Understanding the Sleep-Stress Connection in Menopause
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Lack of sleep and poor quality sleep are two big issues for women in perimenopause and menopause. It can be a challenging time for women, both physically and emotionally. This article outlines what’s happening in your body, and provides six strategies to help you improve your sleep.
The First Signs of Menopause
Poor sleep is an early symptom of perimenopause, and stress can make it worse.
For many women in their forties and beyond, sleep disruptions can often be the first sign that they are in perimenopause – the transitional stage prior to their final menstrual period. Hello 3am wakings, staring at the ceiling and trying to remember if you bought a new tube of toothpaste when you were last at the supermarket! Throw in some hot flashes and night sweats, and it can feel like you’ll never sleep again.
A recent survey of over 4,200 menopausal women in New Zealand named sleep problems as the number one symptom experienced by women during menopause. Eighty percent of respondents experienced sleep issues and, unsurprisingly, 79% complained of fatigue.
As the sleep problems associated with menopause can be exacerbated by stress, it is important to understand the link between these two conditions.
Stress - and the hormonal changes in perimenopause and menopause - switch on your fight-flight system and releases stress hormones that consequently impact sleep.
The link between stress, sleep and menopause
Stress and sleep are intimately connected, and this relationship becomes even more pronounced during menopause.
The hypothalamic-pituitary-adrenal (HPA) axis is a network of glands that regulates the body's response to stress. When the hypothalamus senses a threat, it releases a hormone called corticotropin-releasing hormone (CRH). CRH travels to the pituitary gland, which releases another hormone called adrenocorticotropic hormone (ACTH). ACTH travels to the adrenal glands, which release glucocorticoids, such as cortisol and adrenaline.
Cortisol is often called the "stress hormone" because it is released in response to stress. It helps the body to cope with stress by increasing blood sugar levels, suppressing the immune system, and reducing inflammation. However, too much cortisol can have negative health effects, such as weight gain, fatigue, and difficulty sleeping.
Adrenaline is another hormone that is released in response to stress. It helps the body to prepare for "fight or flight" by increasing heart rate, blood pressure, and breathing rate. Adrenaline can also make people feel more alert and focused.
As women approach menopause, the fluctuations in estrogen and progesterone can cause the HPA axis to become dysregulated, resulting in a vicious cycle of sleeplessness and stress, and triggering a cascade of other symptoms, making each day without sleep harder than the last.
The cost of sleep deprivation
Sleep deprivation affects wellbeing, plus productivity, performance, income, and increases the risk of chronic health conditions, and injury at work.
Economically, sleeplessness is a significant issue. A 2021 report by the Sleep Health Foundation estimated the cost of poor sleep in Australia at $14.4 billion each year in financial costs, with a further $36.6 billion in non-financial costs related to loss of well-being.
At an individual level, the fallout from chronic insomnia is equally devastating. Research has shown that productivity in the workplace is negatively impacted by lack of sleep, with higher levels of work impairment in workers who sleep fewer than 5 hours per night. Poor sleep has also been associated with higher levels of personal injury, chronic health conditions and poorer mental health outcomes.
The stress of poor performance can lead to difficulty sleeping, which can further impair performance. This can create a vicious cycle that is difficult to break.
Menopausal women are particularly vulnerable to this cycle, which can lead to feelings of anxiety, guilt, and worthlessness, which can make it even harder to sleep.
As a result, women are more likely than men to experience chronic sleep problems. This can have a significant impact on their physical and mental health, as well as their ability to work and care for their families.
Is it any wonder that menopausal women are leaving the workforce early in droves?
Strategies for getting your sleep back on track
Sleep preparation is an ongoing process that starts from the moment you wake up and ends when you fall asleep. The way you manage stress throughout the day can have a big impact on your sleep quality.
There are many things you can do to reduce stress and improve your sleep. Exercise, meditation, and mindfulness are all great ways to calm your mind and body. Journaling can also help you process your thoughts and feelings.
If you're struggling to manage stress on your own, seek professional help. A therapist can teach you coping skills and help you develop a stress management plan.
Remember, everyone is different and what works for one person may not work for another. The key is to find what works best for you and to make sleep a priority in your life.
Here are some additional tips for reducing stress and improving sleep:
Get regular exercise. Exercise is a great way to relieve stress and improve your overall health. Aim for at least 30 minutes of moderate-intensity exercise most days of the week.
Create a relaxing bedtime routine. This could include taking a warm bath, reading a book, or listening to calming music. Avoid watching TV or using electronic devices in the hour before bed, as the blue light emitted from these devices can interfere with sleep.
Establish a regular sleep schedule and stick to it as much as possible, even on weekends. This will help train your body to expect sleep at a certain time each night.
Make sure your bedroom is dark, quiet, and cool. These conditions are ideal for sleep.
Avoid caffeine and alcohol before bed. These substances can interfere with sleep.
If you can't fall asleep after 20 minutes, get out of bed and do something relaxing until you feel tired. This will help prevent you from associating your bed with frustration.
Summary
Menopause can be a challenging time for women, both physically and emotionally. Sleep problems are a common symptom, and they can have a significant impact on quality of life - both at work and at home.
The good news is that there are things you can do to improve your sleep during menopause. By addressing the underlying causes of sleep problems, such as stress and anxiety, and by making lifestyle changes, such as getting regular exercise and establishing a regular sleep schedule, you can get the restful sleep you need.
If you are struggling with sleep problems, talk to your doctor. They can help you rule out any underlying medical conditions and recommend additional treatment options.
References
Dear, L. (2023) NZ Menopause Survey , Menodoctors. Available at: https://files.menodoctor.com/pdfflipbooklets/nz-menopause-survey
Hafner, M. et al. (2015) Health, wellbeing and productivity in the Workplace, RAND Corporation. Available at: https://www.rand.org/pubs/research_reports/RR1084.html?fbclid=IwAR3GvntL7Hb26Q10OZY9wBwoLgltyBIfyYEB03ymXldp9zW1s33FSrmwsU8
Sleep Health Foundation (2021) Rise and try to shine: The social and economic cost of sleep disorders in Australia. rep. Available at: https://www.sleephealthfoundation.org.au/files/Special_reports/Final_report_-_Cost_of_sleep_disorders_-_14042021.pdf
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