One of the most common changes in perimenopause is in how women sleep (or don’t, rather). I regularly hear from patients that they struggle and the struggles vary from difficulty getting to sleep, to sleeping lighter in general to waking at 3 am every night unable to get back to sleep. Many perimenopausal women suffer from the consequences of poor sleep including fatigue and irritability, which lead to poor lifestyle choices (i.e. drinking more caffeine and eating more sugar to perk yourself up) which can aggravate mood and worsen anxiety and depression, which affect sleep…it’s a vicious cycle that can be very difficult to get out of.

Where to Start?

Stress reduction. Perimenopausal women are under a tremendous amount of stress. We have children, spouses, aging parents, pets, careers and/or stressful jobs all requiring our attention and care. It is very easy to focus on the needs of the important people in our lives and not our own. Our cups overfloweth.

Create boundaries to protect your valuable time: say NO more often (and not just to your kids and spouse/partner), leave work by 6, and don’t check your work email until the next morning, and dedicate a moment to yourself each day, for self-care. This could be as much or as little time as you want, but I challenge you to carve out 30 minutes EACH day to bring the focus back to you.

• Meditation: I see and feel the biggest eye-roll when I talk to patients about this one, but you get the biggest bang for your buck here. Most people think you have to sit in silence for an hour every day in order for it “to work”, but good news! Only 12 minutes a day and your body begins to reap the benefit of meditation. There are many apps and YouTube channels dedicated to this. I use the app Calm.com, but have also enjoyed Stop, Breathe and Think and Head Space. Each of these sites and apps offer guided meditations that are as short as 2 minutes, so you have no excuse! Try one at bedtime and again in the night if/when you wake.
• Journaling: Get those thoughts and lists out of your mind at bedtime and onto paper. Tell your brain that you’ll come back to the list the next day.
• Time with girlfriends: hash things out, get things off your chest, find out what they are struggling with (I bet it’s the same stuff you are!), get ideas about problem-solving, and see what your friends are doing to cope day-to-day. Our women friends are VITAL parts of healthy aging and stress release and these are probably the first relationships to be pushed back when we are busy and need them the most. Make it at least a monthly event to get together with your lady friends. Your soul will thank you for it.

FRIEND: ARE YOU GETTING ENOUGH SLEEP?

ME: SOMETIMES WHEN I SNEEZE, MY EYES CLOSE.

“Sleep Hygiene”

This is a term that insomniacs know well, but few practice these simple strategies that can have a huge return. Terri Gross on NPR’s Fresh Air recently interviewed a professor of sleep science from UC Berkeley named Matthew Walker about his recent book, Why We Sleep: Unlocking the Power of Sleep and Dreams. I haven’t read the book, but listened to the interview in which he talks about these sleep strategies and also reminds us of the effects of short and long-term sleep deficits (they are HUGE).

• Get 8 hours of sleep, no less. Each night. You can’t make up for lost sleep on the weekend…sorry to burst that bubble!
• Schedule your to-bed and waking times and keep to that schedule as much as possible, even on weekends.
• If you are awake for more than 30 minutes in bed, get up and go to another dark, quiet room. Our brains learn very quickly to associate the bed with being up and alert if you lie awake in it. You want the bed to be associated with rest, not stress.
• Screens off! Turn your phone and TV off the hour before you should go to bed (not when you want to go to bed).
• Exercising too late in the day will make it hard to get to sleep. Ideally you would exercise in the morning or at least by 6pm. I have friends and patients that wake up extra early to get to that class they love at the gym (you would schedule this in to your sleep schedule to ensure you are still getting your 8hrs of beauty sleep). I met a woman recently who goes later in the morning to a gym near work and her employer allows her to work from home those mornings and arrive at the office after her work-outs (and her company pays for the gym membership!). If you can’t get to a gym, there are tons of videos and online exercise programs available. My favorites are the 7-Minute Workouts by Johnson & Johnson (a free app for your tablet or phone; no gear required!) and Betty Rocker’s free 30 day challenge.
• Listen up! I’ve referred patients to sleep specialists and have noticed the advice to listen to audiobooks if you wake in the night. Apparently, it turns the volume down on the part of the brain that can become stimulated and stressed in the night. I use Amazon’s Audible as it syncs to the books I’m reading on my Kindle (so cool!), but your local library is an excellent source of free audiobooks. The key here is to have the book ready to go, so all you have to do is push play (the last thing you want to do is be fumbling with your phone, finding that app, searching for the book…all of which wake your brain up even more).
• Track your cycles. I’ve said it before, but because I use the Clue app, I know when I should be ovulating and when to expect my next period. I’ve learned, too, and have heard from many other women, that sleep patterns can change during your cycle. I know to expect 1-2 nights of very early wakings per month, no matter what I do. They always happen a week or so before my upcoming period and I’ve learned to notice them, get out of bed and start the day. That’s often when I’m writing to you! I feel less stressed about these days because they are predictable and I know my good sleep will return soon.
• Alcohol. Ugh. I love a glass of wine at the end of the day but studies consistently show, I hear it daily in my practice and experience it personally that drinking even a small amount disrupts sleep. Your sleep is lighter and you are more likely to wake in the night with trouble getting back to sleep (the 3 am wake-up!). I also hear from women that when they tune in to this one factor, they notice an increase in night sweats and sometimes disturbing heart palpitations and anxiety on nights they drink. For some reason that I do not understand, red wine is the worst offender. Again, ugh…
• Caffeine will disturb your sleep. Try not to ingest any (coffee, green or black teas, energy drinks, chocolate) after 2pm.

