If you feel as if you’re not sleeping as well as you used to, it may not be all in your mind: A raft of studies have now confirmed that, starting around age 40, shifting hormones can have a very real impact on a woman’s quality of sleep.
In perimenopause, the most frequent complaint is “what’s called ‘maintenance insomnia,’ in which you have no trouble falling asleep but you can’t stay asleep as long as you feel you need to,” says Lisa Shives, MD, of the University of Chicago/Evanston Hospital & Northshore Sleep Medicine. In fact, early-AM awakenings were the most frequent complaint among the younger women in a study analyzing the sleep reports of a multi-ethnic group of 3,000 women who were between the ages of 42 and 52 when the 7-year follow-up began.
As you transition into menopause and beyond, sleep problems seem to go hand-in-hand with other physical symptoms. Not surprisingly, women who have more frequent hot flashes and/or night sweats have more trouble falling or staying asleep. Decreasing levels of the hormone estradiol and increasing levels of follicle stimulating hormone may be to blame.
Here’s how to improve your sleep life:
Don’t go to bed if you’re not actually sleepy. It sounds foolish “but many women have trouble falling asleep because they confuse feeling tired, which means you may need a little quiet time, with feeling truly sleepy, which is what happens when you literally feel your eyes getting heavy and ready to close,” says Shives. “Getting into bed when you’re not truly sleepy just raises the anxiety level about not being able to fall asleep.”
Keep the lights low two hours before bedtime. Light—and lack of it—is the number one signal to the brain that you should be going to sleep. If you like to read before bedtime, use only a reading lamp, no other lights in the room. And if you’re what Dr. Shives calls a “fragile sleeper,” avoid the computer. “The suprachiasmatic nucleus, which is the part of the brain that is the circadian timekeeper, is super-sensitive to light stimuli, so the light emanating from your computer screen is signaling the brain that it’s bright daylight,” she notes.
Get the TV out of your bedroom. More than 50 percent of Americans have one there—and Shives is convinced that the most popular shows today, many of which revolve around stressful situations such as murders or crimes, rev us up to a point where it would be hard for anyone to simply fall asleep. Constantly shifting visual images is also stimulating, not calming, to the brain.
Take a hot bath or shower. “I can’t believe I got a medical degree to hand out the advice my grandmother gave me, but it does help,” admits Shives. The reason, though, isn’t necessarily that heat is calming, but that the chill you feel when you come out helps the body begin the natural cooling process that takes place during sleep, when our bodies naturally reach their lowest body temperatures about five to six hours into the night.
Don’t eat anything for one to two hours before you go to bed. Again, it’s what we’ve heard in the past but it’s true. While a light snack two hours ago won’t keep you awake, a heavy meal any closer to bedtime than three to four hours can add to sleep and digestive troubles.
If you can’t control when you go to sleep, be in firm control over when you get up. Use the trick that behavioral therapists are finding helps many insomnia patients: Set your alarm for eight hours after your desired bedtime, regardless of when you actually fell asleep, and make yourself get up. Use all your willpower—and multiple alarm clocks if necessary—combined with bright light to make yourself get out of bed and start the day, even if you barely got any sleep. It’s the only way to start a sleep routine, a key measure for turning around an out-of-sync sleep-wake cycle.
When you wake up in the middle of the night, give yourself 15 minutes or so to fall back asleep, then take action. Rather than just lie there endlessly and become more and more anxious about falling back to sleep, do something to calm down. If you like meditating or doing yoga, give it a try. Listen to an audiobook or read—but choose a book that doesn’t have a plot that will keep you awake wanting to find out what happens next. “Consider a book you’ve read many times before, or poetry, or spiritual reading, something that will be a pleasure to read again,” advises Shives.