Sleep and Menopause: Natural methods for relieving sleep problems and other menopause symptoms together
The women I talk with and treat as patients want to understand how menopause may affect their sleep and their health. Of course, they also want to know what to do throughout menopause to sleep, feel, and perform at their best.
There are some basic tenets that we all know contribute to healthy living, all of which are important during the menopausal transition:
• Eating healthfully
• Managing stress
• Maintaining healthy relationships and social connections
• Staying intellectually stimulated
• Sleeping well
These core practices can go a long way to helping women transition through menopause feeling good, sleeping soundly, performing at their best, and achieving the quality of life they desire for themselves. Still, even with these healthy routines in place, many women experience symptoms of menopause that disrupt sleep and daily performance, and interfere with quality of daily life.
I’ll talk here about specific therapies and treatments that can help both sleeplessness and other menopause symptoms. Sleep and menopause symptoms can influence and often aggravate each other. For example, short on sleep, you’re more sensitive to pain, and also to mood swings and stress. Hot flashes may make you more prone to obstructive sleep apnea. Given the complex relationship between sleep and menopause symptoms, it makes a lot of sense to consider ways to address these issues together, with therapies that can benefit both.
I’m focusing here on natural and non- or minimally-invasive forms of therapy. In a separate article, I’ll talk about the basics of hormone replacement therapy, and what the latest science tells us about how it may fit into a woman’s menopause treatment plan. Every woman is different, with her own symptoms, her own individual health issues and risks, her own sense of what forms of treatment make sense for her. This is not medical advice; it is a starting guide for a conversation with your physician, to talk about how to best address menopause symptoms—including sleep.
I recommend acupuncture to a number of my patients with insomnia and other sleep problems. For women in menopause who are having trouble sleeping, I’m particularly inclined to recommend acupuncture. That’s because this ancient practice of Chinese traditional medicine can help improve sleep as well as other disruptive, unwelcome symptoms of menopause.
Acupuncture stimulates blood flow throughout the body, and its practitioners say it restores balance to the body’s energy, or Qi. Frequently helpful in relieving pain, acupuncture is also used to treat a broad range of conditions, from high blood pressure to anxiety and depression, PMS to digestive conditions including irritable bowel syndrome, and substance addictions.
Scientific studies show acupuncture can work effectively to improve sleep in women in perimenopause and postmenopause. A recent analysis of research found acupuncture treatment is linked to increases in estrogen levels in the blood, and a reduction in sleep problems. (Remember, declining estrogen is associated with more frequently disrupted sleep.) Another recent study found acupuncture may improve both sleep quality and overall quality of life for post-menopausal women who have insomnia. Insomnia and other sleep disorders become more common in women during the menopausal transition.
Acupuncture can be effective for other symptoms of menopause, according to research. A recent study found that six months of regular acupuncture sessions was linked to a significant reduction in hot flashes and night sweats. Women who had 20 sessions of acupuncture over six months saw their hot flashes and night sweats decrease by more than a third, compared to women who didn’t receive the treatment. Acupuncture’s benefits had some staying power, too: the study found the improvements to hot flashes and night sweats lasted for at least six months beyond treatment. Research has also shown acupuncture may improve bone structure and bone function, and could help women in menopause guard against bone loss and osteoporosis.
Other mind-body therapies
Acupuncture isn’t the only mind-body therapy that can improve sleeplessness and symptoms of menopause. There’s a growing body of research showing that other mind-body practices can help protect and improve women’s sleep and health, and address specific symptoms of menopause. Research shows that mindset can play a significant role in managing symptoms of menopause. Mind-body treatments including Tai Chi, yoga, and qigong offer women a number of benefits and protections, including:
• Reducing the risks of cardiovascular disease and insulin resistance, a contributor to type 2 diabetes
• Improving and managing a woman’s cardiovascular response to stress
• Calming the nervous system
• Strengthening the body, improving muscle strength, balance, and flexibility, and improving bone structure
• Relieving muscle and joint pain and stiffness
• Improving sleep quality, reducing the symptoms of insomnia, making it easier to fall asleep and stay asleep
Let’s look more closely at some of the mind-body therapies that have been studied for their effectiveness in treating sleep and menopause symptoms:
Yoga. Yoga has been shown to significantly reduce overall symptoms of menopause, and help with hot flashes and night sweats, muscle and joint pain, anxiety and other mood problems associated with the menopausal transition. Across a range of studies, menopause symptoms showed improvement by as much as 36-80 percent. Research also shows yoga can improve cognitive function, boosting memory, focus, and attention.
