"How did you sleep darling?" is the habitual morning question from my husband. How "well" and particularly how "badly" we sleep is not only a subject of marital discussion but is also a national and international obsession.
Obviously, sleep requirements vary by individual but most healthy adults need between 7 and 9 hours per night. Sleeping well is vital for looking and feeling good, regardless of our age. It doesn't matter if we lead a healthy lifestyle or are as fit as a fiddle, we are only as good as the amount of sleep we get and a bad night's sleep will almost certainly leave us feeling lethargic, unable to concentrate, bad-tempered and in some cases depressed.
There are a multitude of reasons why people don't sleep, worry and stress of course being the most common. Personally, I have suffered a range of sleep issues in my lifetime each with their own set of challenges, including being married to a prolific snorer .
According to the Great British Bedtime Report, however, I am not alone and "partner disturbance" as it is aptly called is the UK's second most common cause of disrupted sleep with women more likely to be affected than men (31% compared to 19%).
Partner disturbances like child disturbances are similar in that over time your body and mind develop their own coping mechanisms. The same cannot be said, however, of the shift in sleeping patterns that accompanies the transition to menopause - which is when women start to commonly experience really significant changes in the quality of their sleep and I am no exception.
Going to sleep is not a problem for me, the issue is that I wake up during the night often at 3am and then have difficulty returning to sleep again, if at all. This inability to stay asleep is known as "maintenance insomnia".
A Fitbit devotee for some time now, I became obsessed with checking my sleep stats and was horrified to see that on average I was clocking up just 5 hours sleep a night and that I was restless or fully awake anywhere between 16 and 20 times a night.
According to the Sleep Council "A ‘very poor’ night’s sleep can be defined as less than five hours: and a third of those who suffer from insomnia routinely sleep for less than five hours". To deepen my misery I completed the Council's Great British Sleep Survey and was not surprised to learn that my sleep score was 3.75/Low.
For women like me on the journey from peri-menopause through menopause, the hormonal fluctuations occurring in our bodies at this time throw our body's chemistry completely out of kilter. This can wreak havoc with our emotional and physical state and disrupt sleep enough to induce insomnia and because the shift to menopause can last a number of years insomnia symptoms can go from transient and temporary to chronic and severe during this time. It is also a vicious circle because the more sleep you lose the worse everything else is. Fun it most certainly isn't and it can have a significant impact upon your family. This was my husband's white flag email:
I have written previously about my quest to attempt to address various lifestyle issues arising from my menopause and this email was probably an incentive to get on with it. Along with increased irritability, insomnia was one of the primary reasons I sought expert advice earlier this year. Yes as a parent I have known debilitating tiredness, but the exhaustion from insomnia in menopause is totally unforgiving.
During my consultation, the results of my hormone tests, showed I was lacking in progesterone, the happy hormone, whose primary function is to relax us and keep us calm, all of those qualities we need to not only keep us balanced, but also to ensure restful sleep.
Declining estrogen at this time also has a role to play and whilst my tests showed my decline in estrogen wasn't as marked as my progesterone, estrogen does help to deepen our sleep and therefore could be the reason I couldn't stay asleep.
It is now 3 months since I was first prescribed a course of bio-identical hormone therapy and during this time I have returned for a follow-up consultation. The initial prescription went some way to addressing my symptoms, with my husband in particular noting an improvement in my moodiness or as he fondly calls it a reduction in my flash to bang and I was also managing to stay asleep at night more than I had previously.
Everything that happens on the course to menopause is down to your hormones and you quite simply can 't control your hormones without medication, but equally hormone therapy is not for everyone, so hormones aside, what are the best ways of combating insomnia in menopause and getting a good night's sleep?
- Invest in a decent bed. Given that we spend a third of our lives in bed, a comfortable bed is vital regardless of whether you are menopausal or not. Obviously the quality of the mattress has a big part to play in this and the Sleep Council recommends that we replace our mattress at least once every seven years. The choice is extensive now and is no longer just about soft or hard either, new to the market foam mattresses adapt to all body shapes, sizes and sleeping styles.
- Use natural bedding. Avoid synthetic fabrics to ensure you keep cool whilst you sleep, which if you suffer from night time sweats during the menopause is a great help. Good ventilation in the bedroom is also advised.
- Sleep schedule. Make sure to only go to bed when you feel sleepy, and get up if you find yourself awake for longer than quarter of an hour. By reducing the time in bed you spend awake you can improve your ‘sleep efficiency’, and as a result your sleep quality.
- Sleep hygiene. Keep all electronic devices from the bedroom. It is really tempting to just check your "instagram" or your "twitter" before nodding off but it all acts as unnecessary stimulation. The best advice for a restful night's sleep is universally to go to bed at a set time, avoid caffeine before bed and opt instead for a calming drink (my personal favourite is Pukka night-time tea) and do something to help you relax whether that be relaxation techniques or simply reading.
- Keep moving. Whatever your life-stage, exercise is important full stop to combat a range of physical and mental health issues but a sedentary lifestyle in menopausal women is strongly associated with insomnia. Regular exercise will improve it. Find something you enjoy, try new things and keep it varied.
- Mindfulness. A bad night’s sleep often makes you feel irritable the next day, but it also works the other way around - feeling low can increase your risk of future sleep problems. Being aware of what is going on inside us and around us can help to lift our spirits when we are feeling low. Mindfulness can help as can meditation with developing awareness of your breathing.
- Supplements. Vitamin and mineral deficiencies can also contribute to a poor night's sleep. It is known that magnesium deficiency can cause insomnia and a lack of potassium can lead to difficulty staying asleep throughout the night. In addition Vitamin D deficiency has also been linked to excessive daytime sleepiness, so if menopausal insomnia is an issue it is worth investigating including these supplements in your diet. The other fail safe one I would add to this is Evening Primrose Oil.
Sleep and physical health have a two-way relationship. Ill-health can make it hard to sleep but equally poor sleep can also increase our risk of future illness. As well as employing all the recommended ways of ensuring I get a good night's sleep, my hormone dosage has been adjusted according to my last meeting. A month in and in terms of my sleeplessness it has been limited to maybe a handful of nights which whilst they have made me feel totally miserable, when I think back to where I was at the beginning of this year is a big step forward.
I am as my consultant has told me still "work in progress", after all the peri-menopause can last for a number of years. For now at least though the quality of my life is improving because fundamentally I am sleeping better and as my family can vouch the well-being of the household is dependent upon my sleep!
Do you have any tips for dealing with insomnia? If so I would love you to share them.