A good night’s sleep is one of our main pillars of health. Insomnia during perimenopause and menopause can lead to many issues such as fatigue and weight gain. There are several factors that can lead to sleep difficulties during this hormonal transition, such as hormone imbalance, sleep hygiene practices, medications, sleep apnea, nutrition, and blood sugar control.

First and foremost, we must optimize sleep hygiene. Here are 10 tips to get you started:

1. Aim for 7-9 hours of sleep per night. Set a regular schedule for bedtime/waking times. A 2017 CDC Survey revealed that roughly 56% perimenopausal women and 40.5% menopausal women report less than 7 hrs of sleep per night. 
2. Make your bedroom quiet, dark, and cool. Turn off the TV/phone! A large observational study found that more than 40,000 women who sleep with a TV or a light on were associated with a 17% increased risk of gaining 11lbs over the course of 5yrs. Another study found that even a small amount of light during sleep can activate the nervous system to a more activated and alert state, which can have profound effects on heart rate and insulin resistance. Melatonin is only secreted in darkness so any sort of light can block melatonin production. 
3. Go to bed when you feel sleepy. If you do not feel sleepy, do something else to relax your mind such as reading, practicing diaphragmatic breathing, taking an Epsom salt bath, or light stretching. 
4. Upon waking, it is best to obtain sunlight or full spectrum light to help promote a regular circadian rhythm.
5. Avoid alcohol, especially within 3-4 hours of your bedtime. Many people use alcohol to help to reduce the time to fall asleep, however sleep is severely disrupted during the second half of the night after alcohol use, further disrupting your natural circadian rhythm. 
6. Minimize or avoid caffeine. Even in the morning, caffeine can decrease natural endogenous production of melatonin. Many of us are slow metabolizes of caffeine so even your morning cup at 7 am may affect your sleep at night. 
7. Minimize added sugars and refined grains in your diet. Research has shown that higher intakes of these foods increase the odds of insomnia due to blood sugar dysregulation. Higher intakes of dietary fiber, whole grains, low sugar fruits (berries), and vegetables have been associated with lower risk of insomnia. We want our blood sugar to be on a steady ride vs a roller coaster. Eating plenty of protein and fat with each meal helps to support your blood sugar. If you feel like you need a snack before bedtime, opt for something protein-rich, such as a hard boiled egg, handful of nuts, spoonful of almond butter, or a slice of turkey.
8. Exercise daily, but avoid high strenuous exercise within 2 hours of your bedtime. 
9. Practice stress management. High stress translates to high cortisol, which can negatively affect sleep. Stress is naturally a part of our lives, but if we change how we respond to that stress, we can re-regulate our nervous system and cortisol levels. Deep belly breathing is a great way to stimulate the parasympathetic nervous system, through activating the vagus nerve. We can ground ourselves by breathing into our diaphragms- inhale for 4 seconds and exhale for 6 seconds. This activates our parasympathetic nervous system, resulting in relaxation. 

When these suggestions simply don’t cut it, we often then do hormone testing to assess your metabolic function (HbA1c, insulin, glucose) and your hormones (cortisol, estrogen, progesterone, and DHEA) to give us more insight regarding the individual metabolic and hormone imbalances causing sleep disturbances.

Common Causes of Insomnia Include:

1. Low progesterone is associated with perimenopause and menopause. Low progesterone can cause anxiety and insomnia. A transdermal progesterone cream can be helpful if labs warrant it. 
2. High cortisol or low cortisol can cause insomnia and sleep disruption. A saliva test can assess this. Higher nighttime cortisol is associated with a “wired and tired”  feeling and thus poor sleep. Seriphos is an amino acid supplement that I often use to decrease high nighttime cortisol. Additionally, Adaptogens are a category of botanicals that help to support a natural level of cortisol, a healthy sleep cycle and help us respond to stress. One of my favorite adaptogens is Ashwagandha. 
3. Blood sugar dysregulation and insulin resistance. Lack of sleep can cause decreased glucose tolerance, decreased insulin sensitivity, and increased glucose production. Other signs of blood sugar dysregulation are abdominal weight gain, headaches, dizziness, fatigue after eating, and episodes of being “hangry.” While this may be the trigger to poor sleep, this can further explain why poor sleep leads to weight gain and obesity. 
4. Low melatonin. Cortisol and melatonin are inversely related- when one is high the other is low. Upon waking, we should have a spike in cortisol, and it should decrease throughout the day. Melatonin then should increase after we go to bed and decrease prior to waking. A sustained-released melatonin supplement taken prior to bedtime can not only help an individual fall asleep but also stay asleep.

If you are struggling with insomnia, reach out for support. The consequences of sleep deprivation can be significant. Naturopathic doctors are trained to address the underlying cause of your insomnia. We are here to help you!

References

2017 CDC Survey – https://www.cdc.gov/nchs/products/databriefs/db286.htm

Festa A, et al. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000 Jul 4;102(1):42-7. 

Greenberg AS, Obin MS. Obesity and the role of adipose tissue in inflammation and metabolism. Am J Clin Nutrition. Feb 2006. Vol 8 (2); 4615-4655.

Hargens TA, Kaleth AS, Edwards ES, Butner KL. Association between sleep disorders, obesity, and exercise: a review. Nat Sci Sleep. 2013;5:27-35. Published 2013 Mar 1. doi:10.2147/NSS.S34838

Mullington JM, et al. Sleep loss and inflammation. Best Pract Res Clin Endocrinol Metab. 2010 Oct; 24(5):775-784.Park Y-M M, et al. Association of Exposure to Artificial Light at Night While Sleeping With Risk of Obesity in Women. JAMA Intern Med. 2019;179(8):1061-1071. 

Editor’s Note: The information in this article is intended for your educational use only. Always seek the advice of your physician or other qualified health practitioners with any questions you may have regarding a medical condition and before undertaking any diet, supplement, fitness, or other health program.