This post is about natural solutions, therefore I don’t cover medications. There are natural supplements that can help with sleep, and I’ll mention my favorites at the end. However, we Functional Medicine practitioners like to say that “you can’t supplement your way out of sleep problems.” This is true for medications as well.
Sleep problems are not a deficiency of a supplement or a medication.
The first three posts in this series describe how to change your lifestyle. Other than ruling out sleep apnea or breathing problems, do this first in all cases. Work with your lifestyle, and with your sleep hygiene. You need to get your sleep hygiene in order, as the importance of this is well documented.
Sleep problems usually mean there is a miscommunication between your brain and adrenal glands, disturbed circadian rhythms. They tend to worsen with stress, during perimenopause and menopause, and with age. I prefer to start with a thorough assessment of the communication between your adrenals and your brain.
Acupuncture for sleep
This meta-analysis of 34 studies shows that acupuncture reduces sleep disturbances in perimenopausal and postmeno youpausal women, regardless of the type of acupuncture. Specifically, acupuncture:
- reduces sleep disturbances
- increases serum estradiol (estrogen)
- reduces serum follicle-stimulating hormone (FSH)
- reduces luteinizing hormone (LH)
In the previous post I wrote that low estrogen, and high FSH and LH cause vasomotor symptoms, which in turn cause night wakings.
You may be afraid of acupuncture, because you may have fear or discomfort about “needles.” Find an experienced, gentle acupuncturist who uses fine Japanese needles. This type tends to be relatively painless. Many people don’t feel any sensation, other than a sense of calm and relaxation. Acupuncture modulates your nervous system, and moves you out of a stressed or anxious state into a relaxed state.
Progressive Muscle Relaxation (PMR)
Progressive Muscle Relaxation (PMR) is effective for the relief of hot flashes, night sweats, and sleep disturbances in perimenopausal and postmenopausal women, according to a randomized control trial.
PMR is based on the theory that relaxation is incompatible with tension and anxiety. Therefore applying relaxation should decrease anxiety and tension.
There are many types of PMR. My favorites are body scan recordings from Mindfulness Meditation, like track five here, or one of the five choices here, or The Mindfulness App, or simply Mindfulness App.
I also like the body scans used in the Feldenkrais Method®. I recorded this set from a live class. It includes body scans, and gentle movements with the hands, which are deeply relaxing to the nervous system. It’s hard to stay awake if you listen in bed!
“Paced breathing” is effective for hot flashes, anxiety, and sleep. You can practice it easily throughout the day, while standing, sitting, driving, walking, or lying down. There are apps that can guide you, such as Breathing Zone. If you search “paced breathing” you will find many different apps to choose from.
Here is a short easy article with instructions for paced breathing.
Or, simply follow these instructions:
- Inhale slowly through your nose to the count of 4. Expand your belly while you inhale, three dimensionally: forward, out to your sides, toward your back, and towards your pelvic floor.
- Hold to the count of 2.
- Exhale slowly through your mouth to the count of 4.
This type of meditation brings your attention to your breathing and body sensations. It’s shown to improve symptoms of stress, pain, anxiety, depression, and sleep. In this study, mindfulness meditation improved hot flashes, night sweats, and sleep.
Mindfulness meditation elicits a relaxation response, which leads to significant reductions in hot flash intensity, and the concurrent symptoms of tension, anxiety, and depression.
- Jon Kabat-Zinn
- Elisha Goldstein
- Apps: The Mindfulness App, or Mindfulness App
Cognitive behavior therapy
In ongoing studies such as this one, researchers are evaluating the efficacy of cognitive behavioral therapy for menopause-related insomnia.
Cognitive behavioral therapy for insomnia (CBT-I) is a form of psychotherapy with demonstrated benefits in 70% to 80% of individuals with insomnia. CBT-I focuses on the cognitive-behavioral-emotional triad to address sleep disturbances, by challenging and reframing thoughts. Behavioral management strategies include relaxation techniques and stimulus control.
Cognitive behavioral therapy (CBT) is the “treatment of choice” for managing the sleep/wake complaints of “Primary Insomnia” sufferers.
Cognitive behavioral therapy (CBT-I) eases insomnia symptoms and fatigue in menopausal women. The improvements are “robust,” even 6 months after treatment ends.
If you don’t have access to a CBT therapist, telephone-based CBT-I was shown to improve sleep in perimenopausal and postmenopausal women with insomnia and hot flashes. There are books and self-help programs for CBT, such as this one.
If you do discover that you have sleep disordered breathing, including sleep apnea, it is important to treat it. If excess weight is causing airway restriction, weight loss will help. In addition, you can get an oral appliance to widen your airway. If needed, a CPAP breathing machine will make a world of difference.
These disorders increase 3.5% in frequency after menopause. Without treatment, your sleep can be quite disrupted, and you may experience significant fatigue during the day.
Herbal medicine and supplements
Sometimes the best course is to use small doses of bio-identical hormones. This can include DHEA, pregnenolone, melatonin, progesterone, and/or estrogen. I prefer small doses of individually tailored bio-identical hormones. The proper use of CBD (cannabinoids) can also greatly help sleep. You need professional help with these courses of action.
Here is a list of many of my favorite herbs and supplements for sleep. Each has a different mechanism, such as affecting GABA receptors, lowering cortisol, or quieting your mind. Often a combination or “cocktail” approach works best. These are under the sleep category in my Dispensary. I highly recommend professional guidance when using herbal medicine or supplements. Also, the market is not well regulated, so brands do matter!
- Kavinace and Kavinace PM
- Cortisol manager
- Calms Forte
- End Fatigue Revitalizing Sleep®
- Relora Plus
- Passionflower Extract
- HPA Axis Sleep Cycle
- Gaia Sleep Formula
- Gaia Sleep and Relax Tea
- Traditional Medicinal’s Nighty Night Tea (not in my dispensary)
If you need help, please schedule an appointment.
I welcome comments and questions below.