By Barb Depree, MD
If you're wearing a Fitbit to bed, like a patient I saw last week, you might be seeing pretty colored charts that confirm just exactly how poorly you slept last night. And if you're like her, it may only be increasing your stress about what you already know: You're tired! You'd like to sleep through the night!
Yes, as you're likely tired of hearing, it's hormones. Estrogen and progesterone are in decline, and the mix of hormones (add cortisol, the "stress hormone" to the cocktail, too) may be less friendly to sleep than it once was. Hot flashes, which can happen day or night, come with a surge of adrenaline, from which you need to recover before you can settle back to sleep.
A few of the people I've talked to for The Fullness of Midlife, our podcast, have had some light to shed on our sleeplessness. Joan Vernikos, a retired NASA health science researcher, says sleep is "like a cleaning service in an office. ...The cleaning service starts out by emptying the garbage cans, by tidying up, picking up—and that's what happens with the brain during sleep in the various cycles. If you wake up and you don't sleep well, not only are you going to make mistakes the next day, but you're not going to detox your brain."
Menopause can sometimes bring its own befuddlement, right? Memory lapses. Foggy thinking. Well, add in some sleep deprivation and a brain in desperate need of a "detox," and you can imagine a day that you'd rather forget.
Another podcast guest, Dr. Pamela Peeke, gave us a pep talk about making "sleep hygiene" a priority. She points out the relationship between sleep and diet: We're much better able to be in control of our appetite—not because we lack self-discipline but because of busy hormones at work in our bodies—when we're well-rested.
Make "sleep hygiene" a priority? Well, it sounds good. And there's plenty of reason to do it, from easier healthy eating to clear-headed days. Here's what it takes:
Make your bedroom comfortable for sleep. Is it dark enough? Cool enough? You might want to layer your bedding like you layer your outerwear for a hike on an early spring day—so both you and your partner can be comfortable throughout the night. Consider white noise if sounds are keeping you awake. If now is not the time to invest in your good sleep, when is?
Exercise. To patients in my office, I recommend 45 minutes five days a week of real exercise—walking, swimming, biking. Something that gets the heart-rate up. If some part of that can be outdoors, even better, because natural light helps us with our sleep-wake cycles. Get it in early, so you can avoid exercise in the three hours just before bedtime.
Stay awake during the day. I know it's tempting to nap when you're not sleeping well at night. But napping for more than 20 to 30 minutes can make it more difficult to sleep deeply overnight, which is when that brain detoxing that Joan talked about happens.
Ease away from stimulants and heavy foods. The effect of caffeine can change as our bodies change. And the relaxing effect of alcohol wakes us up later when we're metabolizing it. Digesting heavy foods can do the same.
De-stress generally, but especially as part of a pre-bed routine. Excess stress is a health challenge for us at any age. While it's unlikely you can eliminate stress from your life, you can at least develop some routines for putting it in its place before you turn in for the night. Set a routine—yoga for relaxation, reading a novel, writing in a gratitude journal, taking a hot bath—that signals that it's time to settle down. Avoid screens in the hour before bed, especially contentious text or Facebook exchanges or upsetting documentaries. And remember what Joan said when you're churning at night: "What you're thinking of in the middle of the night is spam. Delete it! You can't do anything about it."
A perhaps unexpected side effect? Since stress and fatigue are two of the three most common obstacles to sex (the third is lack of privacy), you just might find yourself with a little more romance in your life.
Makes "sleep hygiene" sound a little sexy.
Barb DePree, MD, has been a gynecologist for 30 years, specializing in menopause care for the past 10. Dr. DePree was named the Certified Menopause Practitioner of the Year in 2013 by the North American Menopause Society. The award particularly recognized the outreach, communication and education she does through MiddlesexMD, a website she founded and where this blog first appeared. She also is director of the Women's Midlife Services at Holland Hospital, Holland, Michigan.