Recap: Last week we talked about three specific problems people have with sleeping in perimenopause. They were nightmares, night hot flashes/sweats and just plain waking in the middle of the night.
I heard from so many of you who are suffering from these things, and I’m glad it helped. Please share that piece while you can – most of my in-depth content goes behind a paywall this weekend as the free subscription period ends. (I’m offering a 20 percent off deal if you subscribe before Sunday. Grab it now, here.)
This week I’m tackling the overall issue of crappy sleep and what to do about it. This won’t be the last I cover the topic, because it really is the foundation of everything. If you can’t sleep you can’t think, it’s harder to eat well, you can’t handle stress and your body isn’t able to do the important work of recovering. You start to literally break down.
One thing that’s important: if you take some time to care for yourself in the ways that I mention, you send a message to every part of your body that you care. About you. And you start to come back to life, little by little.
This list is by no means exhaustive. It’s just things I did that helped, and why. Things that you can do too, without too much time, energy or money.
I plan to publish more pieces in the coming weeks and months on other sub categories, including:
> hormone therapy and sleep
> the best sleep supplements
> the best sleep-related gadgets + gizmos
> how to get through the day after a night of wretched sleep
> changing your thoughts to change yourself to change your sleep
Why we can’t sleep
This is so complicated, because of the massive midlife sandwich. (Keep reading) And then there is perimenopause: When progesterone drops in the early stages, it can scramble our entire stress response system, also known as the hypothalamic-pituitary-adrenal (HPA) axis.
According to the findings of a small 2021 study involving 121 women published in the journal Euroendocrinology, progesterone is inextricably linked to our psychosocial resilience; the lower our progesterone goes in perimenopause, the more we can struggle with wellbeing and mental health.
And it can already be low when we get there, for a variety of reasons.
This process involves nothing less than a recalibration of how our entire nervous system operates – and it can leave us wide open to a range of mood issues, including depression, anxiety, insomnia and more, findings bolstered by a 2015 review published in the American Journal of Psychiatry.
In a nutshell: One of the first problems people experience as their hormones change on the ramp to menopause can be sleep.
What happens
There are long, short and medium-term impacts. Short term, life sucks. Patience thins, resilience diminishes, brain function suffers and, to put it super simply, our body seeks energy through food – hence sugar cravings. Without good sleep, our body isn’t doing the vital repair work it needs. Poor sleep is connected to a variety of undesired outcomes, including the on ramp to most diseases: metabolic dysfunction and insulin resistance. In just one example, the increased risk of diabetes from poor sleep was most recently found in a new study across a diverse population of 36,000 Americans, published in Diabetologia.
What we can do
Make it a priority from the moment we wake. Make you a priority. (Repeat after me: I am a priority) I don’t know about you, but wishing and hoping has never been very effective as a strategy for getting what I want. We have to choose us in this regard, and that involves making a game plan and sticking with it. I’m going to cover sleep and hormone therapy in a future post. But for now, even if you are on hormone therapy, good sleep hygiene will only serve you.
No screens before bed
Nothing, and I repeat nothing, messes up my sleep like looking at my phone anywhere near bedtime. Even if I glance at it sideways – and I try, I really do try this weekly – the impact is palpable. Although not everyone is impacted in the same way, a population-based, cross- sectional study of more than 20,000 people in China, published in the Frontiers in Psychiatry journal in June 2022, revealed it’s harder for older people than young. Whether it’s the light or the EMFs, or the upsetting content that’s unavoidable these day, whenever I break this rule I end up paying the price.
Progressive muscle relaxation
A single-blind, randomized controlled study that just dropped in Menopause, the journal of The Menopause Society in North America, on the effect of progressive muscle relaxation exercises. The study was conducted over six months in 2022 in 63 post-menopausal women in the US who reported poor sleep quality. The study group of 31 women were assigned PMR daily (including a CD provided by the Turkish Psychologists Association) for eight weeks, while the control group just did their own thing. Using standard fatigue and sleep quality measurements, the women doing PMR reported better sleep and less fatigue. This has to be one of the easiest things to do, ever, you can do it in bed at night, accompanied by a recording from YouTube or Spotify (careful looking at the screen though) and it helps with all kinds of stress and anxiety, too. According to Anxiety Canada, you take a slow, deep breath and tense particular muscle groups in your body. Then release the muscles and notice how you feel, before moving on to another group.
