Sleep Matters

SLEEP

Sleep disturbance is a common symptom experienced by women in the perimenopause and menopause.   Night sweats, a need to get up to pass urine, anxiety and an over-active mind can all disrupt sleep leading to tiredness, poor concentration and impaired memory.  Combined with midlife concerns and worries about family, friends, elderly relatives and work, it is easy to see how sleep can be elusive. 
 

What can I do to help myself?

  • Get up, and go to bed, at a regular time each day, including weekends
  • Early in the day, go outside into daylight. Bright light inhibits the release of melatonin, our sleepy hormone, helping us to feel more awake
  • Avoid caffeine.  General advice is that caffeine should be avoided beyond mid-afternoon.  However, many people are very sensitive to the effects of caffeine and need to have their last cup of tea or coffee at 12 midday. Remember that chocolate also contains caffeine.
  • Eat early. A heavy meal before bedtime can cause heartburn and indigestion which can disturb sleep
  • Exercise. At least 30 minutes of exercise per day, ideally outside in bright light, will help overall health and sleep. Try to avoid exercise in the 2-3 hours before bedtime, the raised body temperature associated with exercise can inhibit sleep
  • Avoid alcohol.  Alcohol may initially help you to fall asleep, but it reduces rapid eye movement sleep resulting in sleep of poor quality and duration
  • Avoid napping on the couch in the evenings as this will reduce the sleep pressure required for a good night’s sleep
  • Keep the bedroom cool. A fall in core body temperature helps to initiate sleep
  • Prepare for bed.  Anyone who has a child will be familiar with The Bedtime Routine.  In most homes this combines bath time, a warm drink and a story.  This routine tells our child that playtime is over, now is the time to rest.  If we plucked our child from play in the garden straight into bed, we would not be surprised that the child did not immediately fall asleep!  The same is true for adults. A warm bath will help you to relax and the drop in core temperature when you climb out will help to initiate sleep
  • Mental deceleration is important – make a To Do list so that intrusive thoughts of work/home/life responsibilities do not disturb sleep
  • Ban blue light from the bedroom.  We are all aware that we should switch off all electronic devices well before bed- time but this takes discipline.  The blue light of electronic devices inhibits the release of melatonin, our sleepy hormone, making sleep more difficult. Having our phone/iPad/laptop in the bedroom can be a reminder of work pressures that will inhibit restful sleep
  • Only go to bed when you are sleepy
  • If you waken in the night and have failed to get back to sleep after 15-20 minutes, get up out of bed and do something quiet that helps you to relax. Only return to bed when you feel sleepy again
  • Remove visible clocks from the bedroom to prevent anxious clock watching in the night
  • Keep the bedroom for sleep, if your brain associates this space with work/TV/exercise it is less likely to sleep
  • Aim for 7-8 hours of sleep per night.
     

Can medication help?

  • HRT is the most effective treatment for reducing night sweats and hot flushes. If night sweats are disturbing sleep, HRT can help
  • Local vaginal estrogen can work to improve itch caused by vaginal dryness, vulval irritation, urinary frequency and the need to get up to pass urine in the night
  • Sleeping pills are not recommended. While they may help you get to sleep, they do not induce a natural sleep and interfere with the important brain functions that occur while we sleep. Next day grogginess can impair driving ability, increase the risk of falls and lead to poorer memory and recall.
     

What else can I do?

  • The National Sleep Foundation has further resources available at https://www.thensf.org/sleep-health-topics/
  • Practice Mindful Breathing. This is a simple breathing technique that has been shown to settle the mind and can encourage sleep
    • Lie in a comfortable position, eyes closed
    • Breathe in through the nose for a count of 3
    • Hold at the top of your breath to a count of 4
    • Breathe out through the mouth to a count of 5
    • Repeat
    • Your mind may wander, just bring it back to focus on the rise and fall of your breath, if it helps place one hand on your abdomen to feel it rise as you breathe in, and fall as you breathe out
  • If you continue to struggle, Cognitive Behavioural Therapy can help. The particular therapy for sleep disturbance is called CBT-I. Your GP may be able to refer you for this locally or alternatively services are available on a private basis nationwide.

Dr Alice Duffy

Last updated May 2021

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