Insomnia during menopause: How to deal with sleep issues

Menopause is a natural part of the ageing process. It marks the end of a woman’s reproductive years. It is a result of declining reproductive hormones or due to a surgery, chemotherapy or radiation. During this phase, many women complain about insomnia. We tell you the causes of insomnia during menopause and how to reduce its impact.

What is menopause?

Menopause is a phase in a woman’s life when the menstrual cycles stop and end her ability to reproduce. It can occur due to different reasons, including ageing. Here are three stages of menopause:

1. Perimenopause

The time leading up to menopause is called perimenopause. This can begin nine to ten years before menopause. This is when women may start noticing changes in their menstrual cycles and associated symptoms. These symptoms are largely because of a gradual drop in estrogen levels. But women still go through menstrual cycles.

2. Menopause

In this phase, the ovaries completely stop working and women no longer have periods. They are diagnosed with menopause if they have no periods for 12 consecutive months.

3. Postmenopause

This is the stage after menopause. However, some women continue to get menopausal symptoms after the menopause transition.

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Most common menopausal symptoms are:

• Hot flashes
• Night sweats
• Cold or hot flashes
• Difficulty sleeping (insomnia)
• Emotional changes (irritability, mood swings)
• Vaginal dryness
• Urinary urgency or incontinence
• Worsening of premenstrual symptoms, irregular or heavier or lighter periods than usual.

“Every woman’s period is different, and so is menopause. So, not everyone will experience the same symptoms in menopause,” says gynaecologist and obstetrician Dr Sonamm Tiwari.

Why do women have sleeping difficulty during menopause?

Many patients complain of insomnia as a major symptom during the menopause phase. “Insomnia is a disorder that prevents you from having good quality and adequate sleep, now this could be a reason for either difficulty to fall asleep or to stay asleep. Major factors contributing to this are hot flashes, mood disturbances, urinary urgency, headaches, or even tender breasts, shares Dr Tiwari.

Difficulty in holding urine and frequent night visits to the bathroom drain a lot of energy and add to the frustration, thereby disturbing the sleep cycle.

What should women eat before bedtime during menopause to sleep well?

“Dairy is proven to improve sleep,” says clinical dietician Reena Poptani. Foods high in the amino acid glycine and tryptophan found in milk and cheese may promote deeper sleep in menopausal women. “Dairy consumption is also linked to a decreased risk of premature menopause, which occurs before the age of 45,” she says.

What diet tips should women follow during menopause?

A balanced diet is good at every age and stage of life. But a diet rich in magnesium may have health benefits for any woman going through menopause. Magnesium is a mineral found in green leafy vegetables, bananas, nuts, seeds, beans and whole grains. It may help to improve sleep quality. Here are some more diet tips:

• Phytoestrogens are compounds in foods that act as weak estrogens in the body and provide benefits. Foods that naturally contain phytoestrogens include soybeans, broccoli, chickpeas, peanuts, flax seeds, barley, grapes, berries, plums, and green tea.
• Flaxseed contains lignans which are powerful antioxidants. They can increase levels of circulating estrogens.
• Garlic is rich in a component called allicin that reduces inflammation and is a great source of phytoestrogens.
• Soy contains isoflavones, which act like estrogen in the body and can potentially decrease the risk of breast cancer.

The decline in estrogen levels during menopause also increases women’s risk of fractures. Dairy products, such as milk, yogurt, and cheese, contain calcium, phosphorus, magnesium, and vitamin D, essential for bone health. The inclusion of adequate protein in diet, legumes, dairy, and animal protein leads to higher bone density in menopausal women.

Incorporating these superfoods into a daily diet can naturally replenish the estrogen lost during menopause and help to reduce menopausal symptoms like hot flashes or mood swings.

How can women sleep better during menopause?

There are different kinds of treatment approaches for insomnia. “The primary approach is cognitive behavioural therapy which helps us recognise the trigger patterns for poor sleep,” says Dr Tiwari. These could be certain behaviours, habits, thoughts or even surroundings.

The majority of menopausal symptoms come from a lack of estrogen and progesterone hormones, so there is another approach to treat menopausal problems. That is hormone replacement therapy (HRT). This supplies minimal hormones to the body as the natural hormonal level declines. HRT is available as oral tablets, local patches or even topical gels and creams.

Some women may also need mood stabilisers, muscle relaxants, antidepressants, melatonin or certain sedatives which can be best prescribed after evaluating you physically and maybe after some blood tests.

Natural remedies such as breathing exercises, an off-screen time before bed, listening to calming music, maintaining a low temperature in the room, and eating healthy and early dinner can also be very helpful.

Menopausal insomnia can reduce or even go away with the right treatment approach which may include both mental and physical exercise and may or may not require medications. Many women may experience bouts of insomnia from time to time. This may last from days to months if not treated properly.