We spend 1/3rd of our lives sleeping and we all need 7-9 hours of good quality sleep each night. What I write next applies to everyone, male and female, Sleep is vital to us all, but levels of insomnia in women are higher than in the general population so let’s look at why and how to address this.

We have five different stages of sleep; REM (rapid eye movement) sleep—when we dream—and non-REM sleep with four stages of light sleep and deep sleep. Deep sleep and REM sleep are essential for us to function.

Why Is Sleep Important?

When we sleep, we need less energy so the body uses this energy to restore and repair. During deep sleep, a number of processes occur in the body, such as DNA repair and remodelling (DNA contains our genetic code and is responsible for how we grow develop and function). We also make proteins at this time. Hence poor sleep and lack of sleep are associated with cancer—a correlation has been found with breast, endometrial, prostate, colorectal cancer and acute myeloid leukaemia. Sleep quality also affects our hormones.During sleep, our bodies relax and so our blood pressures and heart rates decrease. We get more blood flowing to our extremities and our core body temperature cools. This all helps protect our cardiovascular system. Accordingly, poor sleep causes raised blood pressure, increased risk of heart attacks and cardiovascular disease deaths such as stroke.During REM sleep, cognitive processing takes place so we have enhanced learning and memory, it also helps us cope with fear and anxiety; poor sleep correlates with anxiety and depression. Premenstrual syndrome and post-traumatic stress disorder (PTSD) is worsened if sleep deprived 2 weeks prior to a traumatic event.

What Drives Sleep?

During the day, we have a build-up of a substance called adenosine, which causes sleepiness. We also have our body’s internal body clock known as the circadian rhythm which is influenced by how much light and the type of light we are exposed to, when and what we have eaten, when and if we exercise, and our body temperature. This internal body clock is controlled by a part of the brain known as the suprachiasmatic nucleus in the hypothalamus. The light we are exposed to affects the production of the hormone melatonin which promotes sleep. We need our core body temperature to drop at night; the body does this by vessels at our extremities dilating (widening to allow more blood flow) so that heat goes from our core to extremities.

Why Sleep Is Important During The Menopause?

During the perimenopause and menopause, we have less sex hormones. Less estrogen and testosterone cause multiple symptoms (see blog on “What is the menopause and what is happening to the body”). Less progesterone causes less of the chemical messenger Gamma- aminobutyric acid (GABA), which has sleep enhancing effects and helps with stress reduction.

When we sleep our stress hormones decrease significantly, so hormones such as cortisol are affected by poor sleep which in turn affects estrogen, progesterone and thyroid hormone production. Weight can be an issue during the menopause and there are hunger hormones called leptin and ghrelin which are influenced by sleep.

Leptin is a hormone named from the Greek word “leptos” which means “slender”. It signals the body to feel full and so this hormone stops us from feeling hungry. Leptin is produced during sleep so you are less likely to over-eat if sleeping well as leptin will be produced in higher quantities. Ghrelin is the hunger hormone that drives you to eat. Poor sleep leads to an imbalance of leptin and ghrelin and is associated with eating more and increased body weight. Better sleep also means enhanced insulin sensitivity and you are less likely to develop type 2 diabetes.

With symptoms such as hot flashes (hot flushes in UK) or night sweats, it can be harder to get to sleep but as we need to control our risk for cardiovascular disease and Alzheimer’s disease (higher risk in post-menopausal women), it is important to try and prioritise sleep. It will help to control our symptoms, weight gain and make us feel more rested as well as reduce our risk of longer-term issues.

How Can I Get Better Sleep?

In our modern world and busy lives with TV, screens and lighting everywhere, we can be going against our natural body clock. As a result, it is vital for both men and women to prioritise sleep just as much as diet and exercise when it comes to our health.

The first step is consistency. There is no such thing as making up for lost sleep on the weekend. You should aim to go to bed and wake up at the same time each day. Provide yourself with the opportunity to get 7-9 hours sleep per night.

Have a wind down routine. Remember your body clock and light. Avoid screens before bed (the blue light from them will inhibit melatonin production), consider blue light blocking glasses if working late or turn the lights down dim or consider candlelight for a relaxing atmosphere. Consider a sleep mask or use black out curtains to keep the room dark. Remember temperature. Keep your bedroom cool. We need our core body temperature to drop to initiate sleep, so exercising right before bed is not the best idea. A warm bath helps as it shifts heat from your core to extremities helping us cool down.

Yoga and meditation help with sleep as they decrease our sympathetic nervous system and so again blood gets shunted from your core to extremities so we cool down centrally. There is also reduced heart rate and energy expenditure following yoga and meditation.

To help your body clock, try to get some natural light first thing in the morning, it can be better to exercise earlier in the day, but exercise in general will help with deep sleep if it is not before bed. It increases core body temperature—meaning it may take longer to cool down and fall asleep.

Avoid large meals later in the evening, particularly carbohydrate rich meals, always try to eat at least 2-3 hours before you go to bed if possible. Keep well hydrated during the day.

Avoid caffeine and alcohol. Not only doing so is important for menopausal symptoms, but also caffeine blocks adenosine which builds up during the day to produce the sleep drive. Therefore, avoid caffeine from the afternoon onwards. Alcohol interferes with sleep quality, so although you may feel it helps you get to sleep, poorer sleep quality is the result. Caffeine and alcohol also decrease the absorption of magnesium. Magnesium helps sleep by activating the parasympathetic nervous system and helps regulate melatonin. Nuts and seeds such as almonds, cashews, pumpkin seeds and spinach are rich in magnesium (see blog on “How diet can affect your health during the menopause” for more on diet).

Daytime naps can be good, provided they are of a short duration (20-30 mins) and can be helpful if one feels sleepy. However, they should only occur in the first half of the day, i.e., not after 3pm ideally. Remember the sleep drive and build-up of adenosine; having a nap too close to bedtime will interfere with that build up and make it harder to fall asleep. This will lead to less sleep and poorer quality sleep so keep the naps for earlier in the day.

Women Need Better Sleep During The Menopause

Poor sleep leads to hormone imbalance. The consequences of poor sleep are:

• Twice as likely to have a higher body mass index indicative of obesity (i.e., BMI 30 or higher).
• Increased risk of type 2 diabetes
• More likely to develop Metabolic syndrome (a combination of high blood pressure, diabetes, etc. leading to complications)
• Higher risk of cardiovascular disease (heart attack, stroke and hypertension)
• Poor mood (e.g., anxiety) and depression
• Poor memory and risk of Alzheimer’s disease
• Increased correlation of certain cancers, e.g., breast, endometrial and colorectal cancer

Postmenopausal women already have a higher risk of cardiovascular disease and Alzheimer’s so it is important to prioritise sleep.

Now on to the benefits of a good night’s sleep:

• Clears toxins (i.e., deep sleep)
• Clears amyloid which has been linked to Alzheimer’s disease.
• Helps to consolidate new memories
• Leads to better mood
• Improves memory and focus
• Enhances libido
• Improves hormone regulation
• Enhances cardiovascular health
• Reduces risk of cancers
• Reduces inflammation
• Helps with weight reduction

It can be hard to sleep due to the hormonal changes and symptoms of low estrogen but making some lifestyle changes with diet, exercise and taking some of the steps above can help to improve sleep which will in turn help with menopausal symptoms.

Dr. Sherina Fernandes, MBBS, BSc, DCH, nMRCGP, IBLM, BSLM, is a lifestyle physician working as a clinical lead for a telehealth company in the UK. Her main interests are preventative medicine using a lifestyle approach, women's health and preventing burnout.