, risk-takers, or anxious. They also tend to skip breakfast, use more substances, and spend more time on electronics.
If you’re a morning chronotype and you’re not sleeping well due to menopause symptoms, you may still wake up at 6 a.m. even if you were awake for several hours in the middle of the night.
Understanding why this happens can reduce the stress you feel when you wake up early even though you didn’t sleep well the night before. You’re either an early morning riser or you’re not.
So, adjust your schedule. If you’re a morning chronotype, workout and schedule meetings in the morning.
If you’re a night owl, adjust your meetings and workout schedule to the evening.
Optimize your day with this knowledge.
Take small steps as you “reset your clock”
Reset your clock by slowly making adjustments to your day. Which habits set you up for a poor night of sleep?
Sleep is a ripple effect. If you feel tired, you’re more likely to engage in unhealthy behaviors. You’re less likely to exercise and eat healthy. You’re more likely to eat junk food and drink caffeine. Breaking this cycle can be challenging when it continues day after day.
But, you have to start somewhere. Focus on what you do during the day. Then, move on to your bedtime routine.
How to create a bedroom environment for sleep
Are you feeling sleepy from all those daily activities? It’s time to focus on a bedroom environment that helps you sleep better.
1. Try to use the bedroom for only two activities – sleep and sex.
Don’t look at your phone, watch TV or exercise in your bedroom. You have to signal to your body the bedroom is only for two activities, and they both happen in bed.
2. Make your room dark.
Ambiance matters.
Get room darkening shades and dim the lights signaling to your body that it’s time to sleep.
You can wear a sleep mask over your eyes to signal darkness to your body.
3. Cool down your room.
Four out of five people said a cool room temperature was one of the most important factors for good sleep in a National Sleep Foundation poll.
So, what’s the magic temperature? Approximately 65 degrees Fahrenheit. It can vary, depending on the person. Most doctors recommend between 60 and 67 degrees.
Your body temperature naturally dips at night, so turning down the temperature helps signal to your body that it’s bedtime.
If you keep your bedroom warmer, it may cause a higher core body temperature. When that’s the case, you may not enter the restorative sleep cycle you need or will spend less time in that stage of sleep.
If there’s a big difference between your core temperature and extremities, it can also cause you to wake up in the middle of the night.
So, turn down the thermostat.
If you’re experiencing night sweats or hot flashes and need additional ways to keep cool, use a fan, get cool sheets like silk, or keep an ice pack under your pillow. There are also cooling sheets and pajamas which will help keep you cool and wick away sweat.
4. Keep your bedroom quiet or consider sounds that will help you sleep.
The only noise should be the hum of a white noise machine, a fan to keep cool, calming music that eventually turns off, or perhaps binaural beats.
You listen to these two beats with headphones or earbuds. Over a period of time, binaural beats can change your brain wave activity and your arousal levels.
So, if you’re energized before bed, by listening to certain sleep-inducing tones before bed, you can ease your body into sleep mode.
Creating a bedtime routine
In addition to an environment that’s cool, dark, and quiet, create a bedtime routine that you follow every night.
Around the same time each evening, take steps to wind down from a busy day. Calm your mind and body, so you’re ready for a restful night of sleep.
Set the stage by dimming the lights, turning down the thermostat, turning off devices, and turning on calming music.
You can make it an evening for the senses:
- Diffuse a relaxing oil on the nightstand.
- Listen to calming music.
- Practice meditation.
- Journal (gratitude or other).
- Turn off devices.
- Turn down the lights.
- Try a white noise machine.
- Take a warm bath before bed. The dramatic drop in body temperature after a warm bath can help stimulate sleep.
- Drink chamomile tea or other caffeine-free herbal tea.
- Practice yoga.
While most exercise should be done during the day, at least 2-3 hours before bedtime, some yoga poses may prove beneficial before bed. The poses and deep breathing can bring your body into a relaxed state.
Go ahead and put on your pajamas or other loose-fitting clothing, and remember to move the yoga mat to another room. You’re only using your bedroom for sleep and sex.
For ideas, Harvard suggests several simple yoga poses.
How to fall back asleep when you’re awake in the middle of the night
You’ve set the stage for sleep, and hopefully, you fall asleep fast.
But, what is it about menopause and those middle-of-the-night awakenings?
Hot flashes, night sweats, and other hormonal changes can impact your quality of sleep and arousal level.
Even if you are exhausted, you may still wake up at 3 a.m. and struggle to fall back asleep.
1. Don’t worry about not being able to sleep.
When you wake up in the middle of the night, don’t be judgmental. Try not to worry about the fact that you’re not asleep or it’ll make it harder to fall back asleep.
Don’t look at the clock or your phone. It only adds to your worries and makes falling back to sleep more difficult.
2. Tense and relax your whole body progressively.
Try progressive muscle relaxation. While the goal is to relax, you’re going to start by tensing up your muscles.
Start at your toes and work your way up to your head. Tightly tense each muscle group for five seconds. Then, relax. That will progressively relax the major muscles in your body, helping you fall back asleep.
3. Distract your mind.
You can distract your mind by counting backward, singing a song, or visualizing yourself somewhere else.
If you need guidance, try Sleepcasts by Headspace. They have free ones on YouTube, and then you can also purchase a subscription for longer ones.
You’ll want to have these at the ready if you’re having trouble sleeping, as you don’t want to be searching on your phone at night. It will only make it harder to fall back asleep.
4. Try the auditory illusion – binaural beats.
Again, you’ll want to have the beats ready to go, so you’re not looking for them in the middle of the night.
With these beats, the music plays the same tone at different frequencies so your brain hears a third tone. That third tone is the difference between the first two.
Learn how that auditory illusion works and how to find the best tone to put you to sleep.
