As women enter menopause, changes in sleep patterns are a common concern. Sleep can be difficult during this time of hormonal, physical, and psychological changes. Prior to menopause, about 12% of women experience problems sleeping. The incidence of insomnia and other sleep problems jumps to 40% during and after menopause. Though many women think this is just something they have to live with, like hot flashes, lack of quality sleep can have a dramatic impact on health and quality of life.
Science is showing that hormone changes play a significant role in sleep changes. For instance, as progesterone and estrogen levels decline, women are more apt to develop sleep apnea – when breathing stops and starts during sleep. Sleep apnea affects the body’s ability to regulate blood pressure and blood sugar, impairs cognition, and places added stress on the cardiovascular system. If you suspect that sleep apnea is occurring, contact your doctor for advice on how to address this common problem.
Do Prescription Sleep Medications Help with Insomnia?
It might seem convenient to ask your doctor for a sleep-aid prescription, however, studies show that these medications may not support healthy sleep patterns in the long term. The Study of Women’s Health Across the Nation (SWAN) study looked at 238 women who started using medication for insomnia (11 sleep pharmaceuticals were included in the study). They were compared to 447 women who didn’t take sleep drugs. The study duration was two years.
All of the women (avg. age 49.5) in the study reported “difficulty falling asleep on 1 out of every 3 nights, waking frequently on 2 out of 3 nights, and waking up early on 1 in every 3 nights of the week. More than 70% of women in both groups reported disturbed sleep at least 3 times a week.”
The one and two-year assessments did not show any significant changes in sleep between the two groups. The researchers concluded that though this was not a causal study, only correlative, the long-term use of prescription medications for insomnia was not linked to better quality sleep. The researchers noted that most of the medications for sleep are designed to be used for six months or less, and this study was the first to examine the long-term use of common prescription sleep aids.
What About Melatonin?
Melatonin is another commonly used sleep aid sold as a dietary supplement. To understand its use, it is important to know what melatonin is and what it does to the body for sleep.
Melatonin is a hormone the body produces in response to darkness. “Our natural melatonin in the brain is strongly suppressed by light, so it will only increase once we are in dim light, like sunset,” says naturopathic doctor, Catherine Darley, who is also the founder of the Institute of Naturopathic Sleep Medicine. “It signals to the brain that it is time to sleep by making us drowsy and dropping our core body temperature. Melatonin also enters the circulation and signals to cells throughout the body that it is night.”
The body’s pineal gland produces between 0.1 and 0.9 mg of melatonin per day. However, the human gut mucosa produces five times more melatonin than the pineal gland, which is yet another reason for maintaining a healthy gut. Production of melatonin declines starting in our twenties and continues through age fifty when a negligible amount is produced.
Dr. Darley and a group of integrative medicine experts published a study, Is Melatonin the Next Vitamin D? In it they say: “the largest contributor to melatonin imbalance would be those subject to jet lag, shift work, overuse of artificial light at night (e.g., from cell phones, computers, and fluorescent/LED light), or challenges to their circadian rhythm due to environmental or seasonal changes.”
This means that the ideal circumstance for taking melatonin is when our circadian rhythm isn’t in sync with the environment, for instance, jet lag or shift work. It can also be used to shift the body clock and support healthy sleep patterns during menopause and aging. “The dose, timing, and type of melatonin are all important,” she says. “In sleep and circadian medicine, we generally go with low (i.e., physiological) dose of 0.3mg or 1mg, up to a max of 3mg which is a pharmacological dose. Higher doses of melatonin haven’t been shown to be more effective for sleep.”
She recommends speaking with your doctor about proper melatonin dosage and use. There are a number of benefits of melatonin that are supported by research. In menopause, melatonin can improve body-mass index (BMI) and bone density, but it may also raise LDL cholesterol and triglycerides.
Overall, melatonin has antioxidant and anti-inflammatory properties; it helps regulate cellular mitochondria; and it crosses the blood-brain barrier. Dr. Darcey and her colleagues note in their study that natural sources, called phytomelatonin, have far superior antioxidant and anti-inflammatory properties as compared to synthetic melatonin. This is because natural sources contain chlorophyll, beta-carotene, lutein, and other protective, antioxidant phytonutrients.
There are also contraindications based on the cytochrome enzymes which metabolize melatonin and other compounds, she warns. “Specifically, the anti-depressant fluvoxamine and even caffeine can increase melatonin levels. Some other potential interactions could be with pharmaceuticals, herbal medicines, or nutrients that lower blood sugar or blood pressure, are anticonvulsant, or have immunosuppressive effects.”
Healthy Sleep Habits During Menopause
There are ways to improve sleep despite the disruptions caused by menopause. “Develop lifestyle strategies to improve sleep that center around getting light and darkness at the right times,” says Dr. Darley. “The right light and darkness can have a much bigger impact than people realize.” Speak with your physician (find one here) if these common sleep hygiene habits do not work for you.
- Make sure you get 30 minutes of bright, outside light soon after waking and in bursts throughout the day.
- About 2 hours before bed, turn down the lights to less than 10 lux (there are free lux meter apps for your phone to test your light level).
- Stick to a quiet pre-sleep routine that includes reading, soothing music, and a warm bath.
- Adjust your environment while sleeping. Bedrooms should be as dark as possible, without any night light or LEDs. However, if you or a loved one need a night light as a safety measure, do not get rid of it. Rather, as is appropriate for your situation, consider options that maintain a lower level of light until motion is detected.
- Dietary recommendations that help strengthen the circadian rhythm include eating distinct meals at the same time every day (instead of snacking), and finishing eating 3 hours before bed.
- See the Foods and Melatonin infographic below as a reminder of food that helps increase melatonin naturally.
Above all, do not hesitate to contact a naturopathic doctor if changes in your sleep patterns become consistent and interfere with your daily life. The negative consequences of disruptive sleep can occur within a few weeks (or less) of sleep changes. See INM’s Find an ND tool.