How to Get Better Sleep in Menopause

I’m on a mission to re-brand menopause. It ain’t the old lady, irrelevant stage of womanhood our culture depicts. Far from it. We’re smarter, sexier, and more badass than ever, with more wisdom and life experience that brings a whole new level of freedom. But symptoms during these years and the years leading up to menopause can sometimes make it difficult to embrace. While it’s not a given that you’ll experience them, many women do – and the desire for better sleep in menopause is one of the top I hear when it comes to women’s concerns. 

Sleep problems are very common, affecting about 40 to 50% of women, and can be quite debilitating to the point of insomnia for women in their perimenopausal years. It’s often made worse by night waking caused by hot flashes and night sweats if they’re also affecting you. Even women who have slept well their whole lives sometimes find themselves having disrupted sleep starting at some time in their mid-to-late 40s, often an early sign of perimenopause. Typically women wake up in the middle of the night, unable to fall back to sleep, sometimes just wide awake, sometimes troubled by worrisome thoughts, sometimes woken by night sweats and hot flashes. 

But just because our hormones might make it more challenging, it doesn’t mean our need for sleep is any less. Poor sleep can make everything else feel miserable as well. Sleep is critical to your mood and mind and lack of sleep aggravates many other symptoms that are common in menopause like stress, memory loss, depression, and other physical discomforts. So rather than resigning to potentially years of suffering with disrupted sleep, let me share some of my go-to strategies for wooing a good night of sleep back into your life. 

What Causes Sleep Problems in Menopause?

You may have already guessed it but hormonal changes in perimenopause are largely responsible for wreaking havoc on your sleep. Since both estrogen and progesterone have a role in sleep, declining levels in menopause can cause sleep disturbances. Lower estrogen levels are also responsible for other common menopausal symptoms including irritating and uncomfortable hot flashes and night sweats that can also make sleep miserable as well as anxiety and depression that lead to difficulty falling asleep and frequent night waking. 

On top of that, melatonin naturally decreases with age and because it’s produced from serotonin, whose production is dependent on adequate estrogen levels, the lower estrogen state can also lower melatonin levels. It can be further depleted in the setting of stress (another common byproduct of menopause.) While all of these shifts are natural and normal, it can really become a triple hormonal whammy that’s not setting you up for sleep success!

Why Poor Sleep Matters

Aside from the obvious about how miserable we feel when we're exhausted, and how poor sleep drives us to crave (and eat!) more sugar and carbs, and possibly drink the extra cuppa' that then adds to our sleep problems, not getting enough sleep is actually a contributor to a number of symptoms and medical problems including but not limited to:

• Insomnia is associated with:
• Decreased sense of well-being and quality of life
• Increased anxiety and depression
• Headaches
• Increased risk of accidents for example, car accidents are more common in people with impaired sleep
• Higher systolic blood pressure
• Weight gain
• Cognitive issues including forgetfulness, decreased focus and memory

It's also important not to just chalk poor sleep up to menopause. Stress, alcohol, recreational, OTC, and prescription medications can all cause sleep problems. Underlying medical issues including chronic pain, fibromyalgia, anxiety, depression, restless leg syndrome, reflux, thyroid problems, arthritis, sleep apnea, congestive heart failure, and more, can also cause or contribute to insomnia, and should be considered if it's persistent beyond a few weeks, or is causing significant disruption in your life:

A Natural Approach to Better Sleep in Menopause

While it’s not always easy, remember these hormonal shifts are natural and not something to “fix” or replace with hormone replacement therapy (HRT). That said, we also shouldn’t feel like dealing with erratic hormones is normal or an acceptable way to live without help. There are gentle approaches we can take to support your body and symptoms in this transition with herbs, supplements, and lifestyle approaches. Sleep is one of those areas that we can make a world of difference in if we simply start to pay attention and support our environment. 

Lifestyle Support for Better Sleep in Menopause

While you know I love my herbs, lifestyle approaches for sleep especially shine when it comes to reclaiming the rest you so desperately need and deserve. In fact, sometimes all you need is a commitment to making sleep a priority by optimizing your lifestyle. While there’s a whole host of things you can do which I cover in Hormone Intelligence, here are a few to really emphasize when it comes to sleep problems in menopause.