Yin yoga, foam rolling or simple stretching
When the lockdowns rolled in during the pandemic, I worried the most about sleeping. I had just gotten into a groove after years of unrest – and I didn’t want the stress and uncertainty to mess that up. So I committed to doing a yin yoga class on the Glo app every night, even if just for 20 minutes. Guess what? I slept like a baby. And, even though I was baking – and eating – up a storm like everyone else, I lost weight. It was revelatory.
Yin or restorative yoga takes minimal energy and helps soothe the nervous system and release physical and mental tension for a better, longer and deeper sleep. A 2020 systematic review and meta- analysis published in the BMC Psychiatry journal found yoga to be effective in managing sleep problems in women. If yoga doesn’t do it for you, try foam rolling or even stretching before bed. According to a 2014 study from Japan published in the Bulletin of the Physical Fitness Research Institute, a stretching session yielded better REM sleep and a diminished stress response in participants.
Get support
When I interviewed American holistic sleep coach Morgan Adams for The Hotflash inc Podcast, she pretty much summed up one of the most hard-to-deal with reasons we can’t sleep. It’s that massive midlife sandwich I mentioned earlier. “You know, some, many of us may have children at home still, and we have potentially aging parents,” she told me. “We may be at the top of the career game. And all of these demands just create a situation where we're go, go, go all the time taking care of others and the stress, I think, is really one of the main components of our sleeping problems. And sometimes, we need to kind of take a step back and maybe delegate to some other people in our lives and just draw tighter boundaries and prioritize our own self-care.”
Morning light for sleep and mood
Get up a bit earlier for a walk or just nip outside however you can for a few minutes – without sunglasses. Whatever you do, know this is a very effective tool for resetting your circadian rhythm. Our ancestors rose and slept with the sun, and our bodies work best if we try to respect that to the best of our ability. If you want to deep dive on all the reasons for this, check out the Sleep Toolkit episode on American neuroscientist Andrew Huberman’s Huberman Lab podcast.
And if you want to dive a bit deeper into why the sun works like this, Morgan explains it eloquently: “When the sunlight hits your retina, it sends a signal to your suprachiasmatic nucleus, which is your circadian pacemaker, and from there, this amazing cascade of neurotransmitters and hormones goes off. Your cortisol increases, because that gives you energy. Any melatonin leftover from the night before gets shut off. You boost your serotonin reserves and that prepares the melatonin to be produced the following night. It's like this beautiful symphony of things going on. And it's, it's a really easy intervention.”
Take magnesium and taurine for hot flashes and sleep
This is part of New Zealand-based women’s health expert Lara Briden’s Rescue Prescription for Perimenopause and Menopause, included in her book hormone repair manual. Studies have shown most of the population is deficient in magnesium, which is essential for hundreds of the body’s biochemical reactions, including energy production and muscle and nerve function. Taurine is an amino acid with effects on the liver, brain and immune system, and in women, estrogen can slow how it works. She points out that while this combination is relaxing and sleep promoting, it also cuts down on night hot flashes, which can jolt you awake before the heat sets in and make it hard to get back to sleep.
Get grounding
I’m the crazy lady walking barefoot around the grass in a park near my house – every single day I can manage it. (Yes, something stings me occasionally. Twice someone has stolen my slides and I had to walk home with no shoes – looking even crazier.) I really don’t care how I look, because this is a shortcut to good sleep if ever there was one. A 2015 review of a dozen studies on grounding published in the Journal of Inflammation Research found reductions in pain and inflammation, improvements in wound healing and more.
Editor’s note
Obviously don’t do these things all at once, all the time. That would be impossible. And ridiculous.
If I had to pick 3 doable things, it would be stop looking at screens an hour before sleep, stretch for 10 minutes or a few minutes of PMR before bed and get a few minutes of morning sun in your eyes.