NATUROPATHIC DOCTOR IN ONTARIO
Insomnia in Menopause and Perimenopause
Causes, Impact, and Naturopathic Solutions For Insomnia
Sleep and Insomnia in Menopause/Perimenopause
Sleep disturbances are common during the menopause transition, affecting up to 69% of women. Alongside vasomotor symptoms (VMS) like hot flashes and night sweats, insomnia is one of the most bothersome symptoms that can significantly impact quality of life. Addressing sleep issues during perimenopause and menopause is crucial, as it not only helps improve daily functioning but also mitigates other menopause-related health concerns. This article explores the causes, consequences, and naturopathic treatment options for insomnia in midlife women.
Why Do Sleep Problems Increase During Menopause?
Sleep disturbances during menopause often manifest as frequent awakenings, difficulty falling asleep, poor sleep quality, or waking up too early. These issues arise due to a combination of factors linked to the physiological changes occurring during the menopausal transition, such as:
Hormonal Fluctuations:
Changes in hormones, especially declining levels of estrogen and progesterone, play a significant role in sleep regulation. Estrogen helps maintain sleep, and its decline can disrupt the sleep-wake cycle, while lower progesterone levels have been associated with shorter sleep duration and increased wakefulness after sleep onset (WASO).
Vasomotor Symptoms:
Hot flashes and night sweats follow a circadian pattern, with symptoms often intensifying at night, leading to disrupted sleep. The body’s attempts to regulate core temperature during these episodes can wake a person from deep sleep, leaving them feeling unrested.
Mood and Anxiety Changes:
Perimenopause and menopause are also marked by an increase in anxiety and depressive symptoms, which can interfere with falling asleep or staying asleep.
Circadian Rhythm and Melatonin Production:
As women age, their circadian rhythms may weaken, and melatonin production—a hormone that regulates sleep—tends to decrease, further impairing sleep quality.
The Health Impact of Menopausal Insomnia
Sleep disruption during menopause is more than just an inconvenience. The negative effects extend beyond fatigue, influencing various aspects of health:
Cognitive Function:
Chronic sleep deficits can impair memory, mental clarity, and overall cognitive performance, leading to forgetfulness and decreased productivity. Lots of our perimenopausal patients are concerned that their brain fog is hormonal, but more often than not it’s a direct consequence at chronically poor sleep.
Weight Gain and Metabolic Health:
Poor sleep can alter nutrient metabolism, potentially leading to weight gain and metabolic issues. Sleep and energy metabolism are closely linked, and disruptions in sleep can contribute to the development of metabolic syndrome. This is an example of how the only way to lose weight in a hormonally fluctuant time is to make sure the foundations of health (including sleep) are well established before we move on to hormonal treatments.
Cardiovascular Health:
Sleep disturbances have been associated with increased markers of cardiovascular disease risk, independent of the presence of VMS. Postmenopausal women who struggle with sleep may face a higher likelihood of developing cardiovascular problems.
Hormone Therapy and Conventional Treatments for Menopausal Insomnia
Menopausal Hormone Therapy (MHT):
Using bioidentical hormone therapy can be effective for some women perimenopausal and menopausal women, particularly those experiencing VMS. Oral Micronized Progesterone has shown potential in improving sleep quality and reducing night sweats and hot flashes, and is often considered a safer hormonal option. In some cases adding in low dose estrogen therapy is also needed. The process of screening to ensure menopausal hormone therapy is both safe and will be an effective treatment option is clearly defined and must be customized to each patient.
Cognitive Behavioral Therapy for Insomnia (CBT-I):
CBT-I is a non-pharmacological intervention that helps change negative thought patterns about sleep and establish healthier sleep behaviors. Evidence shows that this is a viable treatment option for menopausal women with insomnia.
Herbal Remedies and Supplements
– Valerian Root and Passionflower: These herbs have been used for centuries for their calming effects and ability to improve sleep quality.
– Magnesium: Known for its role in muscle relaxation and sleep regulation, magnesium supplementation can help ease anxiety and improve sleep.
– Melatonin: Supplementing with melatonin may be beneficial for women experiencing circadian rhythm disruptions, as levels of this sleep-regulating hormone often decline with age.
– Black Cohosh and Red Clover: Traditionally used to manage VMS, these herbs may also indirectly improve sleep by reducing night sweats and hot flashes.
Mind-Body Techniques
– Acupuncture: Some studies suggest that acupuncture can reduce the frequency and severity of hot flashes, which in turn may improve sleep quality.
– Meditation and Mindfulness Practices: Techniques such as meditation, yoga, or breathing exercises can help alleviate stress and promote relaxation before bedtime.
– Biofeedback: Biofeedback training may help individuals learn to control physiological processes such as heart rate and muscle tension, potentially improving sleep.
Lifestyle Adjustments
– Sleep Hygiene: Developing healthy sleep habits can make a big difference in managing insomnia. This includes maintaining a consistent sleep schedule, creating a comfortable sleep environment, and avoiding caffeine or heavy meals close to bedtime. This especially includes keeping your phone out of your bedroom 🙂
– Regular Exercise: Engaging in regular physical activity can promote better sleep, though it’s advisable to avoid vigorous exercise close to bedtime, as it may be stimulating.
– Dietary Considerations: Nutrition in menopause is crucial. Eating a balanced diet that supports stable blood sugar levels and avoiding alcohol or spicy foods in the evening can help reduce sleep disturbances. There is some evidence that a low glycemic diet helps to reduce insomnia. In clinical practice we see that if a woman increases her protein at dinner time, stops eating 3 or more hours before bed, and has adequate overall calorie and nutrient intake, this alone often resolves insomnia.
The Complex Relationship Between Sleep, Hormones, and Health in Menopause
The sleep-wake cycle during menopause is affected by a delicate interplay of hormonal changes, VMS, mood shifts, and aging. This relationship influences not only sleep quality but also various health outcomes, from metabolic health to cardiovascular risk. While conventional treatments like hormone therapy can help some women, many prefer naturopathic approaches for their holistic and individualized nature. Insomnia in menopause is common and multifactorial, involving hormonal, physiological, and psychological changes. Addressing sleep disturbances is crucial for overall health, cognitive function, metabolic stability, and cardiovascular wellness.
Whether opting for conventional treatments, naturopathic approaches, or a combination, the goal is to restore balance and improve sleep quality, ultimately enhancing the well-being of women navigating the menopause transition.
Your Doctors: Meet Dr. Sarah and Dr. Janna
Dr. Sarah Goulding is a licensed naturopathic doctor in Ontario and has a BSc in neuroscience and biology from Dalhousie University (2004), and did her 4-year naturopathic training at the Canadian College of Naturopathic Medicine (2010). She’s since accumulated over a decade of clinical experience, and refined her practice to focus on women’s health and digestion. She is licensed and registered as a Naturopathic Doctor in Ontario by The College of Naturopaths of Ontario (CONO) and is a member of the Canadian Association of Naturopathic Doctors (CAND) and the Ontario Association of Naturopathic Doctors (OAND).
Dr. Sarah Goulding blends science and compassion, and acts as a personal health researcher to help you navigate your health. Tools that she uses include nutrition, supplements and botanicals, bioidentical hormones, and lifestyle modifications. The closer you get to the root cause, the gentler the therapies needed to resolve the issue.
Dr. Janna Fung is a licensed naturopathic doctor with a special interest in dermatology and women’s health. She has a passion for evidence based preventative medicine and strives to empower patients with the knowledge to achieve their optimal health. She understands collaborations is the only way to develop realistic sustainable health/wellness results and strives to develop individualized health goals with patients.