Incorporate an Evening Wind-Down

Maybe you were always the type of person who could go-go-go, then crash into sleep the moment your head hit the pillow. For most of us, that’s not the case, even prior to perimenopause. But if you haven’t had to make a wind-down ritual part of your evening routine, now’s the time! 

Good sleep actually starts in the hours before bed. You have to make it a priority, not just some nights, but truly making it a daily lifestyle ritual. Simple things like turning the lights down low, making time for self-care like a soothing bath, keeping a sleep journal to write your worries away, and staying off devices at least one hour before bed (seriously!) can make a world of difference. Read this article for my top 7 tips for promoting good sleep. It may take some time to see the results and a bit of work to prioritize, but I promise, you’ll thank me later.

Skip the Alcohol (For Real!)

I know that perimenopause sometimes comes with a self-prescribed dose of more red wine but there’s no getting around it – alcohol can tank your sleep. Even a modest amount up to an hour before bedtime can reduce melatonin production by nearly 20% and it’s probably the biggest trigger of hot flashes I can think of. Not to mention it can make you feel depressed and is a breast cancer risk factor. Kissing your evening glass goodbye is one of the quickest and most effective sleep fixes I know – and it only takes overcoming the mental hurdle of letting it go.

Insider tip: red wine is the worst culprit (yes, even your organic, sulfate-free, California pinot noir), so if you’re going to have a drink, have vodka – it’s cleaner and while it still causes many women some symptoms, it’s way better tolerated than other alcohol. Keep it to one drink (you can cheat by splitting an ounce over two glasses), and no simple or added sugar.

Strategize Ahead if You Sweat It Out  

Keep your bedroom temperature no higher than 67 degrees F at night – it’s the ideal sleeping temperature that encourages the best sleep for most of us. Also wear only light cotton sleepwear, and have blankets you can kick off or pull on easily as your temperature varies through the night from hot flash to night sweat. If you have drenching sweats, keep another nightie by the bed – or sleep nude – and incorporate herbs and supplements for hot flashes.

Herbs and Supplements for Better Sleep in Menopause

Several herbs and supplements have been shown to be supportive of good sleep – without the risks of pharmaceuticals. In addition to those mentioned here for general sleep support, the following herbs and supplements have been specifically studied in menopause or for menopausal specific application.

Melatonin

As mentioned above, our melatonin levels decline slightly as we get older – for some women, enough to interfere with sleep. Studies have shown that melatonin supplementation may postpone endocrine aging (tied to your hormone shifts) in women aged 40 to 60 in the menopausal transition, and that this supplementation improves disturbed sleep and other vasomotor symptoms of menopauses like hot flashes and night sweats.

How to use it: 0.3– 3 mg/day

Calcium and Magnesium

A combination of calcium and magnesium, or magnesium alone can promote relaxation and sleep, improve sleep quality, and reduce anxiety. It can also help prevent bone loss associated with perimenopause. Magnesium may also help if restless leg syndrome or muscle cramps interfere with your sleep.  

How to use it: Calcium 800 mg; Magnesium supplement 300 to 600 mg  

5-HTP

Numerous studies have pointed to the beneficial 5-hydroxytryptophan (5-HTP) on sleep, A precursor to the neurotransmitter serotonin, important for sleep duration and quality, on sleep, 5-HTP been shown to both to decrease the time required to fall asleep as well as (heavens part, angels sing), reducing the number of night time awakenings. Taking 5-HTP will raise serotonin levels, an important initiator of sleep.

How to use it: A typical dose of 5-HTP is in the range of 300-500 mg.

Ashwagandha

Ashwagandha is an herb with roots in traditional Ayurvedic medicine, used to nurture and clear the mind, calm and strengthen the nerves, promote a sound and restful sleep, and specifically useful if you’re “tired and wired.” It’s also particularly helpful if you’re also experiencing stress and anxiety, including if you’re finding it difficult to cope with insomnia.

