Sleep and Women's Health

Why Sleep is important for women’s health, particularly around the menopause.

We spend 1/3rd of our lives sleeping and we all need 7-9 hours of good quality sleep each night. What I write next applies to everyone, male and female and sleep is vital to us all, but levels of insomnia in women are higher than in the general population so let’s look at why and how to address this.

We have different stages of sleep; REM (rapid eye movement) sleep – when we dream, and non-REM sleep which occurs in 4 stages including light sleep and deep sleep. Deep sleep and REM sleep are essential for us to function.

Why is sleep important?

When we sleep, we need less energy so the body uses this energy to restore and repair. During deep sleep, a number of processes occur in the body, such as DNA repair and remodelling (DNA contains our genetic code and is responsible for how we grow develop and function). We also make proteins at this time. Hence poor sleep and lack of sleep is associated with cancer – a correlation has been found with breast, endometrial, prostate, colorectal cancer and acute myeloid leukaemia and poor sleep. It also affects our hormones.

During sleep, your body relaxes and so blood pressure lowers, heart rate lowers, we get more blood flowing to our extremities and our core body temperature cools. This all helps protect our cardiovascular system and poor sleep causes raised blood pressure, increased risk of heart attacks and cardiovascular disease deaths such as stroke.

During REM sleep, cognitive processing takes place so you have enhanced learning and memory, it also helps a person cope with fear and anxiety, poor sleep correlates with anxiety and depression, premenstrual syndrome and post-traumatic stress disorder (PTSD) is worsened if sleep deprived 2 weeks prior to a traumatic event.

What drives sleep?

During the day, we have a build-up of a substance called adenosine, which causes sleepiness. We also have our body’s internal body clock known as the circadian rhythm which is influenced by how much light and the type of light we are exposed to, when and what we have eaten, when and if we exercise, and our body temperature. This internal body clock is controlled by a part of the brain known as the suprachiasmatic nucleus in the hypothalamus. The light we are exposed to affects the production of the hormone melatonin which promotes sleep. We need our core body temperature to drop at night, the body does this by vessels at our extremities dilating (widening allowing more blood flow) so that heat goes from the core to extremities.

Why sleep is important during the menopause

During the perimenopause and menopause, we have less sex hormones. Less oestrogen and testosterone causes multiple symptoms (see blog on “What is the menopause and what is happening to the body” ), less progesterone causes less of the chemical messenger Gamma- aminobutyric acid (GABA) which has sleep enhancing effects and helps with stress reduction.

When we sleep our stress hormones decrease significantly, so hormones such as cortisol are affected by poor sleep which in turn affects oestrogen, progesterone and thyroid hormone production. Weight can be an issue during the menopause and there are hunger hormones called leptin and ghrelin which are influenced by sleep.

Leptin is a hormone named from the Greek word “leptos” which means “slender”. It signals the body to feel full and so this hormone stops you feeling hungry. Leptin is produced during sleep so you are less likely to over-eat if sleeping well as this will be produced in higher quantities. Ghrelin is the hunger hormone that drives you to eat. Poor sleep leads to an imbalance of leptin and ghrelin and is associated with eating more and increased body weight.

Better sleep means enhanced insulin sensitivity and you are less likely to develop type 2 diabetes.

With symptoms such as hot flushes or night sweats, it can be harder to get to sleep but as we need to control our risk for cardiovascular disease and Alzheimer’s disease (higher risk in post-menopausal women), it is important to try and prioritise sleep. It will help to control our symptoms, weight gain and make us feel more rested as well as reducing our risk of longer-term issues.

How can I get better sleep?

In our modern world and busy lives with TV, screens and lighting everywhere, we can be going against our natural body clock but it is vital for both men and women that we accept and start prioritising sleep just as much as we look at diet and exercise when it comes to our health.

The first thing is consistency. There is no such thing as making up for lost sleep at the weekend. You should aim to go to bed and wake up at the same time each day. Provide yourself with the opportunity to get 7-9 hours sleep per night.

Have a wind down routine. Remember your body clock and light. Avoid screens before bed (the blue light from them will inhibit melatonin production), consider blue light blocking glasses if working late or turn the lights down dim or consider candlelight for a relaxing atmosphere. Consider a sleep mask or use black out curtains to keep the room dark. Remember temperature. Keep your bedroom cool. We need our core body temperature to drop to initiate sleep, so exercising right before bed is not the best idea. A warm bath helps as it shifts heat from your core to extremities helping you cool down.

Yoga and meditation help with sleep as they decrease your sympathetic nervous system and so again blood gets shunted from your core to extremities so you cool down centrally. You also have a reduced heart rate and energy expenditure following yoga and meditation.

To help your body clock, try to get some natural light first thing in the morning, it can be better to exercise earlier in the day, but exercise in general will help with deep sleep as long as it is not before bed as before it will increase core body temperature meaning it may take longer to cool down and fall asleep.

Avoid large meals later in the evening, particularly carbohydrate rich meals, always try to eat at least 2-3 hours before you go to bed if possible. Keep well hydrated during the day.

Avoid caffeine and alcohol – this is important for menopausal symptoms anyway, but caffeine blocks adenosine which was building up in the day to produce the sleep drive. Therefore, you want to avoid caffeine from the afternoon onwards. Alcohol interferes with sleep quality, so although you may feel it helps you get to sleep, poorer sleep quality is the result. Also, magnesium activates the parasympathetic nervous system and helps regulate melatonin. Nuts and seeds such as almonds, cashews, pumpkin seeds and spinach are rich in magnesium (see blog on “How diet can affect your health during the menopause”  for more on diet). Caffeine and alcohol decrease the absorption of magnesium.

Daytime naps – naps can be good provided they are of a short duration (20-30 mins) and can be helpful if sleepy. However, they should only occur in the first half of the day and not after 3pm ideally. Remember the sleep drive and build-up of adenosine; having a nap too close to bedtime will interfere with that build up and make it harder to fall asleep. This will lead to less sleep of poorer quality so keep the naps for earlier in the day.

Women need better sleep during the menopause

Poor sleep leads to hormone imbalance. The consequences of poor sleep are:

·      Twice as likely to have a raise body mass index and obesity (BMI 30 or higher).

·      Increased risk of type 2 diabetes

·      More likely to develop Metabolic syndrome (a combination of high blood pressure diabetes etc leading to complications)

·      Higher risk of cardiovascular disease (heart attack, stroke, hypertension)

·      Poor mood/anxiety and depression

·      Poor memory and risk of Alzheimer’s disease

·      Increased correlation of certain cancers – eg breast, endometrial and colorectal cancer

Postmenopausal women already have a higher risk of cardiovascular disease and Alzheimer’s so it is important to prioritise sleep.

The benefits of a good night’s sleep:

·      Deep sleep clears toxins

·      Clears amyloid which has been linked to Alzheimer’s disease.

·      Helps to consolidate new memories

·      Leads to better mood

·      Better memory and focus

·      Better libido

·      Hormone regulation

·      Cardiovascular health

·      Prevent cancers

·      Reduces inflammation

·      Helps with weight reduction

It can be hard to sleep due to the hormonal changes and symptoms of low oestrogen but making some lifestyle changes with diet, exercise and taking some of the steps above can help to improve sleep which will in turn help with menopausal symptoms.

If you would like a consultation to help with lifestyle changes during the menopause – CLICK HERE

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