Ways to Improve Menopausal Insomnia

Symptoms of perimenopause often begin about four to seven years before the final menstrual period and can last for several years afterward. Hormonal changes in the body, along with physical changes and life circumstances during this time, contribute to perimenopausal insomnia. Some ways to address perimenopausal insomnia include eating earlier, practicing healthy sleep hygiene, creating a better sleep environment, and considering certain medications.

1. What is Perimenopausal Insomnia? Characteristics and Causes

Insomnia is a sleep disorder that prevents the body from getting enough rest. It is typically classified into two types:

• Chronic Insomnia: Difficulty sleeping at least three times a week for a minimum of three months.
• Short-Term Insomnia: Difficulty sleeping that lasts for a period of three months.

Perimenopausal insomnia includes challenges such as trouble falling asleep, while others may struggle to maintain sleep. Authors of a 2018 review indicate that nighttime awakenings are the most common sleep disturbance for individuals going through menopause.

1.1. Characteristics of Perimenopausal Insomnia

Does perimenopause lead to insomnia? During and after the menopause period, women are at a higher risk of developing insomnia, a sleep disorder characterized by difficulty falling asleep and maintaining sleep. This common condition during menopause may be related to anxiety and depression. Hormonal changes and life circumstances contribute to a decline in mental health in the years leading up to and following menopause, resulting in chronic insomnia.

In the perimenopausal stage, the ovaries begin to produce lower levels of key hormones such as estrogen and progesterone. The decrease in these hormone levels leads to various hormonal, physical, and emotional symptoms.

1.2. Causes of Perimenopausal Insomnia

Perimenopausal insomnia can arise from various causes, including:

1.2.1. Hot Flashes

Hot flashes and night sweats are common vasomotor symptoms during menopause that can negatively impact sleep. When hormone levels fluctuate, they can lead to changes in body temperature, causing sudden feelings of warmth and cooling. This sensation is primarily due to elevated adrenaline levels. The body struggles to recover from these abrupt hormonal changes, resulting in difficulty falling asleep or perimenopausal insomnia.

A 2021 study involving perimenopausal women found that hot flashes affected 42% of participants, with nearly half experiencing perimenopausal insomnia symptoms. Additionally, authors of another 2021 study reached similar conclusions, noting that severe hot flashes and sweating were associated with poor sleep quality.

1.2.2. Changes in Hormone Levels in the Body

During the menopausal transition, the body produces increasingly less estrogen and progesterone, hormones related to the reproductive cycle. These changes affect various systems and processes in the body, including those influencing sleep.

• Temperature Regulation: In menopause, estrogen deficiency makes the brain more responsive to temperature changes. This leads the brain to initiate cooling processes, such as sweating, at lower body temperatures, resulting in hot flashes and night sweats.
• Mood: Fluctuations in estrogen levels can impact neurotransmitters involved in mood regulation. This may explain why mood swings, depression, and anxiety are more prevalent during the menopausal transition, along with related sleep difficulties, including perimenopausal insomnia.
• Metabolism: Menopause affects how the body metabolizes food into energy. Low estrogen levels can lead to weight gain, which in turn contributes to perimenopausal insomnia, sleep apnea, or snoring.
• Circadian Rhythm: After menopause, many individuals experience a weakening of their circadian rhythms, which are biological processes that operate on a 24-hour clock, including the sleep-wake cycle.

1.2.3. Use of Certain Medications

Similar to the natural hormonal changes in the body, alterations caused by medications or dietary supplements can also lead to perimenopausal insomnia.

Researchers in a 2016 study found that the use of certain medications affecting the central nervous system during the perimenopausal period can impact overall sleep during menopause.

2. What Should Be Done to Treat Perimenopausal Insomnia?

Currently, there are various ways to treat perimenopausal insomnia, including the use of medication, therapy, and lifestyle changes.

