Are you struggling to get a good night’s sleep?
Many women find their sleep can go haywire during menopause. But why is this? And more importantly, what can we do about it? Dr Justine Setchell and Dr Jessica Baron from Hormone Health joined us for a Lunch and Learn webinar to tell us more.
Henpicked: So many women tell us sleep is elusive during menopause. Why is this?
Dr Jessica Baron: There are many things that alter your sleep when you’re menopausal. The first one very obviously is hormones. When you’re perimenopausal, your hormones go up and down. Your ovaries aren’t producing oestrogen as consistently as before, which can cause sleep to elude you when you feel you most need it. But it’s a good idea to look at what else is going on in your general health.
Menopause symptoms like hot flushes and night sweats can wake you up, anxiety and depression can also play a part. Other physical things such as heartburn, pain from arthritis, needing to get up for the loo or restless legs can all get in the way of sleep.
Dr Justine Setchell: The drop in oestrogen can also cause an irritable bladder. But women are often in the sandwich generation, that feeling of being squished in the middle with elderly parents to look after at one end and teenagers, also hormonal, at the other. It can be a bath of hormones in some households, with lots of people vying for your attention. Plus a lot of women are still working. This can spiral. If you know you’ve got a lot on your plate, then you start to get agitated about not getting sleep.
If there’s one take-home point from this, it’s that there is no specific ideal length of time to sleep. It varies from person to person. A lot of people get stressed they aren’t getting eight hours’ sleep, which won’t be right for everyone.
Dr Jessica Baron: There are so many magazine articles which say you must sleep for eight hours. But everyone has their own rhythms and so you have to do what works for you. I always think menopause comes at an inconvenient time in life, when you may have a lot else to contend with. Which can really impact on our sleep.
Henpicked: The good news is there are plenty of things we can do to help ourselves. What are our options?
Dr Jessica Baron: The obvious ones are what we call sleep hygiene. Make sure your room is nice and dark, and peaceful. Wear loose-fitting pyjamas, have comfortable bedding and make sure your room isn’t too hot. Basic things like that.
Don’t drink too much fluid before bed, as that will exacerbate you needing the loo. And look to your screen time. If you want to watch something relaxing that’s fine, but don’t do emails and WhatsApp before bed because your mind will be going round and round.
Dr Justine Setchell: There’s a setting you can put on your iPhone that changes blue light to more yellow light, so if you do look at your phone at least you haven’t got glaring blue light. This has been shown to impact on sleep quality.
Henpicked: There are various apps that help you sleep, aren’t there?
Dr Jessica Baron: Yes, I’ve tried a few of them. The one that I would suggest is Headspace, which has small chunks of meditation to use in the day but longer ones specifically for sleep. They last 45 minutes but you’ll be asleep in 15!
You can even get a pillow with headphones integrated so you don’t need to have pods into your ears.
There have also been lots of studies about music being useful, it needs to be slow and soothing and soft. There is some music by Max Richter which lasts for 8.5 hours called ‘Sleep‘ which is very helpful.
Henpicked: Tell us about alcohol – does a nightcap not work?
Dr Justine Setchell: The problem with alcohol is it decreases the amount of restorative REM sleep, which is when we dream and process things. Particularly when people have anxiety or depression, or other things going on, they often find if they can get a good night’s sleep and process some of that they will feel more rested. With alcohol you may get to sleep, but then wake in the night. Alcohol dilates your blood vessels so may increase sweats and flushes.
But this is also age related, in that people don’t metabolise alcohol as well as they age. It stays in your system longer and causes disturbed sleep, so you often wake at 4am and can’t go back to sleep. Plus it increases the likelihood of needing to get up for the loo.
Dr Jessica Baron: You need to think about medications, too. Things like decongestants are stimulants, so don’t use one before sleep. And avoid diuretics that will increase your water flow, and some antidepressants may affect your sleep, so consider when to take them. You could speak to your GP or pharmacist about the best time to take your medication.
Henpicked: One of the other techniques we’ve heard mentioned a lot in relation to menopause is Cognitive Behavioural Therapy (CBT). Can this help with sleep?