How to use it: 500 to 2000 mg before bed in capsules or tea form or tincture dose is 40-60 drops

Hops

One of the key ingredients in beer, hops decreases hot flashes and promotes sleep, so if you’re dealing with a combination of the two, this might be just the herb to try. Hops contains a group of nonsteroidal phytoestrogens called prenylflavonoids. In one randomized, double-blind, placebo-controlled study, 67 menopausal women were given either a placebo or a 100 mcg or 250 mcg standardized hops extract for 12 weeks. At 6 weeks, the 100 mcg dose was significantly superior to placebo. There was a more rapid decrease in menopause symptoms scored for both doses of hop extract, especially the hot flash score.

How to use it: Since this herb is too bitter for tea, I use the tincture (alcohol extract), 1-2 mL (about 40-80 drops) before bed for night sweats. It can make you sleepy, so avoid using before driving. Hops has mildly estrogenic effects so this herb is not recommended if you have risk factors for estrogen receptor positive breast cancer. 

Valerian, Lemon Balm, and Passionflower

Valerian has long been used by herbalists for sleep, and where it seems to really shine is for women with perimenopausal insomnia, with improvements in sleep quality sometimes immediate, and more significant after 4 weeks of use. Its benefits may be even greater when used in combination with either lemon balm, another traditional herb for sleep as well as anxiety, or combined with passionflower and hops, also classic sleep herbs. A study of 100 women aged 50-60 years found statistically significant improvements in sleep quality when valerian was combined with lemon balm compared to a placebo group.

And even more powerfully, one study looked at the effects of passionflower when it was combined with hops and valerian and found it comparable to Ambien, without the risks or side-effects. Passionflower promotes sleep and improves sleep quality, and helps you feel more rested when you wake; also useful for anxiety.

How to use it: Valerian alone 500 mg twice daily, Lemon balm 80 mg daily, Passionflower 320 mg daily. If using tinctures, use 40 to 60 drops of any or all of these, instead.

Relora

A proprietary combination of the traditional Chinese herbs magnolia and phellodendron, Relora reduces stress and anxiety, improves sleep and energy, and reduces cortisol. One of the reasons that I find it to be particularly helpful in the perimenopausal years is not only does it help with stress and sleep, but it may also help to elevate DHEA, which may also help with some of the symptoms of vaginal dryness. It’s a combination that I very often include in my practice when I have women struggling with sleep, mood, their sense of wellbeing, and perimenopausal symptoms.

How to use it: 500 mg at bedtime

Try My Herbal Bedtime Blend

Sip this lovely tea an hour before bedtime to help you relax. Mix 1 teaspoon each of these dried herbs: chamomile flowers, lavender flowers, and lemon balm leaf. Steep in 1 cup boiling water for 10 minutes, covered; strain and sweeten as desired. 

Or, if waking up at night to pee is an issue – skip the tea which might only add to that and try this instead. In a 2 oz. glass bottle mix ½ oz. each of the following tinctures: 

• Passionflower tincture
• Skullcap tincture
• Motherwort tincture
• Lavender tincture

Take 1/2 teaspoon every 30 minutes for 2 hours before bed. If necessary, repeat 1-2 doses if you wake during the night.

Caution: This should not be taken with prescription or OTC sleep medications (but note those medications actually don’t give people more than 30 minutes of sleep and can be dangerous especially for women).

Still Can’t Sleep? HRT for Severe Sleep Problems

In my practice, I always start with herbs, supplements, and lifestyle approaches and very often, they’re enough to help women find their sleep rhythm again. But if sleep disturbances are going on too long and starting to cause a physical and mental-emotional toll, using low dose or progesterone, or combined HRT (hormone replacement therapy) is needed, can be helpful and often a bridge to natural approaches that can then be eventually removed. I always recommend starting at the lowest possible dose for the shortest possible duration. Your midwife, nurse practitioner, licensed naturopath, or MD can help you with a prescription if needed. And again, look to underlying causes in addition to hormone imbalances, to make sure you're covering all the bases for your total best health.

Here’s to getting enough rest so you can enjoy this new freedom and power that these years offer us!