2.1. Use of Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is the first-line treatment for perimenopausal insomnia for those experiencing chronic insomnia. This method helps individuals recognize negative patterns, behaviors, and thoughts that may impact their sleep. After identifying specific patterns, the therapist will provide strategies to address and treat perimenopausal insomnia.

2.2. Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT) is a treatment for perimenopausal insomnia that helps manage menopausal symptoms such as hot flashes, night sweats, and insomnia. This treatment replenishes levels of estrogen and progesterone when the body’s natural hormone levels are declining.

Hormonal changes during menopause can lead to perimenopausal insomnia. HRT aims to restore estrogen and progesterone levels to alleviate symptoms like hot flashes, night sweats, and sleep disturbances.

HRT can be administered in various forms, including creams or gels, patches, and pills. Those using estrogen who still have a uterus should also take synthetic progesterone, often in pill form, to prevent irregular thickening of the uterine lining. Additionally, research suggests that using synthetic progesterone alone can help reduce hot flashes and night sweats. Moreover, melatonin, a sleep-inducing hormone, has been shown to improve sleep during and after menopause, as well as enhance mood and reduce hot flashes.

2.3. Use of Medications

Doctors may prescribe certain medications to treat perimenopausal insomnia. These include:

• Hormonal Birth Control: Low-dose hormonal contraceptives can help stabilize hormone levels in the body, which may reduce menopausal symptoms and improve sleep quality, serving as a remedy for perimenopausal insomnia.
• Antidepressants: These medications can address underlying mental health conditions that may contribute to perimenopausal insomnia. Types of antidepressants that may be used include selective serotonin reuptake inhibitors (SSRIs), duloxetine, amitriptyline, among others.
• Benzodiazepines: These medications can have sedative and muscle-relaxing effects, potentially aiding in better sleep.
• Melatonin: Melatonin is a hormone that regulates sleep-wake cycles. Melatonin supplements can help boost decreased melatonin levels in the body, promoting improved sleep.

3. Can Perimenopausal Insomnia Resolve on Its Own? Tips for Better Sleep During Perimenopause

In addition to the methods mentioned for treating perimenopausal insomnia, this condition may improve with appropriate lifestyle changes. Adjusting sleep habits and the surrounding environment can enhance sleep quality during menopause. Here are some strategies to improve the quality, duration, and onset of sleep:

• Optimize the Sleep Environment: Ensure the bedroom is cool, dark, and quiet.
• Manage Stress: Consider incorporating stress-reducing techniques, such as mindfulness meditation, into your nightly routine.
• Adopt a Healthy Diet: During perimenopause, focus on a low-fat plant-based diet rich in antioxidants, calcium, and vitamin D.
• Avoid Alcohol, Caffeine, and Tobacco: These substances can negatively impact sleep and increase hot flashes.
• Exercise Regularly: In addition to improving sleep, regular physical activity supports heart health, prevents bone and muscle loss, and helps reduce stress.
• Turn Off Lights: It’s important to turn off all lights, including phones, alarm clocks, TVs, and nightlights. Beeping or blinking lights can trigger wakefulness, even during sleep.
• Practice Relaxation Techniques: Techniques such as listening to soothing music or doing yoga before bed can help relieve stress, making it easier to fall asleep and stay asleep.
• Put Down Your Phone: Using smartphones before bed can negatively affect the ability to fall asleep and stay asleep.
• Alarm Clocks: A 2023 study found that insomniacs often check the clock when they wake up at night, which can heighten anxiety about sleep. Turning the alarm clock away or dimming its light may help improve sleep.
• Eat Earlier: A 2021 study found that eating within an hour before bedtime increases the likelihood of waking during the night. Going to bed on a full stomach can also cause heartburn and acid reflux, leading to insomnia.

In summary, this article outlines the causes of perimenopausal insomnia and various treatment options. While many may experience occasional sleeplessness, insomnia related to menopause can persist for weeks or months. If this is the case, it’s essential to consult a doctor for appropriate advice and treatment plans.