Sleep disturbance is one of the most common symptoms for women to start noticing as they move into their 40s. The issue can be trouble falling asleep or staying asleep, and not getting enough sleep.
Upon turning 41 a few years ago, I started to notice changes in my ability to fall asleep at night and to stay asleep all night, and it was frustrating to say the least. Achieving a good night’s rest became increasingly difficult for me.
In this blog, you’ll learn the link between perimenopause and sleep. I’ll explain some of the mechanisms at play and give you some top tips for how to get better sleep in perimenopause.
The Circadian Rhythm And Sleep Issues In Perimenopause
In order to truly understand how to get better sleep, it’s helpful to understand circadian rhythms and their role in sleep.
Circadian rhythms, also called bio-rhythms, are 24-hour cycles that are part of the body’s internal clock. They are constantly running in the background carrying out essential functions and processes.
One of the most important and well-known circadian rhythms is the sleep-wake cycle. Addressing and supporting this cycle is essential if you want to overcome sleep issues in perimenopause and improve sleep quality.
A properly aligned circadian rhythm promotes effortless, consistent, and restorative sleep. Not only that, your circadian rhythm dictates other key aspects of health such as immunity, heart health, mood, and metabolic health.
When your sleep-wake cycle is out of alignment it can lead to significant sleep issues and insomnia.
How does the sleep-wake cycle work?
There are 2 hormones that govern your sleep-wake biorhythm; cortisol and melatonin. If these are out of alignment, you will have trouble sleeping.
Cortisol is an energy mobilising hormone, providing you with energy to get up and get going in the morning.
In a healthy circadian rhythm cortisol is high in the morning upon waking and it increases again within an hour of waking (usually in response to daylight), which is known as the cortisol-awakening response or CAR. Cortisol production is triggered by daylight and it reduces in response to darkness, being at its lowest at nighttime.
On the flip side of this, melatonin should be highest at night time and lowest in the morning. Known as the ‘sleep hormone’, melatonin increases in response to the onset of very low lighting during the evenings and eventual darkness at bedtime, where it increases some more to facilitate good, restorative sleep.
We won’t make both hormones at once, which is the whole idea of the sleep-wake cycle. One hormone (cortisol) wakes us up and the other hormone (melatonin) helps us to sleep. Maintaining a regular sleep schedule can help regulate these hormones and improve overall sleep quality.
Why Can’t I Sleep: Insomnia in Perimenopause?
In our modern world, where we can be in artificial (blue) lighting all evening and not get into natural daylight upon waking (sometimes for hours), many people’s sleep-wake cycles are skewed, leading to poor sleep.
These misaligned light and dark cues are creating havoc in people’s ability to fall asleep at night and or to stay asleep all night.
Then enter perimenopause, where female physiology becomes even more susceptible to circadian rhythm dysregulation.
The hormonal changes that occur during perimenopause (in your 40s) can impact the HPA-Axis (brain to adrenal gland communication), leading to cortisol dysregulation.
Add to this external life stressors, and you have even more cortisol dysregulation and a circadian rhythm thrown further out of whack.
Sleep problems can also arise from erratic fluctuations in oestrogen, which can lead to sharp drops in serotonin, an important hormone for our ability to relax and a hormone that gets converted into melatonin at night.
Declining oestrogen levels in the later stages of perimenopause can cause further disruption because oestrogen helps to regulate the circadian rhythm.
Now more than EVER, your daily habits need to align with the circadian rhythm (sleep-wake cycle) in order for you to achieve quality, restorative sleep and more balanced energy throughout the day.
Habits that prevent us from having a healthy rise in cortisol in the mornings and optimal production of melatonin at night will skew our rhythm.
Other Reasons For Sleep Issues In Perimenopause
Declining/low levels of progesterone, which disrupts the sleep centres of the brain, can lead to trouble sleeping. Low progesterone also increases anxiety which can impact ability to fall asleep.
High histamine during the high oestrogen (earlier) stage of perimenopause.
Impaired ability to cope with stress due to the shifts in oestrogen and progesterone.
Other symptoms that disturb sleep such as hot flushes, increases in bladder frequency, restless legs syndrome, or sleep apnea, all of which can be experienced in perimenopause.
How To Get Better Sleep In Perimenopause
Align your habits with a healthy circadian rhythm for a good night’s sleep!
Your habits in the morning right up to bedtime can help you sleep better:
Good sleep is crucial for overall well-being, and establishing good routines can significantly improve your rest.
