Is Perimenopause Keeping You Up at Night?
Have you found yourself tossing and turning at night, but can’t put your finger on a cause? An unexpected culprit may be to blame: perimenopause.
According to the 2018 Study of Women's Health Across the Nation (SWAN), 39% to 47% of perimenopausal women reported regular sleep disturbances. And that number doesn’t only cover women who have experienced insomnia and sleep issues in the past — many women who have never had issues with sleep before suddenly find themselves restless at night due to the physical, mental, and emotional challenges of (peri)menopause.
Hot flashes (and subsequent night sweats) are often cited as the main cause of sleep disturbance throughout the menopause transition. But other symptoms like sleep apnea, pain, bladder issues, and mental health concerns can also prevent a good night’s rest.
The good news is that none of these problems are untreatable — even though perimenopause can bring unexpected changes, there are plenty of ways to treat them, and get back to feeling like yourself.
Hot Flashes & Night Sweats
A 2003-2004 study survey of pre-, peri-, and postmenopausal women found that many of them began experiencing insomnia around the same age that perimenopause typically begins. In particular, the findings showed that the severe hot flashes that occur during these years — which are among the most common symptoms of perimenopause — are strongly associated with rates of insomnia for women in that age group.
Hot flashes are caused by a rise in adrenaline levels, caused by sudden drops in hormones. It’s a similar chemical response that happens to the body when reacting to stress and switching to fight-or-flight mode. Not only do you experience an uncomfortable rush of heat that may cause night sweats, but your body is also burdened with a sudden burst of energy that can make it very difficult to fall back asleep.
What You Can Do
When it comes to hot flashes and night sweats, prevention is key. If possible, lower your bedroom temperature at night somewhere between 60 and 67 degrees Fahrenheit. Avoid blankets and sheets made with fabrics designed to insulate and instead invest in cooling bedding that allows airflow and wicks away moisture. A simple bedside fan can be a big help in maintaining a cool bedroom temperature, especially in the warmer months. And avoid possible hot flash triggers such as alcohol and spicy foods before bed.
Aches & Pains
Hormonal fluctuations in perimenopause can unfortunately result in various aches and pains, especially joint pain. Estrogen helps reduce inflammation in the body; when estrogen levels drop during perimenopause, the result can be inflammation that we feel in our joints. Other pain-related symptoms like cramps, breast tenderness, and headaches can be traced back to drops in estrogen and other hormones during the menopause transition. And obviously, any kind of pain can make getting to sleep and staying asleep more difficult.
What You Can Do:
If achiness is more of an occasional hassle and not a chronic pain situation, some people find relief with the help of hot/ cold compresses, soothing Epsom salt baths, and gentle yoga poses. The occasional over-the-counter pain reliever is typically safe as long as it’s used as directed. But if you experience chronic pain that consistently keeps you up at night, talk with your doctor about your symptoms and possible treatments.
Urinary Incontinence
During perimenopause, drops in sex hormones can affect muscle strength in the pelvic region, causing millions of women experience urinary incontinence. This can lead to an overall loss of bladder control, involuntary leakage, and an unexpected sense of urination urgency that can make it difficult to sleep and decrease the quality of the sleep that you do get. Fortunately, a 2018 Stanford University School of Medicine study shows that treating incontinence can actually improve the quality of sleep.
What You Can Do
The simplest way to prevent incontinence from waking you up at night is to avoid drinking any beverages for about two to three hours before bedtime, especially avoiding known bladder irritants like alcohol and caffeine. Regular Kegel exercises can help strengthen the pelvic floor for better bladder control overall. And you can always talk with your doctor about medication options for treating an overactive bladder.
Anxiety & Depression
The hormonal changes and life challenges of perimenopause can sometimes help worsen pre-existing cases of anxiety and depression; they can also sometimes trigger anxiety and depressive symptoms among women who have never experienced them before. And unfortunately, insomnia is intrinsically linked to these mental health issues.
Feelings of anxiety or depression can make it difficult to fall and stay asleep. And, in an unfortunate cyclical effect, lack of sleep only contributes to further feelings of anxiety and depression. The cycle can be a difficult one to break, so it’s best to meet with your doctor to talk about your issues and discuss treatments that work best for you.
What You Can Do
In addition to speaking with your doctor, there are lifestyle changes you can make to help your symptoms. A 2020 meta-analysis found that relaxation techniques used to improve sleep such as deep breathing, visualization, and progressive muscle relaxation can also help alleviate symptoms of depression. Cognitive behavioral therapy (CBT), which teaches you how to identify and change thoughts and behaviors linked to insomnia, anxiety, and depression, can be useful for insomnia — there is even a special wing of it. CBT-I, that focuses specifically on reducing insomnia. And cutting anxiety and depression triggers like caffeine and alcohol may also help.
Sleep Apnea
Nearly 20 percent of women develop sleep apnea, a disorder that causes you to stop breathing periodically while sleeping, at some point in their lives. And for a lot of women, sleep apnea develops alongside menopause as they experience co-occurring causes and symptoms such as changing hormone levels, mood disorders, and lifestyle changes. However, women are severely undertreated, with about 90 percent of women who have sleep apnea not knowing they have it.
Sleep apnea wreaks havoc on a good night’s sleep. The stopping and starting of the breath can cause the sleeper to startle awake. Furthermore, sleep apnea can fundamentally change the composition of the brain, which can further impact insomnia as well as trigger a host of other problems including issues with memory, balance and mobility.
What You Can Do
Any suspicions of sleep apnea should be brought to your doctor’s attention. They can refer you to a sleep specialist who can run tests to determine if obstructive sleep apnea is the problem or if there might be another sleep disorder at play. A sleep expert may recommend a therapeutic device such as a Continuous positive airway pressure (CPAP) machine that ensures you get continuous, constant airflow through the night. They may also suggest lifestyle changes that can help such as weight loss and quitting drinking and/or smoking.
Going without a good night’s sleep is tough. But the toughest part might be thinking there’s nothing you can do to fix it. And when it comes to perimenopause and insomnia, that just isn’t true.
