Insomnia and Menopause Part 2 - Indirect Effects

This article is part two of a two-part article reviewing the impact of menopause on sleep and the development of insomnia.

Part 1 reviewed the "direct" effects of reproductive hormone change on sleep. In Part 2, we are looking at the "indirect" effects that combine together to create insomnia in some peri- and menopausal women.

Menopause is rife with hormonal changes - it is the time of life for a woman that often gets defined by coping with some of these hormonal changes. Changes in reproductive hormones can affect sleep directly (see part 1). Other hormonal changes and symptoms can also influence sleep and importantly the way we cope with them.

Hot flushes and night sweats

Menopausal hot flushes are sudden changes in the body that rapidly produce intense heat and sweating and extreme discomfort. In some women, they can provoke nausea. Hot flushes are caused in part by an adrenalin surge - that "fight and flight" hormone that kicks in when we need to act fast in an emergency.1

If these hot flushes occur at night, these are accompanied by night sweats. Sometimes sweating is very heavy and intense, known as hyperhidrosis. These are extremely uncomfortable and irritating and typically will wake the woman up.2

Repeated waking in the night reduces the opportunity to sleep, as the woman will have woken up from her sleep because it is so uncomfortable.

How we can tip into insomnia

Like anything that can wake us in the night, how we handle it could either point us toward insomnia or away from it. If people begin to get anxious about what is waking them or the fact that they aren't sleeping, this sleep anxiety might tip them into insomnia.

If people remain in bed while they are awake as a result of whatever woke them up, this could also tip them into insomnia.

The struggle for menopausal women

These two patterns are widespread in everyone with insomnia, including menopausal women, and they create an association between being in bed and experiencing negative feelings and anxious thoughts. Menopausal women will struggle a bit more than others in reducing this anxiety when waking from a hot flush. This is harder for them at the moment because their bodies are filled with the adrenalin from the hot flush, making them mentally "keyed up" and hypervigilant.

Also, they may already have a lower sleep drive because of those hormonal influences discussed in part 1 of this article. Mindfulness strategies are particularly important for women with menopause-related insomnia to help handle the "effects" of their own response to waking in the night which can generate anxiety and sleeplessness that goes beyond waking from the hot flush.

Hormones, cravings, and habits

Hormone fluctuations can also create cravings, resulting in sometimes unhealthy eating habits. Unhealthy eating can also affect sleep. For example, eating late night can disturb digestion and the ability to sleep. Further drinks like tea, coffee, alcohol, and soft drinks can disrupt the sleep cycle as can a diet high in poor quality carbohydrates.3,4

What can menopausal women do about sleep troubles?

Women with menopausal insomnia might benefit from a collaborative approach to sleep issues.  A registered dietician may address any dietary issues that can be improved, and, a doctor can provide options for hormone replacement or other interventions. Cognitive behavioural therapy for insomnia can help the woman address insomnia directly.

Do you find your sleep varies throughout your cycle, or are you feeling peri- and menopausal symptoms that are affecting your sleep?  What have you tried that has helped you? Please share with our community!

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