Sleep and Menopause – The Perfect Storm

Thoughts from a mid life menopausal sleep specialist!

Women are at a higher risk of sleep problems throughout their life with around 50% of women in menopause reporting sleep problems. The good news is there are things you can do to improve sleep.

‘I can’t turn my brain off’, ‘as soon as I get into bed my mind turns on’, ‘I worry I won’t cope tomorrow’, ‘I’m worried about my health if I don’t sleep well.’

These are just some of the things I regularly hear from people when they first come to my sleep clinic. Poor sleep saps the joy from life, it creates anxiety and worry and causes people to curtail activities, or withdraw from those things that they once enjoyed (not to mention the constant feelings of fatigue and brain fog).
Throw in menopause along with the challenges women face juggling the pressures of mid-life: work, children, parents and their home, and you have a perfect storm. This results in  many women struggling to meet their responsibilities with the energy, enthusiasm and joy they once did, leaving them feeling like they are failing and unable to see a way out.

I am grateful that Menopause is finally being recognised and better understood, and that the message of prioritising sleep is also being heard. I would, however, argue that until we sort our sleep out we are going to struggle to eat right, exercise enough or manage stress which, along with sleep, are considered the pillars of health and wellbeing. All of these are influenced by the quality of our sleep and will be easier to get right if sleep is optimised. The flip side however is that if we eat right, incorporate more exercise and activity into our days and manage stress, these will in turn help to improve sleep, so in the end we can’t deal with any one aspect of health in isolation.

Whilst HRT can help to improve sleep, it is rarely the silver bullet, so we need to think about what else might help. Cognitive Behavioural Therapy for Insomnia (CBT-I) is the first line of treatment as indicated by the NHS and is the foundation to my treatment programmes. It comprises recommendations relating to day and night routines as well as  strategies to support a tired, busy and anxious mind. CBT-I also challenges the beliefs that people with longstanding difficulties have come to hold about their sleep.

As an occupational therapist specialising in sleep, I have trained in CBT-I and completed post-grad study in behaviour change, so when I work with people one-to-one, we  look at all aspects of their life. By addressing small changes across all areas, they can make improvements to their sleep and overall well being. This might mean looking at the timing of activities or intensity, practising stress management or ensuring routines are in place that support the body clock and encourage a healthier sleep pattern. The key is building consistent habits that support sleep and manage the unhelpful thoughts which undermine those struggling with sleep, even after bad nights. The caveat is that this can take time and requires persistence, but the discomfort of making changes is outweighed by the joy of waking feeling refreshed after a good night’s sleep.

Here are a few things that my clients have done as part of a bigger picture of changes that have led to improvements. One woman found that knitting while listening to her vinyl collection got her into a better place before going to bed. A young professional woman realised through our consultations that she had lost her “commuter time” which gave her time to destress from the day, so she implemented commuter time when working from home, and found it so helpful, she got her boss doing it too. Many implemented morning walks which they enjoyed as it helped get their day off to a better start as well as supporting their sleep pattern. Others started short yoga sessions before bed to calm their mind and release tension. Some diarised break out time during their working day,( 5-15 minutes to do something that helped refresh and reset them and keep the effects of  stress at bay); and others frequently used guided journaling to deal with the many thoughts that continued to fill their minds when trying to sleep.

Improving sleep often requires lots of small changes, so whilst reducing caffeine or screen time is a great start, it may not be enough. We need to see sleep as the consequence of what is happening in our days, not just something that is happening at night. 

So consistency is key…..

Start your days with light, food and movement

Include meaningful activities as well as essential ones in your day

Notice and manage stress before it manages you

Aim to finish the day with a little bit of calm, this could be music, reading or some other form of relaxation

And when your eyes are drooping, and you are struggling to stay alert, then it’s time to get in to bed and allow sleep to come

You can’t force sleep, you just need to remove the obstacles that life creates, and it will happen naturally.

So, try the ideas above and see how they work for you, but if you have struggled for sometime, you may need more tailored support or guidance. If this is you, do get in touch, I would love to help you sleep and live better.

Best wishes

Helen