In search of sleep

Many women making the transition to menopause have trouble sleeping. Several strategies can help you get the rest you need.

If you're a woman of a certain age and you often find yourself staring at the ceiling in the middle of the night, you're not alone. The years leading up to menopause and the period that immediately follows are the times that women are most likely to report problems sleeping, according to the National Sleep Foundation. Many different conditions that are common in this stage of life — including hot flashes, obstructive sleep apnea, and mood disorders such as depression or anxiety — can cause sleep problems.

Lack of sleep is more than just a nuisance. "We now understand that high-quality sleep is absolutely vital to good health," says Dr. JoAnn E. Manson, the Michael and Lee Bell Professor of Women's Health at Harvard Medical School. This means that seeking care should be a priority if you are experiencing problems.

Sleep and health

Experts recommend at least seven to nine hours of sleep a night for most people, although some may need more or less than average. People who regularly get fewer than six hours of sleep are at higher risk for diabetes, heart disease, stroke, cognitive decline, and death from any cause. A lack of restful sleep also makes it more likely that a person will gain weight and have higher levels of the stress hormone cortisol, says Dr. Manson. "It's also been recently discovered that sleep is essential for avoiding or reducing risk of cognitive decline," she says.

Scientists have identified an important brain cleaning function that occurs when your brain is at rest. When you're asleep, a waste clearance system in the body known as the glymphatic system runs what is essentially a rinse cycle in the brain, using cerebrospinal fluid (the clear fluid found in the brain and spine), says Dr. Manson. Experts believe that this fluid flows more freely through the brain when it is at rest during the night. During this time, it washes away a harmful protein known as beta-amyloid, says Dr. Manson. When this process doesn't occur, scientists believe that beta-amyloid can build up, forming the plaques that are characteristic of Alzheimer's disease. Researchers have found that in people who go on to develop Alzheimer's, deposits of beta-amyloid start to appear in the brain at least 10 years before symptoms begin.

Sleep disruptors

A number of factors can disrupt proper sleep in women making the transition to menopause. These include the following:

Hot flashes. Hot flashes, which typically occur in the months leading up to and soon after menopause, are brief episodes in which your body temperature spikes. Experts believe this temperature dysregulation may result from the effect of changing hormone levels on a part of the brain known as the hypothalamus, which acts as your body's thermostat. When a hot flash happens at night, you may awaken as your skin flushes and your body begins to sweat to dissipate the heat. One study found that 40% to 45% of women reported that hot flashes made it difficult to sleep. The frequency of hot flashes is highly variable. Some women have very few; others have one or more during most nights.

Obstructive sleep apnea. As women age, they become more likely to experience obstructive sleep apnea, a condition in which breathing is repeatedly interrupted during sleep, leading to poor sleep quality and daytime exhaustion. It's thought that the condition becomes more common with age because women going through the menopausal transition often gain weight, a risk factor for the disorder. In some women, hormonal changes also make the throat muscles more lax, meaning these tissues are more likely to droop into the airway at night, blocking airflow, according to the National Sleep Foundation.

A large-scale study is currently looking at sleep apnea and how resulting low blood oxygen levels can affect health — specifically whether they're linked to higher risk of conditions such as heart disease, stroke, cancer, or cognitive decline, or a higher risk of death from any cause. "The study will provide valuable new objective data from small monitors that participants wear at night to assess oxygen levels," says Dr. Manson.

Mood disorders. As they enter menopause, women become more likely to experience mood disorders, such as anxiety or depression, which may affect sleep quality. Shifts in the levels of female hormones are believed to trigger problematic mood changes during the transition, leading in some cases to mild depression or panic attacks. (A panic attack is marked by a sudden sense of extreme anxiety, accompanied by symptoms such as sweating, trembling, shortness of breath, or palpitations due to a rapid heart rate.) Sleep disruptions due to nighttime hot flashes also affect mood. Plus, women at this stage of life often are facing multiple demands and stressors that may contribute to mood disorders.

Improving sleep quality

If you are experiencing problems sleeping, Dr. Manson suggests taking the following steps to get a better night's sleep.

Adopt a regular sleep schedule. Go to bed and wake up at the same time each day. The more regular your schedule, the easier it is for your body to fall into a restful rhythm.

Seek help for hot flashes. If hot flashes are keeping you awake, help is available. Your doctor can address the problem with hormonal treatments, such as estrogen therapy (if it's safe for you), or nonhormonal options, most often antidepressants.

Avoid alcohol and caffeine late in the day. Drinking a cup of coffee or a glass of wine in the evening hours can interfere with a sound sleep. Coffee is a stimulant and may keep you from falling asleep. Alcohol may help you fall asleep more quickly, but it is known to interfere with sleep quality; it can cause you to wake up in the middle of the night or early in the morning.

Shut off the (blue) light. Electronics that emit blue light, such as televisions, computers, and smartphones, can also lessen sleep quality, says Dr. Manson. Try to avoid them for at least an hour before bedtime.

Exercise (in the morning or in the afternoon). Regular exercise can promote sleep quality, but whenever possible, do your workout earlier in the day, says Dr. Manson. Exercise close to bedtime may be stimulating, making it harder to fall asleep.

Create a restful environment. People tend to sleep better in rooms that are cool, dark, and quiet. Setting the stage for a restful night's sleep can help you sleep more soundly.

Get checked. If you often feel tired when waking or have trouble staying up throughout the day, or if your partner notices that your snoring is louder and your breathing stops for short periods during the night, you may have obstructive sleep apnea. A visit to your primary care doctor or a sleep specialist can get you on the road to an effective treatment.

Ultimately, while you may think of sleep problems as an annoyance, it's important to your long-term health that you take them seriously and get help if you think you need it.

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