5. Get out of bed.
If none of these sleep hygiene tricks work after 15 or 20 minutes, get out of bed.
The National Heart Lung and Blood Institute says the anxiety of not falling asleep can make it harder to do just that – fall asleep. Walk out of the bedroom and try a relaxing activity like reading a book or listening to music. Come back to the bedroom when you’re drowsy.
6. Consider a consultation with a Chinese medicine practitioner.
In Chinese medicine, there is a system of meridians with which the different parts of the body and the various organ systems are associated. They also have meaning relative to sleep issues which may help provide additional insights that could lead to solutions you may not have considered.
Acupuncture and herbal medicine are potential considerations in your exploration of approaches to getting the sleep you need.
6. Yawn
The yawn is so powerful it’s contagious. Ever yawn after you see someone else yawn?
The spontaneous widening of your mouth and deep, slow breath happens throughout the day, with little thought.
It’s a way of regulating your brain temperature. The deep breath brings cool air into your body and the widening of your jaw increases blood flow to the brain, thus cooling it.
Flip the switch on this and make yawns work for you at night. Consciously yawn repeatedly when you wake up in the middle of the night. Cool down your brain temperature, slow down your breathing, and deliberately focus on your breath. Yawn repeatedly.
Those yawns can actually make you sleepy again.
Techniques and gadgets to improve your sleep hygiene
1. Cognitive brain therapy
If your sleep is so disrupted that it’s impacting your daytime activities, you may be experiencing insomnia. Consult a doctor for a diagnosis and treatment.
In 70-80% of insomnia patients, cognitive behavioral therapy (CBT-I or CBTI) is effective, according to the Sleep Foundation.
The American College of Physicians recommends it as the primary approach, as it’s more effective than medications.
Even if you’re not experiencing insomnia, it’s worth mentioning as all women can informally try some of the CBT techniques and incorporate them into their sleep routine. You can also read a more detailed review of CBT and how it can help you sleep better.
During CBT-I therapy, you explore thoughts, feelings, and behaviors that contribute to insomnia.
The provider helps the individual clarify and reframe misconceptions and challenges to promote more restful sleep. These thoughts may include anxiety about previous experiences, unrealistic expectations of sleep time and quality, and worry over how you’ll feel the next day when you don’t sleep.
Ever had any of those thoughts? You don’t need insomnia to have experienced that. You just need menopause!
In the middle of the night, reframe your thoughts. Here are some ideas.
| Stop Saying This... | And Say This Instead. |
|---|---|
| I won't make it through the day tomorrow. | I've done it before and will do it again. |
| I have too much to do. | I can prioritize and overcome this. |
| Menopause is awful. | This is a time of self-awareness and awakening, and I will come out of this stronger. |
| I may never sleep again | This too shall pass with time. I can only control what I can control. |
What can you say to yourself to help reframe your thoughts at night and help yourself get back to sleep?
2. Paced breathing
Finally, focus on the most fundamental part of life – your breath.
The 4-7-8 method is a popular way to relax your breath.
Breathe in for 4 seconds.
Hold it for 7 seconds.
Exhale for 8 seconds.
Dr. Andrew Weil, founder and director of the University of Arizona Center for Integrative Medicine and a healthy living professional, teaches the 4-7-8 method and suggests learning this technique sitting up.
He instructs you to place your tongue just behind your upper front teeth, and keep it there throughout the exercise. You’ll exhale through your mouth and around your tongue.
Dr. Weil calls it a “natural tranquilizer” for the nervous system. It’s subtle at first and gains effectiveness the more you do it.
Practice paced breathing at least twice a day. That way, you’re an expert when you need to tap into this skill at night.
You can also use it to help calm yourself when something upsetting happens, or you’re feeling stressed, anxious, or angry.
3. Wearable device for better sleep
Like everything else, there may be a wearable device to get you in the right “wave” of sleep. Embr is a wearable that sends engineered sleep waveforms to help control your temperature, so a hot flash doesn’t wake you.
The device instantly cools or warms the inside of your wrist with a thermoelectric heat pump that sends cool and warm sensations to your wrist and eventually to your brain.
Think of it this way – when you’re hot, you may grab a cold towel and put it on your head. That sensation of cold can make you feel better as it communicates with your brain. The wearable device applies the same concept and allows you to cool down naturally.
Embr doesn’t change your temperature but changes the way you feel. Another form of powering your brain to make you feel a certain way.
Wired calls it “bio trickery.”
4. Weighted blanket
You can also try to change the type of blanket that you use on your bed. Weighted blankets are heavier than normal and come in different weights. They’ve been shown to have therapeutic benefits for insomnia and other conditions.
In a small study, a weighted blanket that weighed approximately 12% of your body weight was found to increase the release of melatonin by as much as 30%.
In addition to releasing more melatonin, researchers believe these heavy blankets help your body produce more serotonin (happy hormone), and reduce cortisol (stress hormone). Less stress and more happiness can also improve your sleep, according to the Sleep Foundation.
Weighted blankets are generally safe, but use caution with weighted blankets, especially around children, as they’re heavy and difficult to lift.
The future of sleep
Researchers continue to look for new ways to treat the sleeplessness experienced during menopause. Light therapy may be an emerging technique.
It’s used for people with Seasonal affective disorder or SAD during the winter months. Exposing them to light can boost their mood as there is less daylight during the winter and fewer opportunities to get outside.
The same principle, combined with sleep therapy, may be able to help depression and sleep quality in perimenopausal women according to a small research study at the University of California and presented at The Menopause Society conference.
Participants saw results in just two weeks.
Don’t overwhelm yourself with a long To Do list for a new sleep routine. Try a few of these habits and techniques.
Keep track of what works with a sleep diary.
What sleep habit works best for you?
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