There are many reasons why sleep can become disturbed.
Anxiety, or too much caffeine may be to blame. Underlying health conditions can cause insomnia.
The menopause is also associated with sleep issues. Generally, post-menopausal women are less satisfied with their sleep and as many as 61% report insomnia, compared to only 54% of men.
Despite generally getting less sleep, sleep researchers from Loughborough University say that ideally, women actually need twenty MORE minutes of sleep than men. The extra amount of sleep required, is because women tend to multitask, juggling work and often childcare, so their brains are working harder. ‘Poor sleep has long-term effects including heart disease, diabetes, dementia and obesity – even cancer,’ said Mr Mike Savvas, consultant gynaecologist at King’s College Hospital, and one of the lead consultants at The London PMS and Menopause Clinic. ‘It needs to be taken seriously. The good news is, there are strategies and treatments available.’
When it's boiling hot ...
Find yourself tossing and turning, peeling off pyjamas and bedsheets? Perhaps you even have to get up in the middle of the night to change. Around 75% of those going through the menopause experience hot flushes and night sweats – known by doctors as the vasomotor symptoms. These symptoms occur before and during menopause because of changing hormone levels, including oestrogen and progesterone, affecting the body’s temperature control. ‘There is a strong association between the vasomotor and poor sleep,’ says Mr Savvas. ‘It may be at its worst in the perimenopause, but for some women these symptoms may last for up to ten years.’
Try this: Alleviate these unpleasant symptoms by using fans at night and taking cool showers. Talking to your doctor about treatment is also a good idea. ‘HRT is extremely effective at relieving hot flushes and night sweats,’ says Mr Savvas. ‘Ensuring you have an experienced practitioner means you can get a tailor-made prescription, of the precise requirements of progesterone and oestrogen.
2. Frequent trips to the loo
The other sleep stealer for women in their 40s and beyond is the frequent trips to the loo. ‘Up to 30% of women suffer from urinary symptoms in the menopause, usually the need to visit the loo frequently. Obviously, that can disturb sleep,’ says Mr Savvas. ‘Declining oestrogen is associated with overactive bladder. Without enough oestrogen, there may be atrophic changes in the lower urinary tract leading to this urge to urinate frequently at night.
Try this: Self-help for this aggravating symptom includes avoiding caffeine, alcohol and rich spicy foods, particularly at night-time, as they can irritate the bladder. Losing weight and Kegel exercises can also help. Urinary incontinence may be improved with the use of local oestrogen treatment.
3. All those aches and pains
If you find you can’t get comfy in bed, due to joint and muscle pain, gynaecologists won’t be surprised. Aches and pains can increase in the menopause and musculoskeletal pain is very much associated with menopause. A loss of muscle mass - along with losing bone density - during menopause may also occur at a higher rate than before and existing problems may be exacerbated. Like many sleep-related issues, it can be a vicious circle – is the lack of sleep causing worsening aches? Or is the pain triggering insomnia? We do know sleep is a very important for those with musculoskeletal pain – a lack of good quality rest makes everything feel worse.
Try this: Regular exercise can help reduce the loss of bone density and muscle mass. It may also reduce symptoms of joint pain. Menopause has an adverse impact on overall musculoskeletal health, and there is some evidence HRT may help these symptoms.
4. Your legs can’t stop moving
Restless legs - also known as Willis-Ekbom disease, is a common condition of the nervous system which makes sufferers want to move their legs. Nobody is quite sure what causes it, but if you’re female, you’re twice as likely to experience the condition as males are, and it often affects women during pregnancy and menopause. Sufferers get tingling sensations in their legs at night, some liken it to creepy crawlies on their legs. One study showed 69 per cent of post-menopausal women said their symptoms worsened since their menopause.
Try this: There are self-help techniques which you can experiment with, such as stretching, massage or trying a foot wrap which puts pressure under your foot – anecdotally it is said to relieve symptoms. Consulting a menopause expert is also recommended as certain drugs can help, and sometimes iron deficiency is to blame for this troublesome condition.
5. Worrying the night away
Women are 2 to 4 times as likely to develop depression around some of the menopause compared to younger women, so it’s not a surprise if anxieties and low mood are preventing you from getting to sleep. ‘Women with a history of postnatal depression and PMS are at a greater risk of developing mood changes around the time of the menopause,’ says Mr Savvas. ‘Changes in emotions are common in menopause. These include depression anxiety, irritability, difficulty concentrating and forgetfulness. All of these things can lead to poor sleep but are also worsened by poor sleep.’
Try this: Talking therapies may be useful if worries are keeping you are awake. CBT Insomnia (also known as CBTI) which helps you change actions or thoughts that hurt your ability to sleep well could also be a solution. Talking to your doctor or gynaecologist to see if treatments for reproductive depression would be helpful is also advised.
If you think your sleep problems are menopause-related and would like to talk to a specialist, please make an appointment. Call us on 020 7486 0497 or email firstname.lastname@example.org.
To find our more about menopause and HRT, Professor John Studd, the internationally acknowledged expert in the field of gynaecological endocrinology and founder of The London PMS & Menopause Clinic has made a series of podcasts. You can listen here.