Hot Flushes, Sleep and the Menopause – all your questions answered
As levels of Oestrogen and Progesterone gradually decline during perimenopause and menopause the number of problems of menopause increase. For example, studies show that 50% of women who approach menopause sleep less than six hours a night, compared to the recommended 7-8 hours. According to the National Sleep Foundation, approximately 60% of menopausal women have sleep problems.
So why do these hormonal changes have such a big effect and how can you reduce the impact on your sleep?
Problems of menopause
The most common menopause sleep problems include hot flushes (also referred to as ‘flashes’), sleep disordered breathing, and general insomnia. Other sleep disorders which may develop include restless leg syndrome and periodic limb movement disorder. Both disorders involve involuntary leg movements which can be uncomfortable and disturb sleep.
Progesterone and oestrogen levels decrease during menopause. Generally, oestrogen is an energy booster and progesterone has a soporific (sleepy) effect. This loss in levels of both these hormones have different effects on a woman’s body during menopause.
Let’s look at both in more detail:
Oestrogen and progesterone in menopause
Progesterone – as progesterone has a soporific effect, its decline has a direct effect on both the ability to get to sleep and stay asleep. Progesterone loss has also been linked to Sleep Apnea, a condition of repetitive nightly wakening which needs medical supervision as it disrupts breathing at night.
Oestrogen – the loss of oestrogen in menopause is linked to hot flushes. Hot flushes in menopause occur when there is a surge of adrenalin and therefore an increase in temperature and perspiration. This adrenalin spike awakens the brain, and can often keep the sufferer awake past the flash as it sometimes takes a while for the peak in adrenalin to leave the system.
Another area where the lack of oestrogen causes problems in menopause is in the changes of cognitive function in the brain (short term memory loss) as well as mood control (depression more than anxiety). The direct effect of loss of sleep further exacerbates memory and mood changes associated with menopause, including increased anxiety.
Finally, oestrogen loss is linked to a reduced intake and secondary production of magnesium, a mineral which helps muscles relax, which in turn helps to induce sleep.
Problems of menopause – hot flushes
Menopause sleep problems are in large part, thanks to those pesky hot flushes. These affect up to 80% of all women. Whilst they can last up to ten years the vast majority of women experience hot flush for between 6 months and 2 years.
A hot flush typically starts in the face with an increase in blood flow. As this temperature rise spreads to the rest of the body it can then wake you up. Not only can the increase in body temperature make it difficult to get back to sleep, but hot flushes are accompanied by an increase in adrenaline which can make us more alert and awake.
Top tips for reducing hot flushes in menopause include:
- Keep your bedroom cool
- Spray your face with cold water when you feel an ‘attack’ coming on
- Wear loose and light bedclothes such as silk or cotton
- Invest in light bed sheets that allow your skin to breathe
- Consider stopping smoking
- Reduce or cut out tea and coffee
- Cut down on alcohol and increase iced drinks
- Have a lukewarm bath or shower before bed (avoid hot water)
- And finally, if you think your medicine could be causing or exacerbating the hot flushes see your GP
It’s not all about hot flushes though. Menopausal and postmenopausal women tend to need the toilet more often than premenopausal, so if you suffer from frequent urination, try to stop fluid intake earlier in the evening.
Problems of menopause – Sleep Disordered Breathing
Another common problem of menopause is the change in breathing during and following menopause. Research has shown that this is due to the reduction of progesterone. One of the roles of progesterone is to maintain the open structure of the airways. Postmenopausal women have twice the likely incidence of Obstructive Sleep Apnoea (OSA). This is a condition which is characterised by temporary pauses of breathing, snoring and lower sleep quality.
Progesterone has respiratory stimulant properties that maintain the tone of the genioglossus muscles. Due to lack of this hormone in postmenopuasal women, chances of OSA increase.
Note: when the loss of progesterone is replaced in Hormone Replacement Therapy the incidence of OSA reduces.
Easing problems associated with menopause
Food and menopause
Dietary changes can have a large effect on menopausal symptoms. Soy products such as tofu, soybeans, and soymilk contain phytoestrogen, a plant hormone similar to oestrogen and can lessen hot flushes in menopause.
Supplements such as Ginseng, Extract of Red Clover and Black Cohosh contain phytoestrogens and can help. Evening Primrose oil is also often recommended.
Changes such as having less salt and sugar are also useful as well as eating more Calcium-based food, such as the bones of soft bony fish (sardines) and nuts. Nuts are a great source of Magnesium, especially Brazil Nuts and Almonds as is brown rice and dark green leafy vegetables.
Increasing fibre intake and fluid can soften stools and make it easier to pass, but if you suffer from increased night-time visits to the loo, stop fluid intake earlier in the evening.
Our gut flora is especially important in sleep and can be affected by hormone fluctuations. Try a probiotic or eat natural unsweetened yoghurt to help support the beneficial gut flora.
A more vegetarian-based diet reduces symptoms too, but be aware, spicy and acidic foods may trigger hot flushes.
Avoid eating large meals especially before bedtime.
Sleep and menopause
One way to optimise sleep is to try to go to bed and wake up at the same time, seven days a week. By maintaining a regular sleep routine we strengthen the body clock (or Circadian Rhythm) which in turn makes it easier to get to sleep, stay asleep and achieve a deeper, more restorative night’s sleep.
