Women over 40, menopausal women, and postmenopausal women have unique challenges to getting a good night’s sleep, compared to younger women.
Those of us who have babies at a “mature age” go right from having babies and the sleep disturbance that comes with it, into perimenopause. We don’t have sleep recovery time first. Moms over 40 who get up with babies or young children during the night can be especially challenged. If you are one of these moms, helping your child sleep through the night will help both of you! There are many approaches to this project, too much to go into in this post.
If you are in your 40s, and have sleep issues, insomnia, or a disturbed circadian rhythm (such as feeling tired in the day and wired at night), it’s ideal to tackle these problems while still in your 40s, before you enter menopause.
It’s much easier to sleep well through menopause and beyond, if you prioritize your sleep in your 40s, if not sooner.
Why do women over 40 often struggle with sleep?
These are the reasons, in a nutshell. I’ll explain each of them more, and offer solutions in the next post.
- Sex hormone changes.
- HPA-D (hypothalamus pituitary adrenal dysfunction), AKA “adrenal fatigue.”
- Depression and mood changes.
- Sleep Disordered Breathing (SDB), including sleep apnea.
- Fibromyalgia and other pain.
Reproductive (sex) hormones after 40
Your two major sex hormones are estrogen and progesterone. During perimenopause, which is the months and years before your periods stop completely, progesterone typically lowers first. Sometimes this happens over a long period of time, such as 10 or 15 years.
- Progesterone has anti-anxiety, calming, sedative effects. The first symptoms you may feel in perimenopause are anxiety and poor sleep, which are classic signs of low progesterone. Shorter menstrual cycles (less than 28 days), PMS, and periods that start with spotting are other signs of low progesterone.
- Estrogen tends to fall more quickly, typically close to menopause, which is the period of time when your menstrual cycles wind down and eventually stop. The average age for menopause is 51. Estrogen decline often correlates with poor sleep.
Adrenal hormones and HPA function
During menopause, your ovaries retire from producing estrogen and progesterone, and your adrenal glands take over. This a simplistic way of looking at it, but it’s important. In order to successfully sleep well through menopause, adrenal function must be “online.” Your adrenal glands must be healthy, and the communication between your brain and adrenals (HPA Axis) must be working.
The major adrenal hormone that governs sleep is cortisol. Read more about cortisol and sleep in the last post.
In Chinese medicine, we always improve adrenal function to support a healthy menopause. Every woman is unique in her presentation. You may have a perfect cortisol circadian rhythm, yet overall cortisol may be too high or too low. Or, your rhythm may be disrupted. Knowing these details, through the Dutch adrenal test, or the Dutch complete hormone test, is ideal for knowing exactly how to intervene.
Estrogen decline can cause hot flashes and night sweats
Estrogen fluctuations during menopause can affect your sleep, but it’s more complicated than you might think. Otherwise, hormone replacement would just take care of insomnia for all menopausal women. But in many cases, it doesn’t. I see many women who take hormones, even the best of the bio-identical hormones, with no improvement in sleep problems. Yet for others, hormone replacement is effective in reducing night wakings and improving overall sleep.
What causes night sweats and hot flashes?
When your ovaries produce less estrogen, then your hypothalamus in your brain puts out more female hormones called FSH (follicle stimulating hormone, which signals eggs to ripen), and LH (luteinizing hormone, which signals egg release). The wild fluctuations of LH and FSH affects the nearby vasomotor center of the brain. The vasomotor center regulates your blood pressure, blood vessel dilation, and heart rate. When this center is unstable, it can result in fluctuations in temperature (hot flashes, sweats), and heart rate (anxiety, palpitations, adrenalin rushes). By the way, this is the best current theory to explain hot flashes and sweats, but we don’t fully understand the mechanisms. We just know that hot flashes and night sweats are considered vasomotor symptoms, and can cause night wakings or “arousals” from sleep.
Estrogen also helps regulate the spike of cortisol that we experience in the morning. When estrogen declines, cortisol can rise earlier. You may start waking earlier, as early as two, three, or four AM.
In Chinese medicine estrogen is viewed as a yin substance which cools and anchors the body. It contains (quells) anxiety, adrenalin, sweat, heat. This is why acupuncture and Chinese herbs are often so effective in menopause.
Depression, estrogen, and sleep, a domino effect
Depression is another menopausal symptom. There is a complex relationship between depression, estrogen, and insomnia. It can be a “domino” effect. When estrogen declines, you can experience changes in vaginal tissue, as well as other changes that may affect you emotionally. This can lead to depression, and depression can cause insomnia.
Or, sleep changes can happen first, because of estrogen-related vasomotor wakings, and sleep deprivation can cause depression. You may even feel apprehensive or anxious about sleep, making the whole cycle worse. It’s somewhat a matter of which comes first, the chicken or the egg? Is it the estrogen decline, or the depression? Studies show that women with a history of depression are more susceptible to insomnia during menopause.
Menopause, sleep, and breathing
Did you know that menopausal women have a 3.5% increase in what’s known as “Sleep Disordered Breathing (SDB)?” Before menopause, women have SDB less often than men. After menopause, women are just as likely as men to develop SDB.
Unfortunately, most cases of SDB in women go undiagnosed. Women’s symptoms are different than men’s. Women’s snoring can be softer, what some people refer to as “lady-like snoring.” A woman’s primary symptom from SDB is daytime fatigue and sleepiness. However, health practitioners who treat insomnia and fatigue are not always accustomed to screening women for sleep apnea and other types of SDB, unless the woman is obese. These authors write:
Clinical studies have found that the majority of postmenopausal women who present with insomnia symptoms actually have significant obstructive sleep apnea (OSA).
Why does Sleep Disordered Breathing increase during menopause?
- It turns out that both estrogen and progesterone improve respiration.
- Menopause often comes with weight gain, and the extra weight in your abdomen and neck can cause breathing problems. Since obesity is on the rise, so is SDB.
Fibromyalgia and pain disturbs sleep
The onset of Fibromyalgia, a widespread pain syndrome, increases significantly during menopause. It’s also much more common in women than men. After menopause there’s a 7:1 ratio between women and men with fibromyalgia. Fibromyalgia is almost always correlated with poor sleep. It’s a catch-22 because poor sleep increases aches and pains, and fibromyalgia pain increases poor sleep. Many cases of fibromyalgia improve when sleep improves.
Other types of pain correlate with poor sleep. These includes arthritis, collagen disorders, and inflammatory conditions. Frozen shoulders are more common in women than men, and more common in women over 40. Hip pain, including bursitis and greater trochanter pain syndrome, are also more common in women compared to men, and more frequent during perimenopause and menopause. Achy hips or shoulders can be sleep disruptors.
There are many ways that pain and inflammation can cause night wakings. One obvious reason is that discomfort causes night wakings. Another reason is that pain and inflammation cause internal biological stress, which can raise cortisol and adrenaline, and contribute to night waking.
Please don’t despair
This post may feel like a downer, especially if you are currently having sleep problems. In the next post, which will be out very soon, I will offer my favorite sleep solutions and sleep management strategies for women over 40.