Sleepless in the Saddle (of Perimenopause)
By Catherine Walsh, Registered Dietitian
Sleep, or the lack of, seems to be discussed a lot in my circles in days of late. Is this the case for you as well? Did you know that insomnia affects approximately 50 per cent of midlife women? This fact is astounding and seems to confirm my assumptions that “every second person” (mostly women but also men) I meet has some issues related to their sleep. One coworker recently mentioned that she hasn’t had a good night sleep since 1987. This is distressing to say the least. Let’s examine what is happening and what can be done.Insomnia is characterized by nocturnal symptoms of difficulties initiating or maintaining sleep (or both) for three times per week for a period of at least three months and daytime symptoms that impair occupational, social or other components of functioning. Sleep disordered breathing is another matter outside of this blog post but should be considered in one’s health picture as it can impact 20 per cent of midlife women.
Right now you might be saying how does this have anything to do with nutrition? And why is it on a women’s health nutrition blog? Well the answer is that sleep has plenty to do with nutrition and lifestyle. Sleep, or lack of it, can greatly impact your food and lifestyle choices and conversely your diet can play a big role in how you sleep.
Back to the midlife bit. What age is midlife when it comes to perimenopause or menopause? This can be a full span of 20 years or more so chances are you might be smack in the middle of this time frame of 35-55 years. Just when you get past the “getting the kids to sleep” phase of your life, there is more unrest waiting at the other end. Sigh. But wait, this distress over sleep may be part of the problem. However, awareness may be part of the solution. More on that in a minute.
Science is not clear whether the sleep problems are due to effects of aging on sleep and/or the kicker of menopause being thrown in which can deliver straight to your door the following: hot flashes, night sweats, depression, anxiety and mood changes, weight gain and redistribution of fat in the body along with any co-morbid conditions such as chronic pain. What is a person to do with the hormonal milieu that is brewing up a storm sometimes quite literally in the body? Fun fact: hot flashes occur in 60-80 per cent of women during the menopausal transition.
Since the scare of hormone replacement therapy back in the early 2000’s, and the demographic of an ageing cohort, fan sales everywhere have likely driven us through a sluggish economy of the last 25 years.
We all have a natural circadian rhythm, however, the way of the world currently exerts a lot of pressure on this natural cycle of wake and sleep. Stress of life in general has a negative impact on our sleep rhythms. Add to this that our melatonin, a chemical produced by our brains which acts like a natural sleep drug, wanes with age.
Therefore, to improve our sleep we need to reduce our stress. Eating well balanced meals is a great place to start. Setting time for you and your health as a priority (read: assertiveness) is something many people (read: women) need some work on. Other aspects of diet to be aware of are caffeine and alcohol consumption. Be mindful and moderate of your caffeine intake and timing. Additionally, alcohol may look like a friend to us on a stressful day, but it is a wolf in sheep’s clothes and it can disrupt a good night’s sleep – especially as we age. It is my humble opinion that the rule of thumb with wine as we age should be a glass with dinner, fine. But any more, mix it into a spritzer. Drinking above the moderate amount of one drink per day needs to have much dancing to accompany it. One hour of dancing per drink. Alcohol is also a risk factor for cancer so be aware of this unfortunate buzz kill information as well.
On top of that, alcohol and caffeine are often paired up with food that may be highly processed or have a lot of sugar and sodium. What does a body want to do with these? Store the extra calories and pee to get rid of the sugar and salt which means more trips to the bathroom at night when you could be sleeping.
You may feel like you will never sleep the same again when you get into a spin with your sleep but take heart, there are strategies to help with insomnia. As mentioned, a balanced diet is top of your list. Enjoyable movement (walking, yoga, Pilates, stretching) is another spectacular way to ease the stress. Allow your body to rest as well, maybe take a nice soak in a warm (not hot) Epsom salt bath. Relaxation and enjoyable activity can help take the cortisol down. Sleep hygiene (see link in resources) is so important so make a check list for yourself. Snoring partners and nocturnal tap dancing cats need to be put in another area of the house. Don’t be afraid to have the conversation with your doctor about medications which may include hormone replacement therapy.
There are many non-medical strategies such as stimulus control, Cognitive Behavior Therapy (CBT), relaxation training and sleep restriction techniques (yep, sleep restriction). See some of these links for resources. Any problem that gets attention is bound to get better, however, fixation and focus on something can sometimes make things worse. The CBT strategies help you reframe your thoughts which finds a better path through the perceived misery. Breathing and mindfulness are other techniques to practice and hold lots of evidence for support. So give them a try.
Finally, a sense of humor and support from others, can go a long way anytime you are dealing with anything causing distress. Keep your awareness to the lighter side as humor is a true comrade in the pursuit of a good night’s sleep.
“Cats have it all – admiration, endless sleep, and company only when they want it.” Rod McKuen
Resources: Healthy eating http://www.healthycanadians.gc.ca/eating-nutrition/healthy-eating-saine-alimentation/tips-conseils/interactive-tools-outils-interactifs/eat-well-bien-manger-eng.php Sleep Hygiene https://sleepfoundation.org/how-sleep-works https://www.psychologytoday.com/blog/quiet-your-mind-and-get-sleep Hormone Replacement Therapy http://www.cbc.ca/news/health/hrt-safe-for-some-women-sogc-says-1.4174728 Programs https://www.sleepio.com/ http://www.myshuti.com/ Apps: CBTi https://play.google.com/store/apps/details?id=com.t2.cbti&hl=en References: