What Are The Best Treatments For Insomnia During Menopause?

What are the best treatments for insomnia during menopause? First we need to understand more about what menopause is, and how it can affect our sleep.

What Is Menopause?

It really depends on how you look at it. The official definition of menopause is the first year anniversary after your last period, but I think menopause is so much more than that!

To me, menopause is a huge physical, emotional and spiritual transition. The lead up to menopause can last a few years, and we call it ‘peri-menopause’. On the physical level, it can bring a number of different symptoms like fatigue, vaginal dryness and hot flushes. Emotionally it can cause mood swings, anger, anxiety or depression, and it can affect us spiritually too. Spiritual symptoms are harder to describe, but they include an overwhelming need to be alone, or a new sense of purpose. We could see menopause as an initiation into the ultimate version of ourselves.

During menopause, the ovaries slow down the production of the most potent form of oestrogen. At the same time, the adrenal glands start producing weaker forms of oestrogen needed to protect our health in our elder years. Although we’re told that we’re ‘oestrogen deficient’ after menopause, I don’t believe that’s true. Our oestrogen levels don’t need to be so high, because we don’t want to be falling pregnant in our 70’s, 80’s or 90’s. If all goes to plan, we’ll have a smooth transition, and enough oestrogen to protect our health well into old age.

There’s actually much more to the hormone changes of menopause than this, and hormones are a very complex web. Each affects the other, and there’s a lot of crossover between our reproductive and our stress hormones in particular. Both are made in the adrenal glands, and if they’ve spent years pumping out stress hormones to help us cope with our face paced lifestyle, they’ll struggle to make enough oestrogen. This is partly why some women have real problems with menopause symptoms and need to take extreme measures to get back on track.

Not every woman goes through a natural menopause. Some women have to undergo a very abrupt chemical or surgical menopause as part of their cancer treatment. Whilst the symptoms may be the same, they’re very difficult to cope with on top of the other challenges of having cancer, and insomnia can make life seem almost impossible. Menopause after cancer can be safely managed with the help of prescribed herbal remedies, health coaching or advanced hypnotherapy depending on what’s needed.

How can menopause cause severe insomnia?

Insomnia is a really common symptom, particularly in the earlier stages of peri-menopause. It’s not always linked to anxiety either, and often women experience insomnia for the first time ever during peri-menopause. Over time it can become really debilitating because mental health, performance and mood are all impacted by lack of sleep. Some women also worry about the long term effects on their brain health.

Sometimes menopause insomnia is due to relatively low amounts of progesterone which is needed to create a brain chemical called GABA. GABA is a neurotransmitter that makes us feel super calm and relaxed, and it’s generally higher during the second half of the monthly cycle, when progesterone is usually dominant. During early perimenopause, progesterone levels can drop too low during the second half, which can interfere with GABA production and lead to insomnia at that time.

Hormone imbalances in perimenopause can also play havoc with our sleep-wake cycles. Progesterone helps us to get a restful night’s sleep, and when levels are on the low side, it affects both how long we sleep, and sleep quality. Waking in the very early hours of the morning is really common in peri-menopause, and conditions like SAD where this is a known symptom can be made worse by hormone changes.

Sleep disordered breathing also becomes more of a problem in peri-menopause. Progesterone has a relaxing effect on the back of the throat, and at certain times will make us more prone to both snoring, and pauses in breathing whilst we’re asleep. Because both limit our oxygen intake, our brains naturally wake us up in an effort to get more oxygen in, and often we wake up tired the next day. Learning functional breathing techniques with a trained practitioner like Dr Louise Oliver is a good way to improve your sleep and energy levels if your partner is complaining about your snoring!

And drops in blood sugar can often wake us during the night because we’re hungry. In my case, I’m usually half awake so I don’t realise I’m hungry! Trips to the loo during the night, especially if you haven’t had a big drink soon before bedtime also suggest poor blood sugar regulation.

Insomnia in menopause after cancer

For cancer survivors, radiotherapy, chemotherapy and side effects of drugs like Tamoxifen can include insomnia.

Besides the medication, just the ongoing stress of living through a cancer diagnosis, treatment and now rehabilitation is huge! Many of the cancer survivors I work with struggle with sleep largely due to adrenal depletion from having to cope with the ongoing worry. Some antidepressants can cause sleep issues in some

Does PMDD lead to insomnia during menopause?

PMDD (short for Pre Menstrual Dysphoric Disorder) is an extreme form of Pre Menstrual Syndrome (PMS). There’s a lot about PMDD we don’t currently understand but we do know insomnia can be a part of it, and PMDD can worsen during peri-menopause.

PMDD seems to be related to the brain’s response to progesterone, more than the progesterone levels being out of balance. Women with PMDD don’t get to enjoy the calming effects of progesterone in the same way as the rest of us, because the progesterone has trouble binding to the receptors in their brain. Sometimes this is linked to high levels of histamine in the body, also known as Mast Cell Activation Syndrome (MCAS) and often there will be other tell-tale signs including:

  • A tendency towards allergies or food intolerances.
  • Headaches
  • Red skin
  • IBS type symptoms
  • High libido
  • Sneezing in bright sunlight
  • Anxiety

In ladies with PMDD, treating menopausal insomnia is much more complex, because we also need to look at the wider problem of the PMDD and/or MCAS. Although taking natural remedies for sleep may help, they’re not really tackling the root causes of the problem which need to be addressed at a much deeper level.

Doctors are now starting to treat insomnia with anti-histamines. Although I don’t recommend using them long term if you can find a more natural alternative, it may be useful to try one at bedtime and see if it helps you to sleep. If it does, it would suggest that high histamine is at least part of the problem, and you need to look for ways to reduce your histamine levels. Herbal antihistamines include nettle and chamomile, both of which make me really sleepy!

We also know that women who’ve suffered significant trauma in the past are more likely to have problems with PMDD later on. Where this is the case, addressing the trauma with advanced hypnotherapy, EMDR or talking therapies may be very helpful.

Self care for a good night’s sleep

Depending on how bad it is, you might be able to get some good sleep with simple self care. Here are a few ideas:

  • Supplement magnesium glycinate – it’s very relaxing and helps your progesterone to work more effectively.
  • Have a high protein snack before bed in case low blood sugar is waking you up.
  • Implement a good bedtime routine to help you wind down. Guided meditations in bed can be really helpful.
  • Make sure you’re getting some daily exercise.
  • Diffuse some relaxing essential oil, or put a drop onto your pillow.

Sometimes self-care isn’t quite enough to get you a restful night’s sleep, and you might need some more help.

How to sleep well with natural remedies

As always, in natural medicine we look to address the underlying causes of menopause insomnia. In my experience, the best way to get a good night’s sleep during peri-menopause is to go straight for the hormone imbalances. That means an entirely different herbal regime to the one I’d use for other kinds of insomnia.

In terms of herbs, there a lots of herbal remedies for sleep available to buy, but some are better than others. Whilst some women do well with OTC remedies, it does come with some pitfalls too. Some herbal remedies have poor quality ingredients, or don’t contain the ingredients they say they do. Many of the cheaper herbal and nutritional supplements also contain more fillers than active ingredients, so they won’t work.

If you’ve recovered from cancer and are taking medication relating to that, be aware that some herbs may potentially interact with your medication. I check all of my herbal prescriptions for known drug interactions before dispsensing them for my patients, and monitor them closely.

A good way to take herbs for sleep is with a small cup of herbal tea before bed. Go for the blends which are formulated for sleep, like this one. Two of the key herbs in here, Valerian and Passionflower, are my ‘go-to’ for sleep, with Valerian relaxing the body and Passionflower working more on the mind. Use 2 teabags and make sure you cover your tea whilst it brews for at least 5 minutes before drinking.

Aromatherapy can also be very helpful in getting you off to the land of nod. If you’re not an aromatherapist but you’d like to use oils at home, start with a pre-made blend like this one, and follow the instructions carefully. You could add a drop of oil to a warm bath or footbath, or treat yourself to a foot massage. Diffusing oils in your bedroom, or putting a drop onto your pillow work well too.

If stress and anxiety are part of the problem, menopause hypnotherapy can be really helpful. Not only does it help to rewire your brain towards calmness, it gives you tools and techniques to help you back to sleep.

How I treat menopause insomnia naturally

I always look at sleep issues in the context of other menopause symptoms, and overall health. If a woman has very severe menopause insomnia, often the self-care measures aren’t going to get a complete fix. I put together a main herbal mix to take during the day, which will work on the hormone imbalances, stress response and nervous system all at the same time. I also give my patients a sleep mix to take at bedtime, which helps them to get a much better quality sleep. If they do wake in the night, they’re usually still drowsy enough to get straight back to sleep, and waking refreshed in the morning makes a huge difference to how they feel overall.

Herbal remedies always work better alongside good nutrition, stress management and exercise. Patients with very severe menopause insomnia get the best results on my integrated 90 Day Rescue Programme. Whilst the herbs nudge the body back towards its natural equilibrium, we get the foundations of good health in place and usually see a very rapid improvement!

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