Sleep may seem more elusive during midlife and menopause than any other time of life – even after having a new baby. Ninety-six percent of women in midlife say that poor sleep is one of their top three symptoms of menopause, according to a recent Gennev survey. To make matters worse, it seems like every day there’s another health problem attributed to a lack of sleep”weight gain, memory problems, decreased immunity, and increased risk of diabetes, heart disease, stroke, and even cancer. No wonder you can’t sleep!
“When sleep becomes a constant concern that a person is preoccupied by, that in itself can make it difficult to become a good sleeper,” says Sound Sleep Guru Meredith Broderick, M.D., who is board certified in sleep medicine and neurology.
So, the first step to better sleep is to stop worrying so much about your sleep. We know, easier said than done. That’s why we’ve created this guide to help you to stop obsessing about your sleep and start enjoying a good night’s rest. You may be surprised to find out that some of the most effective strategies are pretty simple. And even if you’re sleep isn’t perfect, there are things you can do to mitigate the negative effects of poor sleep on your health.
Sleep is your body’s rest and repair time. You may think you’re busy during the day, but a lot is going on inside your body at night. Cells are regenerating. Hormones are regulating. Memories are being stored. Your immune system is reinforcing itself. Muscles are getting stronger. Nerve cell connections are being made. All in an effort so you can perform at your best the next day.
To make all of this happen, your body cycles through two types of sleep throughout the night. If you use a sleep tracker like a Fitbit or Apple watch, you may be familiar with some of this. The first type is non-rapid eye movement sleep (non-REM), which includes light and deep sleep. The latter is a crucial time for growth and repair, and if you awaken during this stage, you’ll often feel groggy and disoriented for a while. The second type is rapid eye movement sleep (REM sleep), which involves more brain activity than non-REM. This type of sleep is essential for the processing and storing of information, including memories, in your brain. Overnight you cycle through the various stages, with each cycle lasting about 90 minutes and the REM stage getting longer the more you sleep.
There are lots of reasons women sleep poorly during midlife. Hot flashes. Worries. Night sweats. Restless leg syndrome. Pain. A never-ending to-do list. Urinary issues. Sleep apnea. Even if you don’t have trouble falling asleep, you may find yourself waking up more often throughout the night and having a harder time falling back to sleep. Unfortunately, sleep problems don’t usually disappear along with other menopause symptoms.
But a good night’s sleep doesn’t have to be a dream. Often, when you address underlying issues such as urinary problems or joint pain, you’ll sleep better. Treating menopause symptoms like night sweats and anxiety can also help. That’s why your first step should be to see a doctor with experience treating women in menopause. They will understand what you’re going through and have the most options for helping you. A serious sleep robber that needs immediate attention is sleep apnea. If your partner notices that you’re snoring or appear to stop breathing while you sleep, talk to your doctor about getting checked for sleep apnea. As estrogen levels decline, you’re more likely to snore and even experience sleep apnea, a serious condition that disrupts your breathing. Like other underlying conditions, treating sleep apnea will help you sleep better and wake up feeling rested.
As you’re trying to improve your sleep, you may get fixated on the number of hours you’re snoozing. If you wear a sleep tracker, you might obsess about how much deep versus REM sleep you’re getting. While both quantity and quality are important, Dr. Broderick says the most valuable endpoint is feeling rested throughout the day. “If you feel good, the numbers aren’t as important,” she says. “Feeling good and functioning well during the day are what I care about the most.”
And getting a good night’s sleep, so you wake up feeling rested, starts long before you turn in for the night. “What you do with the time you are awake and the quality of your waking hours has a dramatic impact on your sleep quality,” Dr. Broderick explains. “Being active, engaged, having a purpose, and connection are reasons why you get out of bed in the morning. They also keep you busy and help your body generate the need for deep, uninterrupted sleep.”
While you address any underlying causes that may be keeping you up at night, here are additional steps you can take to set your body up for a good night’s sleep. Some may even help with conditions like anxiety, joint pain, and hot flashes that can rob you of sleep.
If you continue to have sleep issues, consider seeing a board-certified sleep specialist or a behavioral sleep specialist. They can provide cognitive behavioral therapy, which has been shown to be effective for chronic sleep problems.
When you notice a change in sleep pattern that may be associated with the menopause transition, especially if body temperature instability is part of the problem, consider an appointment with a Gennev doctor to address the role that hormonal shifts can play in your trouble sleeping.
The information on the Gennev site is never meant to replace the care of a qualified medical professional. Hormonal shifts throughout menopause can prompt a lot of changes in your body, and simply assuming something is “just menopause” can leave you vulnerable to other possible causes. Always consult with your physician or schedule an appointment with one of Gennev’s telemedicine doctors before beginning any new treatment or therapy.
If you struggled to button your jeans this morning, you are NOT alone. Most women gain about a pound a year on average during the menopause transition. While that doesn’t sound like a lot, the big issue is where those pounds are suddenly going”right to your belly! Belly fat is such a common occurrence that there’s even a name for it, the menopot. Unfortunately, it isn’t just a problem when you’re trying to zip up your jeans, extra weight in this area can lead to a host of health problems.
During childbearing years, the hips, thighs, and butt were likely the go-to spots when you gained weight. But once perimenopause arrives, your middle is more likely to be expanding. Estrogen directs fat to the lower body early in life to support childbearing. When estrogen declines, fat instead migrates to the abdominal area, similar to the pattern in which men gain weight.
