“Though sleep is called our best friend, it is a friend who often keeps us waiting!”- Jules Verne
Don’t you hate it when good friends keep you waiting?
The older we get the more tardy our dear friend sleep may become, and peri- and postmenopausal women may find it hardest of all to get good sleep.
According to the Centers for Disease Control, perimenopausal women between 40 and 59 are 56 percent more likely to sleep less than 7 hours a night than their same-aged sisters who are pre- or post-menopausal. Among participants, being postmenopausal worsened their ability to fall and stay asleep and to feel rested when they woke.
So, if your sleep is a bit crap at the moment, declining or lack of estrogen and progesterone is likely at least partially to blame.
The good news is, even if hormones play a role, you can still get good sleep.
One woman’s poor sleep may be another woman’s normal, so it’s important to understand what we mean when we talk about poor sleep. Generally, poor sleep is defined by insufficient REM or deep sleep (fewer dreams), when sleep is interrupted more often than usual, when it takes longer to fall asleep, when you wake too early, or when you have trouble going back to sleep after an interruption.
While we have this idea that older people need less sleep, that’s actually not true. According to the National Sleep Foundation, our sleep needs remain consistent throughout our adult lives. So if you’re not getting enough sleep to feel rested when you wake, you should take steps to get more zzzzs.
Most of us know well how not getting enough sleep for a night or two affects us: we’re irritable and groggy, we find it hard to concentrate or remember what we learn, we’re less productive, and we may make poor decisions about sugar and caffeine in order to replace the energy that’s missing.
But chronic insomnia or disrupted sleep can have more serious long-term effects as well, including depression, memory problems, increased risk of obesity and diabetes, heart disease and hypertension, suppressed immune system, increased risk of alcohol abuse, and shorter life expectancy.
But don’t let that stress you out – stress is terrible for sleep.
Hormones may be playing a role, but there are other reasons your good sleep might be a bit lacking.
Emotional issues: There’s no question that women in midlife are often dealing with a lot of stress: teenagers or
looming empty nest; relationship issues; aging parents. No surprise here: stress makes it harder to fall and stay asleep.
Physical conditions: Ask any woman who experiences hot flashes, cold flashes, or night sweats – vasomotor symptoms like these can completely derail a good night’s sleep and often happen multiple times during the night. Also, women in midlife are at higher risk of developing sleep apnea; as estrogen drops, we can lose muscle tone in our esophagus (yes, even there – and you thought flappy upper arms were bad), leading to the choking, gasping during sleep due to obstructive sleep apnea. Restless leg syndrome (RLS) strikes many women during midlife, possibly due to fluctuating hormones or because we don’t absorb magnesium, with its muscle relaxation properties, as readily when estrogen levels are low.
Pain: Chronic pain affects many people in midlife: arthritis, back or pelvic pain, frozen shoulder, all can make it difficult to relax into sleep. Unfortunately, not getting good sleep can make us less tolerant of pain and more likely to feel pain more acutely, leading to a vicious, sleep-stealing cycle.
Lifestyle choices: Some of our daily decisions may impact our ability to sleep without us even knowing it. Choices that are best to rethink: exercising too close to bedtime; using devices such as tablets, smartphones, TVs, etc. too close to sleep time; drinking alcohol at night or caffeinated drinks after noon; eating spicy food for dinner; having too much liquid too late at night (which requires o-dark-thirty elimination). All of these are known to impact quality and quantity of sleep.
Most of us know the drill: don’t do the lifestyle stuff listed in the paragraph above. Keep the bedroom cool, dark, and restricted to sleep and sex.
If you’ve tried these and still can’t get the rest you need, don’t panic. There are other ways to combat poor sleep that you may not be familiar with.
Cognitive behavioral therapy for insomnia (CBTi): Ironically, worrying about sleep may be what’s keeping you awake. With CBTi, a therapist will take a look at your mental state around sleep as well as your sleep habits, how you prepare for sleep, your schedule, etc., and suggest modifications to help you sleep better. A clinician may recommend you avoid naps, go to bed later at night, and get up if you’re not sleeping, no matter what time it is.
Sleep restriction: Often a primary component of CBTi, sleep restriction is just like it sounds – fewer hours in the sack. The idea is to tire the patient out with fewer hours of sleep, so when she does go to bed, she goes to sleep and stays there. Ultimately, the patient is allowed to return to normal sleep times, as long as she doesn’t relapse.
Magnesium: Magnesium does a lot for our bodies – including promoting sleep and regulating moods – and most women are running a little short on this essential mineral. Magnesium supplements can cause gastric upset, so consider talking to your doc about the best way to increase your magnesium levels. One pretty safe path is to get more magnesium through your food.
Biofeedback: We have more control over our bodies than we might think, including our heart rate, brain waves, and breathing. We usually let our bodies take control of all that, but when we’re overly stressed, our bodies may not know when to let go and calm down. Biofeedback teaches us to monitor our biological signals and ultimately to control them with our minds, allowing us to slow, calm, and hopefully, finally, sleep. You may have to start this one in a clinic with monitoring equipment, but if you have the means, it may well be worth the money.
Tryptophan: A somewhat less expensive way to promote sleep may be as close as your refrigerator. Tryptophan is an amino acid found in some foods that your body converts into niacin. Niacin helps create serotonin, a neurotransmitter that regulates sleep, and that’s why turkey makes you tired. Combine it with a carbohydrate at bedtime, and you’re ready for some zzzs. Good tryptophan-containing foods are usually high-protein foods such as nuts, seeds, tofu, oats, beans, lentils, turkey and chicken, plus meat, cheese, yogurt, eggs, and fish.
Wouldn’t it be lovely if a pill helped you get good sleep? But it probably won’t, at least not for long. So says Matt Walker, professor of neuroscience and psychology at the University of California, Berkeley. Pills just can’t match the benefits of natural sleep. Pills provide sedation, says Walker, which is different from sleep. Sleep, says Walker, involves “an incredibly complex ballet of neurochemical brilliance that results in numerous areas of the brain both switching on and switching off.” Sedation is just the “switching off.”
Additionally, according to Walker, sleeping pills don’t increase sleep beyond what you’d get from a placebo, and they may increase your risk of death and cancer. So…maybe not pills, then.
Your dear friend, Sleep, hasn’t deserted you just because you crossed the midlife border. She may just need more persuading.
So. Eat nuts. Turn off your iPad. Talk down your heart rate. And let the ballet begin.