Sleep in menopause


Reaching menopause is a natural and inescapable step in most women's lives. Generally, after 45 years of age (but with great variability), women lose the ability to synthesize and produce sex hormones (especially progesterone and estrogen). With this, menstrual cycles cease, marking the end of female reproductive life. These hormonal changes affect the entire physiology and behavior of women, and inevitably end up affecting their sleep too! In this blog, we will discuss women's sleep during this period.


UNDERSTANDING MENOPAUSE


Menopause is not a sudden process. In fact, it is the result of several gradual changes, which can take a few years to complete. Technically, it is not a period, but the exact date of a woman's last period. But even for a few years before this date, it is common to see some signs that it is coming. The main one is the irregularity of the menstrual cycle, which can be longer or shorter than usual. This is a gradual process, which demonstrates that the ability to synthesize female hormones is slowly declining. After menopause, the first few years are often the most difficult for a woman, as there is still some fluctuation in hormone levels. This period is called recent post-menopause. After five years, when a new hormonal condition is well established, we say that the woman is in late post-menopause.


It is during this period of a few years before and after the last menstruation (called perimenopause) that the main symptoms occur. The best known symptoms are hot flashes, which are momentary sensations of intense heat and sweating, caused mainly by a lack of estrogen. Other important consequences are increased symptoms of anxiety and depression, irritability, decreased memory capacity and decreased libido. As post-menopause progresses, other symptoms such as osteoporosis and loss of collagen in the skin are also noted.


SLEEP AND MENOPAUSE


Of all the symptoms of menopause, sleep complaints are among the most common. It is estimated that up to 63% of women have some sleep complaint after this phase. Among the most common complaints and symptoms are insomnia and sleep apnea. These changes are not just a perception; but even from objective changes in the sleep pattern. Below we will discuss changes in sleep during this phase, the main complaints of insomnia and apnea.


Sleep changes


Several objective changes can be observed in the sleep of women after menopause. A study published by researchers at the Federal University of São Paulo in 2015 showed that these women have higher sleep latency (they take longer to sleep), have shorter total sleep time, less efficient sleep and higher number of awakenings than older women reproductive. Furthermore, the percentage of REM sleep is also decreased in this phase. These changes can be the basis of most complaints reported by these women.


Insomnia and sleep complaints


Insomnia is marked by difficulty initiating or maintaining sleep throughout the night, or by complaints of early awakening. These complaints are very common among menopausal women who often have shallower sleep and more difficulty sleeping and more awakenings during the night. These changes are even more common when hot flashes happen at night. But interestingly, even in late post-menopause, when hot flashes are no longer common, symptoms of insomnia persist.


Another common cause of sleep fragmentation during this period is the increased need and frequency of going to the bathroom at night (known as nocturia). Due to hormonal changes, it is common that there is an atrophy in the female urinary system, making the need to urinate greater. This situation makes the woman need to wake up more often during the night, leading to both fragmentation and lower quality of sleep.


Sleep apnea


Sleep apnea is a condition marked by recurrent pauses in breathing during the night. Generally, this disease is much more common among men. However, after menopause, the percentage of women who have apnea grows dramatically.


The main cause of increased sleep apnea in this period of life appears to be decreased levels of progesterone. This hormone is an important respiratory stimulator, preventing apnea during reproductive life. However, reaching menopause, the levels of this hormone decrease a lot, causing women to no longer be under this hormonal protection. Thus, they end up being as prone as men to apnea.


Added to this is weight gain, which is a fairly common feature as well. Overweight and obesity are the main risk factors for apnea, and they end up serving as an additional factor for this disease to become more common during menopause.


DEALING WITH SLEEP COMPLAINTS


The life expectancy of the population around the world has grown a lot in the last decades. This means that more and more women will live longer in menopause. As this is a natural part of women's lives, it is important that we know how to live with the symptoms and work around them as much as possible. There are several possible strategies to ensure quality sleep during this period. Here are some tips.


1. Invest in healthy lifestyle habits: A healthy and balanced routine is a good way to ensure that the effects of hormonal swings are lessened. Additionally, these practices can prevent weight gain, which is a major risk factor for apnea. Invest in regular physical activities, balanced diet and do your best to manage stress.


2. Have a healthy and regular sleep routine: Pay attention to the sleep hygiene tips, establish a progressive sleep routine; turn off the lights, do something relaxing (music, meditation, prayer, reading), have tea or another hot drink, have a light meal, and gradually prepare for bed. Avoid caffeine and the use of electronic devices around bedtime.


3. Don't self-medicate: There are many drug treatments available for the menopause period. However, none of them should be done without proper medical supervision, as every treatment can include some side effects. This is true for all types of treatment, including sleep medications, hormone replacement therapy, and the use of natural alternatives such as isoflavone. Talk to your gynecologist about it, to assess whether these medications are suitable for you.


4. Complementary therapies are effective for menopause insomnia: Some alternatives such as yoga, massage, acupuncture, meditation and mindfulness have been shown to be effective in treating sleep disorders in women at this stage of life. Invest in one of these therapies, choosing the one that you would feel most c