There is nothing worse than not being able to sleep. The initial boredom as the minutes tick by; the encroaching panic as you count your thousandth herd of sheep; the existential abyss of 3 a.m. when your deepest regrets compete for attention with remembering you need to change the furnace filter.
And while the causes of sleeplessness are many 鈥 caffeine after noon, before bed, that second glass of wine with dinner 鈥 there鈥檚 one common culprit that鈥檚 harder to predict: your hormones.
In particular, sleep disruption is a common symptom of the hormonal changes that begin with and continue in (defined as not having a period in over a year) and beyond.
Perimenopause can begin in your early 40s 鈥 occasionally as early as your 30s 鈥 leading up to the 鈥渕enopausal transition,鈥 which is before your period stops for good but while you鈥檙e experiencing symptoms like hot flashes, mood changes and irregular periods and, well, post-menopause is the rest of your life: that鈥檚 a sizable population of sleepless folks struggling to get eight hours of restorative shut-eye during some of the most demanding phases of their lives.
鈥淥ften the complaint is frequent awakenings during the night,鈥 said Judith R. Davidson, a psychologist and somnologist (that鈥檚 a sleep doctor) at Queen鈥檚 University, and author of a guide to 鈥渞eversing insomnia鈥 called 鈥.鈥 鈥淚f you鈥檝e had sleep difficulties like insomnia before the menopausal transition, you are more likely than those who have not to continue to have sleep difficulties, and they may worsen.鈥
In fact, 40 to 56 per cent of people in the menopausal transition and post-menopause report difficulty with sleep, according to Davidson, who added that hot flashes are often the cause. On the flip side, she noted, up to 60 per cent of people don鈥檛 report sleep difficulties with menopause so 鈥 reasons to be hopeful if you鈥檙e not there yet.
What can you do to combat hormone-related insomnia, if you鈥檙e experiencing it? We asked Davidson for her evidence-based expertise for falling, and staying, asleep.
Address the hot flashes
鈥淜now that it is normal to have some sleep disruption due to hot flashes,鈥 said Davidson. 鈥淗ot flashes occur as estrogen levels drop. They seem to involve both a shift in the internal temperature set-point and an arousal; these happen at the same time.鈥 She added that people have hot flashes for a median 7.4 years, although this can vary widely among individuals.
She recommends 鈥渋n the moment鈥 interventions like cooling your forehead with a damp cloth, or removing blankets and turning on a fan when you鈥檙e in the midst of a hot flash.
Seek sleep help if you need it
Davidson defines insomnia as 鈥渢rouble falling or staying asleep at least three nights per week, that interferes with functioning and that persists for at least three months.鈥 What鈥檚 the best way to deal with it? 鈥淚f the awakenings start becoming longer and are interfering with your well-being, then cognitive-behavioural therapy for insomnia has been shown to be the most helpful intervention for women with hot flashes and insomnia.鈥
There are a number of digital resources she recommends, including , and , which can help you tackle your insomnia without even having to change out of your PJs. A bit like having a sleep therapist in your pocket, these are apps that offer 鈥渟leep training鈥 on your phone, taking you through everything from how to properly track your sleep to behavioural changes that will help you sleep better.
As for medication, Davidson hasn鈥檛 seen 鈥済ood evidence鈥 for medications to help with sleep disruption specifically related to menopause, but that鈥檚 a conversation you should have with your own primary care provider.
Try not to stress about troubled sleep
We鈥檝e all been there: you鈥檙e up at 3:30, your alarm goes off at 6 and you鈥檇 do anything to get a split second of REM before your hectic day starts in, oh great, only two hours now. The worst thing you can do is start worrying about sleep in the middle of the night, said Davidson. 鈥淭his can prolong the awakening. I know it鈥檚 easier said than done, but worrying, problem-solving, analyzing and planning are all mental activities that tend to prolong nighttime awakenings.鈥
Instead, consider getting out of bed entirely and going into another room, doing something calming that鈥檚 not scrolling TikTok and trying again when you feel sleepy.
Practise good 鈥渟leep hygiene鈥
Good sleep starts when you鈥檙e awake. Davidson鈥檚 list of tips for what she calls 鈥渟leep hygiene鈥 (or habits): getting fresh air and movement during the day, turning off electronics at least an hour before bed, managing your levels through activities like meditation and journaling, and watching your alcohol intake. The Sleep Health Foundation suggests avoiding alcohol for at least four hours before bed, while binge drinking (defined as more than four drinks in one sitting for women) can disrupt your melatonin levels for up to a week. Also: watch out for sneaky sources of caffeine, like dark chocolate or hot cocoa.
Nap if you need to
One piece of advice we particularly like: take a nap during the day if you get sleepy. Per Davidson, the optimal nap time is between 1 and 4 p.m. One Harvard study found that a 45-minute siesta can improve your ability to learn, while another in the Journal of the American Geriatrics Society reported that over 65s who napped for 30 to 90 minutes performed better on memory tests. (A note of caution: those who napped for longer than an hour and a half performed just as badly as those who didn鈥檛 nap at all.)
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