Winding down at the end of the day

What’s a girl to do without chocolate and red wine at the end of a long day?? This is your challenge, to explore ways of filling up your bucket doing things for yourself that are not sabotaging your sleep and affecting your health. Cuddle with your honey, call that friend you haven’t spoken to in a while, write a letter, have sex, journal, do something crafty, take a class to learn that thing you’ve always wanted to learn, get together with girlfriends for a walk, take a bath, do some yoga, start a blog…

Okay, so you’ve started exercising in the morning, forego that 3 pm Pumpkin Spice lattè for a walk around the block, and have traded your evening wine for a cuddle and an episode of Stranger Things (so good!) but you are still struggling to snooze. Here are some natural therapies that may help (check out the Resource page for links on where to find these):

Supplementing for Sleep

• Magnesium powder. I’ll probably mention Magnesium in every post I write. I love magnesium. It is so safe, so cheap, so effective and most of us are deficient. Magnesium relaxes our muscles and brains. Many folks notice a deeper, cozier sleep once they start taking Magnesium at bedtime. I like Natural Calm Magnesium powder, but Garden of Life’s Relax and Restore contains no sweeteners. Start with the recommended dose on the bottle. You’ll know you’ve taken too much mag if you have diarrhea the next day, so take a little less the following night to find your sweet spot. If your belly can’t tolerate mag citrate, try mag glycinate or mag threonate.
• Calms Forte by Hylands. This is a homeopathic blend that promotes a peaceful mind and restful sleep without interacting with your medications. Chew 3 of these at bedtime and again in the night if you wake.
• Melatonin (for getting to sleep only; melatonin will not help you stay asleep). Try 1mg under the tongue and increase if needed. Typical doses vary between 1-5mg. If you feel groggy the next morning take less to see if you get improvement without brain fog.
• Cortisol Manager by Integrative Therapeutics. This is a great formula for reducing cortisol levels that are too high. You may have trouble getting to sleep or you may wake you in the night with that list of things you need to do. Take 1-2 at bedtime; even better, have your cortisol values evaluated by your naturopath!
• Progesterone cream. I don’t use this cream all that often, but it can be helpful for improving sleep quality in perimenopause. It’s especially useful f you find you consistently get your worst sleep from ovulation to your period. This is the time when we should be making the most progesterone, but don’t because that’s what happens in perimenopause. Progesterone is relaxing to the brain and occasionally the low-dose creams are enough for an effect (sometimes oral works better). I like the Protocol and Xymogen brands as they are metered pumps of bio-identical progesterone; each pump is 20mg. You rub it on your inner arms at bedtime.
• CBD. Did you know this chemical in Cannabis (marijuana) is legal in all 50 states? On its own, it has no hallucinatory effects but is a powerful sleep aid. I like the liquid forms because you can better adjust the dose to get as much as you need. It doesn’t work for everyone but has been hugely helpful for women in my practice (myself included!).

Is OTC for me?

I am frequently asked if over-the-counter pharmaceutical sleep aids are safe? Maybe not. A recent study showed an increase in dementia risk in older folks using Benadryl long-term at night for sleep. Try to find another option! If the strategies above are not working,  see your Naturopathic physician for a more tailored approach. Now, put down your phone, close your laptop, and get some sleep. Sweet dreams~

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