Yoga can also provide substantial improvements to sleep problems. In scientific studies, yoga has been shown to:
• Elevate sleep quality
• Shorten the time it takes to fall asleep
• Diminish nighttime awakenings
• Improve sleep efficiency (that’s a measurement of the time you spend sleeping compared to the total amount of time you spend in bed)
• Reduce reliance on sleep medications
• Increase daytime energy
Tai Chi. Like yoga and other mind-body therapies, tai chi has been shown to have broad benefits for health and quality of life. For women in menopause, tai chi may be helpful in improving a range of symptoms and lowering risks for disease. Studies show tai chi may have a protective effect on metabolic and cardiovascular health, helping to reduce the risk of insulin resistance, lowering inflammation, and improving cardiovascular function. Tai chi can lift and balance mood, reducing symptoms of depression, anxiety and stress. It also improves physical strength, balance and flexibility in women—even more effectively than brisk walking, according to research – and has been shown to increase bone strength.
A study of the effects of tai chi in postmenopausal women found it aided weight loss, increased strength and balance, and lowered blood pressure.
This ancient, gentle exercise that focuses on breathing and slow, deliberate movement also delivers some real benefits for sleep. Research indicates tai chi can help reduce the symptoms of insomnia, help you fall asleep more quickly, sleep more soundly, and get more sleep overall.
It’s easy enough to think of massage as an indulgence – and a great massage certainly does feel good! Massage also has important therapeutic value, including for women in menopause. Therapeutic massage stimulates blood circulation, activates the body’s lymphatic system, reduces fluid-retention and swelling throughout the body, and releases tension in muscles and joints. It can improve flexibility, and reduce pain. Massage also calms the nervous system, and can help reduce stress, alleviate anxiety, and pave the way for better sleep. A 2011 study of the effects of regular massage (2 times a week for 16 weeks) on postmenopausal women found it significantly improved symptoms of depression and anxiety. The study also found massage benefited sleep by several measurements, improving sleep quality, shortening the time it takes to fall asleep, and contributing to feeling more refreshed after a night’s rest. Postmenopausal women who received massage also moved more quickly into REM sleep, and spent more time in deep, slow-wave sleep. These stages of sleep are critical for mental and physical restoration and rejuvenation.
CBT—Cognitive Behavioral Therapy
Many women during menopause wrestle with sleep problems and symptoms of depression, anxiety, or other issues with mood. I see this in a number of my patients, who feel frustrated and debilitated by changes to mood and sleep that often accompany menopause. I explain to my patients that sleep problems and mood disorders often go hand in hand. A significant majority—roughly three-quarters or more—of people coping with depression also have difficulty with their sleep. And poor, insufficient sleep makes people more vulnerable to depression, anxiety and other problems with mood. Add the hormone changes associated with menopause to the mix, and it’s not surprising that so many women in menopause suffer dual issues of sleep and mood.
Remember, estrogen and progesterone help to stabilize mood and keep stress in check. Fluctuations and declines to these important mood-regulating hormones can bring about symptoms of depression and anxiety even in women who haven’t experienced these conditions before.
As a clinical psychologist specializing in sleep, I use cognitive behavioral therapy as a core element of my work with patients. What is CBT? A form of therapy that brings awareness and change to thoughts, feelings, and actions or habits related to an issue or set of unwanted symptoms. There’s a specifically designed version of CBT for insomnia (CBT-I) that has been shown a tremendously effective tool for sleep problems, working as well or often better than sleep medication. CBT is also effective at addressing menopause symptoms, both on their own and in conjunction with sleep issues. Studies show:
• CBT can help improve sleep and relieve symptoms of depression in menopausal women who experience both
• CBT can be used to reduce the discomfort of hot flashes and night sweats
• In women who experience menopause symptoms after undergoing treatment for breast cancer, CBT can help to improve sleep, mood, and hot flashes or night sweats
• CBT can improve insomnia symptoms in women suffering from chronic pain, and reduce the degree to which pain interferes with their ability to function at their best during the day. For women in menopause who have muscle and joint pain, or other types of pain that interfere with sleep and quality of life, CBT can help.
This form of therapy has a lot of advantages as a treatment for sleep and menopause symptoms. Typically, CBT targeting these symptoms involves a short course of treatment. Research shows benefits to sleeplessness and other menopause symptoms in as few as 4-8 CBT sessions. Individual and group CBT sessions are options available to women—and so are guided self-help versions of the therapy, using apps, CDs, and books. Make sure you’re relying on a well-trained, certified and experienced therapist, whether in group or individual sessions or in guided self-help treatment.
Next, we’ll look specifically at hormone replacement therapy, it’s benefits and risks, and how it may help some women suffering from sleep and other disruptive menopause symptoms rest, perform, and feel better.
Michael J. Breus, PhD, DABSM
The Sleep Doctor™