One of the core symptoms of the menopausal transition is sleep disturbance. Peri-menopausal and menopausal women often complain of difficulties initiating and/or maintaining sleep with frequent nocturnal and early morning awakenings. Sleep difficulties can be related to fluctuating or declining oestrogen and progesterone levels which influence neurotransmitters in the brain. Sleep difficulties can also occur as a result of menopausal symptoms such as hot flushes or restless legs. The good news is you can protect your sleep by establishing healthy sleep habits.
Set your circadian rhythm by going to bed at the same time and rising at the same time daily. As soon as you can, expose yourself to morning light, which helps to keep good circadian rhythm, promoting healthy melatonin levels in the evening and allowing you to sleep earlier.
Minimise stimulants before bedtime, including blue light from devices, caffeine (ideally no more than 2 cups daily and before 2 pm), and alcohol and exercise (best to avoid 3 hours prior to sleep). It’s also a good idea to eat at least 3 hours before bedtime.
Schedule adequate down time prior to sleeping by avoiding in depth discussions, arguments and stimulating books/TV. Instead, consider what helps you to relax such as music, a bath, meditation, positive journaling or affirmations.
A bath may help to relax muscles and reduce tension. Add 1-2 cups Epsom or Magnesium salts and 10 drops lavender oil.
Set a comfortable sleep environment by decreasing irritating noises in your space by closing windows or using ear plugs. Make sure your sleeping area is the correct temperature range (not too hot or too cold). Closing blinds to make the room dark also helps to promote healthy melatonin levels prior to sleep.
Consider your eating habits. Researchers have found that eating a diet that is high in sugar, saturated fat and processed carbohydrates can disrupt your sleep, while eating more plants, fibre and foods rich in unsaturated fat — such as nuts, olive oil, fish and avocados — seems to have the opposite effect, helping to promote sound sleep. Avoiding refined carbohydrates and free sugar in the evening which reduces melatonin levels needed for healthy sleep patterns should also be considered. If you are waking up regularly in the night, consider what is causing this – it could be a drop in blood sugar so remember to balance macronutrients during the day to include protein and complex carbohydrates at each meal of the day. A healthy snack such as an oatcake with almond butter might help before bed to stabilise blood sugar.
Consider supplementation or herbal/homeopathic support. Ideally it is best to speak to a qualified practitioner for an individual approach, but many people do well on magnesium glycinate before bed (200-400 mg is a typical dose). Melatonin can be prescribed by a qualified doctor if needed.
Herbal medicine has much to offer in the treatment of sleep problems and there are multiple options of relaxing and sedative herbs. These are just a few of my favourite ones:
Chamomille
Chamomile is widely regarded as a mild tranquillizer and sleep-inducer. Sedative effects may be due to the flavonoid, apigenin that binds to benzodiazepine receptors in the brain.
Chamomille can be easily taken as a herbal infusion, and I would recommend infusing for 15-20 minutes to gain an effective dose.
Passionflower
One of my favourite herbs, it has a sedative, relaxing, calming and nervous restorative action which is excellent when the brain is overstimulated alongside physical exhaustion.
Generally considered to be more effective in an herbal infusion it is the alkaloids and flavonoids which are thought to be the active constituents, alongside maltol and ethyl-maltol which may be responsible for the sleep-inducing and muscle relaxant activity attributed to passionflower.
Hops
Is a cooling sedative, making it a great choice for menopausal women who are waking due to night flushes or feeling hot.
It is a nervine, strong sedative, analgesic and hypnotic. The main indications for hops are sleeplessness from worry and anxiety, restlessness associated with nervous tension, headache and restless leg syndrome.
The valerianic acid is a sedative and the volatile oils including humulene are sedative, hypnotic, analgesic, antiseptic, carminative and antispasmodic.
Ashwaganda
Ashwagandha has over 4,000 years of traditional use in India. It is considered a tonic medicine for improving energy, memory and learning, promoting libido and reducing anxiety.
Ashwagandha is calming and anti-inflammatory.
It is used to improve sleep, reduce anxiety, improve memory and reduce inflammation and oxidative stress in the body.
RCTs have shown Ashwaganda to reduce cortisol in the body, which is helpful in protecting the body against the harmful effects of stress and increasing resilience.
I use it commonly in capsules, although traditional use is in a milky drink before bed.
Oatstaw
Oats are highly nourishing and restorative. They are an excellent nervous system tonic, useful in anxiety, fatigue, insomnia and depression.
Taken before bed, milky oats infusion or tincture supports deep refreshing sleep.
Oat Straw is high in silica & minerals & has connective tissue restorative qualities for bones, muscles, tendons & nerves.
Oat Tops (aka. milky green oats or seed of unripe plants) contains saponins & alkaloids and is neurotonic and an adaptogenic nervine useful in anxiety and depression.
Valerian
Valerian is one of the most relaxing nervines herbs and can be very helpful in aiding a peaceful sleep.
It can be used to reduce tension, anxiety, and overexcitable states.
Valerenic acid, one of the constituents within valerian is both sedative and antispasmodic. It binds GABA receptors, release GABA and inhibits GABA degradation which causes CNS sedation and smooth & skeletal muscle relaxation.
Limeflower
Limeflower is an gentle nervous system relaxant, useful in anxiety and insomnia.
Its volatile oils are responsible for the sedative action.
It makes for a refreshing and pleasant herbal tea, excellent for taking before bed.
Napping
The National Sleep Foundation suggests 7-9 hours of sleep for an adult, and if sleep is deprived, napping can help combat effects of sleep deprivation/repay sleep debt. This can be a great technique to use through menopause and is much better than reaching for coffee or sugar if you are fatigued, I find power napping to be a wonderful tool.
The length of nap /type of sleep determines the potential health benefits:
10-20 mins. Reduces sleepiness/improves cognition
20-30 mins. Enhances creativity, sharpens memory
30-60 mins. Sharpens decision making skills
60-90 mins. REM sleep, problem solving
Restricting naps to early afternoon is best (between 1pm -3 pm)
Exercise
Exercising improves sleep for many people.
Specifically, moderate-to-vigorous exercise can increase sleep quality by reducing our sleep onset – or the time it takes to fall asleep – and decrease the amount of time we lie awake in bed during the night. Additionally, physical activity can help alleviate daytime sleepiness and, for some people it reduces the need for sleep medications.
Exercise has so many more benefits for our mental health, bone health and to maintain a healthy weight.
Within the Dr Sally’s Botanicals range we have a Nightcap tea and Cooling organic herbal tea, both of which can be used to aid sleep and based on formulations used in my clinical practice for the last 17 years.
At Orchard Barn Health we also have a qualified medical herbalist and an Integrative and Functional Medicine Women’s Health clinic run by myself, which specialises in an integrative approach to perimenopause and menopause.
Dr Sally Moorcroft
Integrative and Functional Medicine Doctor
Orchard Barn Integrative Health Centre, Stallingborough, Grimsby, NE Lincolnshire.
DN41 8AJ