Dr Jessica Baron: There’s more and more evidence among the menopause community that CBT can be used for all kinds of menopausal symptoms. It can be very useful with sleep as it equips you with tools to help you reframe your thoughts.
Henpicked: Is it important to form good habits?
Dr Justine Setchell: A lot of the things that I generally advise my patients around this time is to think ‘fit for 50’. This is our midlife, a point where we take the time to think what am I doing well, what can I improve on, how can I either get fitter or remain this fit and healthy? A lot of general advice will improve people’s sleep.
Try to have a normal Body Mass Index (BMI). It is more difficult to lose and manage weight in menopause but it can be done. People with a BMI over 30 will often have sleep apnoea, diagnosed or undiagnosed, where they stop breathing for periods of time in the night. Oxygen levels can drop very low in extreme cases. Many are undiagnosed but may not have normal breathing patterns. Additional weight puts pressure on your neck, while a big tummy puts pressure on your lungs. So a normal weight will help you sleep.
Exercise, too. A brisk early evening walk is great, it doesn’t have to be strenuous. And things like yoga and Pilates are great strength exercises, but can also help you relax.
A lot of people are working from home at the moment and it’s tempting to roll out of bed to work then back to bed. But if you take a walk first thing, then lunchtime and after work, you’ll have an hour’s worth of exercise without really thinking about it.
Henpicked: Can HRT help with sleep?
Dr Jessica Baron: Absolutely. HRT stabilises your oestrogen levels. Taking the right HRT for you will definitely get rid of night sweats and hot flushes, usually within two weeks. So you won’t wake up because of night sweats. There are different cocktails of HRT but one particular micronised progesterone, Utrogestan, will complement oestrogen and protect the lining of your womb. If you take it orally at night this is a sedative in its own right.
Dr Justine Setchell: One thing to say is if you’re finding it hard to wake up but don’t want to take this progesterone earlier if it makes you sleepy you can swap. It can also be used as vaginal pessary, so I would suggest using it this way instead.
Henpicked: Any recommendations to help with restless legs?
Dr Jessica Baron: There are medications you can take specifically for this. It is not a particular menopausal thing, this happens to men and women. While HRT won’t combat restless legs, it can help you sleep better so you may not wake as much with this conditions.
Dr Justine Setchell: Anecdotally, many of my patients have found that early evening exercise can help with restless legs.
Henpicked: Can antihistamines have an impact on sleep?
Dr Jessica Baron: They can be very useful for sleep. Piriton in particular is good to take in the evening if you struggle with hay fever or allergies. It’s a fairly gentle way to get off without a hangover in the morning.
Dr Justine Setchell: Melatonin in slow-release form can also help. But in the UK this is only licensed for the over 55s, which is a bit late for menopausal women. But you can buy it over the counter elsewhere, so you can get some if you’re abroad.
Henpicked: Any more advice for bladder issues?
Dr Justine Setchell: Systemic oestrogen – a patch, gel or tablet – can help a lot. But sometimes you need a topical oestrogen, such as a pessary, to replace the oestrogen locally and calm the bladder. Vaginal oestrogen is very low dose – a year’s worth is equivalent to one tablet – and very safe. A lot of women suffer in silence with bladder symptoms without realising even if they didn’t want to take HRT they may accept taking something more locally. Many doctors are doing consultations over the phone or on Zoom, so don’t put off seeking treatment.
Dr Jessica Baron: If you’re having breast cancer treatment you need to discuss with your specialist but a lot will be very happy with this. It can also lead to more comfortable sex.
Henpicked: What about the old-school ways, like cocoa or Ovaltine before bed?
Dr Jessica Baron: Absolutely. Just don’t make it too big as it will affect your bladder. But hot milk can improve serotonin levels.
Dr Justine Setchell: And chocolate has tryptophan which increases serotonin. So hot chocolate is even better!
Dr Justine Setchell:
Holds Certificate in Menopause Management, and is a member of The British Menopause Society and a Diplomate of the Royal College of Obstetrics & Gynaecology.
Dr Jessica Baron:
GP specialising in women’s health for 20 years. Holds FSRH Certificate in Menopause Care. Member of British Menopause Society.
There’s more information on Hormone Health’s website: