• Rayne Roberts

Sleep and the (peri) Menopausal Woman

There are many theories as to why we need sleep. Some suggest that sleep plays an active role in processes such as optimal brain function, regulation of emotions, energy levels, the repair of cells, tissues and organs as well as supporting the removal of toxic substances (1).

However, it’s not uncommon for peri-menopausal women (where periods are irregular but still there) or menopausal women (no period for at least 12 months) to complain of difficulty falling or staying asleep, often with night time or early morning wakings (2,3).

Having your sleep disturbed can make you feel lethargic, emotional and can create a heightened perception of your menopausal symptoms (4).

What causes the problem?

For your stage of life there are two key factors:

Hormones

Around the menopause, progesterone levels generally start to decline altering your levels of GABA, a calming brain chemical. Partly built using magnesium and vitamin B6 from foods, GABA plays an important role in promoting calmness and good sleep (5,6).

Stress

Your “stress hormone” cortisol provides a boost of blood sugar energy enabling you to run for that bus, meet that deadline and other “micro-stressors” consistent with everyday life. Yet in reality life is a succession of micro-stressors, with each one instigating the release of cortisol. This affects our natural sleep rhythm and can manifest itself as the inability to switch off at night.

Additionally, we recognise that shift work patterns, too warm a bedroom, blue light from phones and iPads, snoring partners etc impact your sleep - and we recommend visiting The Sleep Council for general sleep hygiene advice.

TIPS FOR IMPROVED SLEEP

Nutrition Tips

  • Avoid caffeine and alcohol as they activate your "stress hormone" cortisol. Replace with soothing Lemon Balm or Chamomile teas

  • Skipping meals or eating refined carbs (white breads, pasta, flour based meals) can induce a cortisol release which will wake you up during the night. Foods like berries, apples, pears, wholegrain bread, wholemeal pasta and noodles, legumes and brown rice will release energy for your brain, heart and lungs to function overnight

  • Eat plenty of vitamin C rich foods such as vegetables and fruit to support your cortisol producing adrenal glands

  • Promote relaxation and support GABA levels with magnesium rich foods like leafy green vegetables, nuts and wholegrains

  • Ensure a daily intake of foods containing B vitamins such as meat, fish, eggs and wholegrains like oats and brown rice

  • Considerable evidence shows your gut bacteria regulates your sleep patterns (9). Support these colonies with leafy green vegetables, onions, leeks and Jerusalem artichokes, fruits such as berries, apples and pears, plus oat, buckwheat and quinoa wholegrains.

Lifestyle Tips

  • Manage your stress levels

  • A warm bath with a cup of magnesium-rich Epsom Salts twice a week is a good way to top up magnesium levels (11)

  • Ensure your bedroom is cool (and your bath not too hot!) – your body needs to drop 1-2°C before sleeping (12)

  • ​Practice yoga particularly "pranayama", which has been shown to significantly reduce insomnia and menopausal symptoms (18)

CAN SUPPLEMENTS HELP?

​Targeted supplements may work for some people when all else has failed. You should talk to a nutritional therapist to assess what's best for you and you must clear all supplements with a nutritional therapist or your GP if you are taking any prescribed medication.

Magnesium

According to registered Nutritional Therapist, Linda Sims, “low magnesium levels are common in menopausal women”. She recommends sipping water during the day containing magnesium citrate (try Lamberts Healthcare’s MagAbsorb powder or NutriAdvanced’s MegaMag Calmeze) plus a 375-400mg magnesium citrate tablet in the evening until your sleep patterns are established.

L-theanine

Found in tea leaves, L-theanine may reduce “mental chatter” at bedtime, support the relaxation response and improve sleep quality. Try Cytoplan’s L-theanine vegan capsules or Lamberts Healthcare’s L-theanine with calming lemon balm (see below).

Lemon Balm

Lemon balm prevents the body from converting GABA into a more excitory brain chemical so you’ll feel calmer for longer. In 3 small studies, between 300-1000mg of lemon balm extract reduced anxiety, insomnia and stress (13,14).

Valerian

Valerian regulates GABA’s calming activity (15). Studies show that taking 300-1000mg of valerian at night reliably improved sleep quality in people with insomnia and restlessness (16). It may also reduce pain associated with periods (17) if you're still in that mode.

KEY POINTS

  • Disturbed sleep is a common complaint during the menopausal period.

  • Reduce your stress levels

  • Eat foods which support your body’s relaxation mechanisms

  • Eliminate stimulants

  • Practice yoga - two 1 hour sessions per week

  • Talk to a nutritional therapist who can compile a personalise plan for you based on your symptoms. Find out more here

References

1 Vyazovskiy, V. (2017). Sleep, recovery, and metaregulation: explaining the benefits of sleep. Nature and Science of Sleep 2015; 7, pp.171–184.

2 Ameratunga, D. et al. Sleep disturbance in menopause. Internal Medicine Journal 2012;42(7), pp.742-7.

3 Santoro, N. (2016). Perimenopause: From Research to Practice. Journal of Women's Health, 25(4), pp.332-339.

4 Larson, R. & Carter, J. (2016). Total sleep deprivation and pain perception during cold noxious stimuli in humans. Scandinavian Journal of Pain, 13(1), pp.12-16.

5 Follesa, P. et al. (2000). Allopregnanolone synthesis in cerebellar granule cells: roles in regulation of GABAA receptor expression and function during progesterone treatment and withdrawal. Molecular Pharmacology, 57(6), pp.1262-1270.

6 Ehlen, J. et al. (2010). GABA involvement in the circadian regulation of sleep. GABA and Sleep, pp. 303-321. Springer:Basel.

7 Winkelmayer, W. (2005). Habitual Caffeine Intake and the Risk of Hypertension in Women. Journal of the American Medial Association, 294(18), p.2330.

8 Johnson, S. (2018). The multifaceted and widespread pathology of magnesium deficiency Journal of Women’s Health 2016 Apr 1; 25(4), pp.332–339.

9 Jenkins, T. et al. (2016). Influence of Tryptophan and Serotonin on Mood and Cognition with a Possible Role of the Gut-Brain Axis. Nutrients, 8(1), p.56.

10 Baker, F. et al. (2018). Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nature and Science of Sleep, Vol 10, pp.73-95.

11 Gröber, U. et al. (2017). Myth or Reality—Transdermal Magnesium?. Nutrients, 9(12), p.813

12 F Murphy, P. & Campbell, S. (1997). Night-time Drop in Body Temperature: A Physiological Trigger for Sleep Onset?. Sleep, 20(7), pp.505-511.

13 Kennedy, D. et al. (2004). Attenuation of laboratory-induced stress in humans after acute administration of Melissa officinalis (Lemon Balm).. [online] Pdfs.semanticscholar.org. Available at: https://pdfs.semanticscholar.org/de8d/56fcb9b841ecc5ca68883c1f945f8f595979.pdf [Accessed 25 Jan. 2019].

14 Kennedy, D et al, D. (2002). Modulation of mood and cognitive performance following acute administration of Melissa officinalis (lemon balm). - PubMed - NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12062586 [Accessed 25 Jan. 2019].

15 Benke, D. et al. (2009). GABAA receptors as in vivo substrate for the anxiolytic action of valerenic acid, a major constituent of valerian root extracts. Neuropharmacology, 56(1), pp.174-181.

15 Bent, S. et al. (2006). Valerian for Sleep: A Systematic Review and Meta-Analysis. The American Journal of Medicine, 119(12), pp.1005-1012.

16 Cuellar, N. & Ratcliffe, S. (2009). Does valerian improve sleepiness and symptom severity in people with restless legs syndrome? [online] Available at: https://www.ncbi.nlm.nih.gov/pubmed/19284179 [Accessed 25 Jan. 2019].

17 Mirabi, P. et al. (2011). Effects of valerian on the severity and systemic manifestations of dysmenorrhea. International Journal of Gynecology & Obstetrics, 115(3), pp.285-288.

18 Afonso, R et al. (2012). Yoga decreases insomnia in postmenopausal women: a randomized clinical trial.

Menopause, 19(2):186-93

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