Your brain also likes routine and a bed-time routine makes it easier to get to sleep. A warm bath (if you don’t suffer hot flushes), brushing your teeth (with the bathroom light off), followed by reading a book are all great ways to relax and get your mind ready for sleep.
Avoid taking technology into the bedroom as this stimulates the mind. The blue light from tech screens has also been proven to keep us awake. Blue light suppresses the body’s release of melatonin; the sleep hormone. Avoid all screens from about an hour and a half before bedtime. Consider purchasing a good old fashioned alarm clock, if the temptation to do the social media doom scroll is too much when setting your morning alarm!
Another routine worth developing is to have a system of falling back to sleep if you wake up from a night sweat. The key here is avoid doing something which could wake you up further, so keep the lights off, and stay in bed if you can. Avoid looking at tech or switching the TV on and make sure you have a glass of cold water and a change of clothing to hand too.
In addition, it’s always worth making sure you aren’t waking up to use the toilet in the middle of the night, so avoiding drinking drinks late at night is a wise strategy.
Relaxation techniques, meditation, breathing exercises and yoga are great tools to aid sleep throughout our life. They are especially beneficial during menopause as they can also help with the mood alterations associated with menopause and reduce stress too.
Stimulants such as nicotine and alcohol are best avoided, especially before bedtime. Whilst alcohol can help you get to sleep it reduces the amount of deep restorative sleep and can increase hot flushes. Caffeine is also best avoided, or stopped at lunchtime given its well-known effects on sleep. Caffeine takes around eight hours to leave the system and as a stimulant, it can also trigger those dreaded hot flushes.
If you are losing sleep at night, whilst a nap around the Lunchtime Siesta period can be useful it’s always best to avoid a nap too close to bedtime. This can prevent you from sleeping well at night. Also aim to keep your nap to a 20-minute power nap if possible.
Sleeping in the foetal position can help reduce the pressure on the abdomen (verses on the back or face down). Sleeping on the left-hand side can avoid pressure on the liver and can help brain detoxification at night too.
Weight and menopause
With the declining oestrogen levels after menopause, it’s easier to gain weight, particularly around the abdomen. Higher body weights are associated with Obstructive Sleep Apnoea (OSA).
With regards to diet, a Mediterranean diet is recommended as best for health and sleep but remember it’s best to avoid spicy, acidic and large meals before bedtime as all of these can trigger hot flushes.
If you are having trouble sleeping, at any age, exercise is one thing to consider as a way of improving both quantity and quality of sleep as well as your vitality and general mood. Exercising outdoors in the morning is a great way of getting your morning dose of endorphins, the feel-good hormones produced by exercise, with the sunlight strengthening your Circadian Rhythm and helping with Vitamin D production too. Exercise has also been shown to decrease menstrual pain possibly due to the endorphin production which are also natural pain killers.
Weight training is often recommended to menopausal women because it is low impact and increases bone density, therefore good for ladies that are in the stages when Osteoporosis risks are higher due to low oestrogen levels.
Strength training is also recognised as a means of controlling hot flushes and night sweats because women with a higher lean body mass (essentially with more muscle than fat), have reduced vasomotor symptoms of menopause (sometimes by as much as 70%).
Building lean muscle fat can actually help women live longer because it helps keep diseases such as cardiovascular disease, some cancers and osteoporosis at bay, all conditions that often affect post menopausal women.
During menopause, the reduction of oestrogen and progesterone leaves women less able to cope with the many stresses of daily life. Introducing strength training can help release endorphins that can improve well-being and state of mind, as well as building confidence and self-esteem.
Want to get started with weight training but don’t know where to start? Check out the Strength Training Guide for Beginners.
Hormone Replacement Therapy (HRT)
From a medical perspective, treatment with Hormone Replacement Therapy (HRT) has been found to help relieve menopausal symptoms. The two main ones are Oestrogen Replacement Therapy (ORT) or with oestrogen and progesterone (Hormone Replacement Therapy (HRT).
The individual effects vary from woman to woman, depending on the form taken (pill, patch, gel, cream or injection) and the number of years used. However, research now suggests that HRT can raise the risk of certain health conditions, such as blood clots, stroke and heart diseases. If you are considering taking ORT or HRT speak to your GP about any concerns you may have.
It’s important to remember that not all sleep problems around premenopausal and menopausal age are due to hormonal changes. Age related issues such as joint pain and incontinence can also contribute to loss of sleep. If you are having trouble sleeping, please see a specialist. Things which they can consider are Cognitive Behavioural Therapy (CBT) to help with any anxiety or depression which can be influenced by lost sleep (or causing it). Slow release Melatonin (the sleep hormone) can also be prescribed. Melatonin production can often decrease with age.
Remember; the changes of menopause are temporary. This can make the mental challenge of coping with the symptoms of menopause manageable.
This article was written by guest writer, Dave Gibson of The Sleep Site. Dave is a Sleep Coach, Hypnotherapist and Osteopath with over 20 years practice in London. He specialises in sleep, stress and weight management. A Natural health care professional with huge dedication and extensive knowledge, in his Osteopathy course Dave qualified top in all four years which has only been done twice in the 100 years of the course!