Remember what it was like to get eight solid hours of deep, uninterrupted sleep and wake up feeling rested and energetic? If not, you’re probably a member of a not-very-exclusive club: sleep-deprived forty- and fifty-something women. “There’s an enormous rise in sleep problems with the onset of perimenopause, which is usually around your midforties,” says Nancy Collop, MD, director of the Emory University Sleep Center in Atlanta and president of the American Academy of Sleep Medicine. “Even if you were a sound sleeper before, you’re likely to begin having problems now.” And if you’ve always had trouble snoozing, your nights will probably get worse before they get better (improvement may happen in your sixties—one reason to look forward to aging!). Only 45 percent of peri-menopausal women report getting a good night’s sleep almost every night, says the National Sleep Foundation.
What’s to blame: hormonal shifts, coupled with new family obligations, such as needing to take care of elderly parents. “The result is that many women see their sleep quality go downhill,” says Nanette Santoro, MD, professor and chair of obstetrics and gynecology at the University of Colorado in Denver.
Poor sleep does more than make you yawn during meetings; it’s lately been linked to heart disease, diabetes, weight gain, Alzheimer’s and cancer. “Too many women struggle with sleep problems during the menopause years, thinking it’s just something they have to live with,” says Collop. But research shows there are effective solutions.
Hormones Matter (A Lot)
“Hormones are at the crossroads between the brain and the body. When they shift, it affects all your systems,” says psychiatrist Robert Hedaya, founder of the National Center for Whole Psychiatry in Chevy Chase, Maryland. For instance, scientists have recently learned that the hormone progesterone in high oral doses functions like a natural sleeping pill. “It acts on the neurotransmitters in the brain to trigger relaxation, reduce anxiety and decrease sleep disruptions,” says Jerilynn Prior, MD, founder of the Centre for Menstrual Cycle and Ovulation Research at the University of British Columbia in Vancouver. But progesterone levels drop during perimenopause, possibly interfering with the deep REM stage of sleep and increasing middle-of-the-night awakenings, which in turn contributes to the predawn insomnia familiar to many women in their forties and fifties.
The perimenopausal and postmenopausal shifts in sex hormones account for arguably the most sleep--disturbing experience in this stage of life: hot flashes. For reasons that are not quite clear, the inner thermostat goes haywire, causing up to 85 percent of American women to experience hot flashes around the time of menopause. Since a decline in core body temperature is essential to falling (and staying) asleep, anything that raises the temperature at night may wake you up.
The stress connection
A decline in estrogen influences your stress levels—and hence whether you’re relaxed enough to nod off—in a few ways. Estrogen increases the availability of serotonin, the feel-good neurotransmitter that relaxes the nervous system. It is also converted into melatonin, the brain chemical that tells the body it’s time to go to sleep, says Hedaya. When your levels of estrogen plummet during perimenopause, the intricate interplay of signals gets disrupted, and sleep troubles follow.
In addition, if you have been under stress for a long time, you become more sensitive to lower estrogen levels, which means that you get easily worked up during the day and are wakeful during the night, becoming alert at the slightest noise or touch and having trouble falling back asleep. Couple this with “the tremendous number of psychosocial stressors that hit at this age,” from launching teens into the world to caring for aging parents, and you get a “double whammy” that sabotages sleep, notes Jan Shifren, MD, director of the Vincent Menopause Program at Massachusetts General Hospital in Boston.