Healthy sleep habits, also known as sleep hygiene, are essential for improving nighttime rest and overall well-being. Unhelpful daytime routines can negatively impact sleep quality, so it’s important to adopt better habits.
Quality sleep can enhance your daytime energy and mood, making it easier to function effectively.
By focusing on sleep hygiene, you can create an optimal sleep environment and establish routines that promote better sleep quality.
Here Are My Top Tips: From Morning to Night
In The Morning:
- Get out into natural daylight within 30 minutes of waking (or use a 10,000 LUX light box in darker months and get outside once daylight is up). Light into the retina stimulates the CAR plus switches on anti inflammatory signals for the day
- If there is no cloud cover or it’s sunny, just 5 minutes will do
- If it’s cloudy, you’ll need 10 mins outside
- If there is dense cloud clover, you’ll need 20-30 minutes
- Get some cold water exposure, e.g. switch your shower to cold for the last 60 or so seconds or invest in an ice bath if you have outdoor space! I personally have a Lumi ice bath in my garden that I sit in each morning, allowing me to get daylight and cold exposure upon waking.
- Do some movement, such as a short or longer walk or jog (preferably in nature), a short yoga flow, or some jumping jacks!
Engaging in these morning habits can help regulate your sleep cycle, assist you to fall asleep faster, and to sleep better.
During The Day:
- Limit caffeine, ideally having none after midday
- Get outside into daylight as many times as you can, even just for a few minutes at a time
Improving these daytime habits can significantly enhance your sleep quality.
During The Evening:
- Dim the lights everywhere at home from early evening, making it darker closer to bedtime
- Avoid intense exercise. Gentle walking or some restorative or yin yoga is great
- Finish dinner within 3 (MAX. 2) hours of going to bed
- Wear blue-light blocking glasses for watching TV, looking at your phone, tablet, or laptop. I personally wear Bon Charge Blue Light Blocking Glasses. You can use this link to automatically receive 15% off at checkout (search for ‘Blue Light Blocking Glasses’)
- NO screens or bright lighting in the hour leading up to bedtime
These habits can significantly contribute to a good night’s sleep.
At Night / Bedtime:
- Keep your bedroom cool and dark
- Check for ‘light-pollution’ in the bedroom such as from outside street lamps, LED alarm clocks. And figure out ways to minimise or eliminate this
- Use a black-out eye mask or black-out blinds if needed. I have personally been wearing a black-out eye mask for years now and it’s been a game-changer.
- Go to bed before, or no later than 11pm
- Avoid switching lights or screens on in the middle of the night. E.g. if you wake to use the toilet in the night, do it in the dark!
- Try using a weighted blanket (if all other habits are in place and you are still having issues)
- Try a Yoga Nidra body scan sleep meditation (e.g. Insight Timer App) or sleep story (e.g. Calm App). This can help drop you into sleep or easily fall back to sleep if you wake in the night
- Established guidelines in sleep medicine recommend these strategies to improve sleep quality and manage sleep disorders like insomnia.
Other Important Factors To Consider
Avoid being too low carb ESPECIALLY at dinner time.
Consuming about 30-40g of (complex, unprocessed) carbohydrates with dinner helps in 2 ways:
- It supports blood sugar regulation throughout the night by triggering a prolonged insulin release. This can help to lower cortisol levels and prevent you being woken by a blood sugar drop or spike in cortisol
- It helps to the amino acid tryptophan to cross the blood-brain barrier for conversion into serotonin and then melatonin
- Go to bed and get up at the same time 7 days a week
- Manage stress, because cortisol elevations impact the circadian rhythm
- Regulate blood sugar (for healthy insulin and cortisol regulation). Because blood sugar swings are stressful for the body and further disrupts your circadian rhythm. Your ability to regulate blood sugar across the day (e.g. through your meals) has a direct impact on your ability to fall asleep and stay asleep. For more info on how to eat for blood sugar balance, refer to my previous blog post here.
- My favourite supplements for nervous system and sleep support (and also relieve hot flashes and night sweats) are magnesium glycinate, taurine, and glycine. Taken together around bedtime, these three perimenopause essentials can work wonders for your sleep, and your life!
If you’re experiencing sleep issues since being in your 40s and you just want a good night’s sleep then I really hope this post has been helpful! Sleep problems can often be influenced by dietary choices, pre-bedtime routines, and environmental factors, so making mindful decisions is crucial. I’d love to hear from you if you have any questions or feedback! You can email me at francesca@francescaliparoti.com 🙂