The location of the fat isn’t the only difference. Weight gained in the hip, thigh, and butt areas is usually subcutaneous, right below the skin. But when you start packing on pounds in your midsection, the fat builds up deeper and around your organs. This fat, called visceral fat, appears to be more active than surface fat, releasing substances, affecting hormones, and increasing your risk of high cholesterol, heart disease, diabetes, and even cancer. According to a study in the Journal of the American Heart Association, women with more central body fat had a 10 to 20 percent greater risk of having a heart attack during the seven-year study than women with more overall body fat. A widening waistline can even be risky if you’re otherwise a healthy weight.
Vanity aside, it’s smart”possibly even lifesaving”to take steps to manage your midsection.
Don’t worry, you won’t have to do dozens of crunches. It’s impossible to spot reduce. Instead, a comprehensive approach to all-over weight loss is your best strategy for shrinking your belly and protecting yourself against future health problems. Here are some additional steps that may target belly fat.
Eat more fiber, especially the soluble kind. This type dissolves in water to form a gel-like substance that helps to lower cholesterol and glucose levels. It also appears to help keep belly fat at bay. For every 10-gram increase in soluble fiber, there was a four percent decrease in the accumulation of abdominal fat, according to a study in the journal, Obesity. Good sources include oatmeal, oat cereals, barley, beans, nuts, lentils, peas, apples, blueberries, oranges, Brussel sprouts, and sweet potatoes. Fiber also helps by filling you up for fewer calories and improving digestion.
Kick up the intensity. All exercise is good for your health and body weight, but pushing yourself a bit could help slim down your middle. When researchers tracked over 1,000 adults for five years, they discovered that those who did some type of vigorous exercise”think jogging, jumping rope, fast cycling, speedy walking”at least a few times a week accumulated less belly fat than those who rarely or never got their heart rate cranking. An easy way to up your intensity is by adding short intervals to your usual workout. So, if you normally walk for exercise, speed up or jog for 30 to 60 seconds, then recover for a minute or two, and repeat throughout your workout. Increasing the speed of any activity or adding some impact”if your joints don’t mind”will ratchet up the intensity.
Skip the cocktails, or at least limit them. Drinking alcohol has been linked to a larger waistline, though it’s not exactly clear why those Cosmo calories seem to be drawn to your middle. Most drinks are high in calories, contain a lot of sugar, and often contribute to poor food choice when you’re indulging.
Pick up some dumbbells. If you’re not strength training, you’re losing vital muscle mass that fuels your metabolism. The decline can start in your 30s and means that you’re burning fewer calories. No wonder it’s harder to lose weight and easier to gain it as you get older. But lifting weight, using resistance bands, or doing body weight exercises like pushups can curb the loss and even rebuild some of the lost muscle. And according to research, it can help shrink belly fat. And just two or three workouts a week will do the trick. You can even pump out some reps while your binge watching your favorite show.
Find a way to chill. We know, we sound like a broken record. But, when you’re stressed, your body pumps out higher levels of the stress hormone cortisol. One of the effects”there are many negative ones“of increased cortisol appears to be a bigger belly. The good news is there’s no right way to relax so pick what works for you. Walk. Meditate. Listen to relaxing music. Take some deep breaths. Do yoga. Sit on the couch and stroke your dog or cat.
Most importantly, stick with these healthy habits. Because visceral fat is so deep you may not notice the changes right away, but research has found that even if you don’t drop any pounds, you’re reducing your risk of future health problems.
A large waistline puts you at risk for metabolic syndrome, a cluster of symptoms that can lead to heart disease, type 2 diabetes, stroke, and other health problems. If you have any of these related symptoms or are taking medication for any of them, you should see a doctor.
Increased belly fat is also a primary risk factor for insulin resistance”a precursor to diabetes, and a warning flag for heart disease, stroke, fatty liver, and vascular disease.
Other warning signs that should prompt a call to your doctor:
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The information on the Gennev site is never meant to replace the care of a qualified medical professional. Hormonal shifts throughout menopause can prompt a lot of changes in your body, and simply assuming something is “just menopause” can leave you vulnerable to other possible causes. Always consult with your physician or schedule an appointment with one of Gennev’s telemedicine doctors before beginning any new treatment or therapy.
While hot flashes are practically synonymous with perimenopause, some women experience the other extreme: a bone-deep cold that no matter how many blankets you layer on, you just can’t warm up. Or you may be in a warm room and suddenly feel chilled and begin shivering. Sometimes cold flashes come on the heels of a hot flash when damp, sweaty clothes only make them worse. Other times, they come alone and mysteriously. Cold flashes usually pass within a few minutes, but they can last for up to 20 minutes and are more common at night.
Cold flashes are considered an unusual perimenopause symptom, but given the number of women we’ve heard from who are experiencing them, we’re starting to think that cold flashes are more common than doctors realize.
Much like hot flashes, cold flashes are likely caused by the hormone havoc going on in your body. As estrogen levels drop, the hypothalamusasthe part of your brain responsible for regulating your body temperatureasgets overly sensitive, and therefore temperature regulation can be unstable.
Cold flashes can also be triggered by a panic attack or anxiety. During a panic attack, your body releases adrenaline and other stress hormones that can affect its ability to regulate body temperature.
Although they’re less common than hot flashes, cold flashes are no less disruptive, especially at night. And given how rare a decent night’s sleep can be during this time of life, learning how to manage cold flashes may give you a shot at some vastly improved rest.
Here are some steps you can take to help even out your body temperature:
Limit caffeine and alcohol. Not only can they disrupt your sleep, but these substances also influence your body’s temperature regulation system.
Avoid sugar, spicy foods, and nicotine. All can be triggers for cold or hot flashes.
Be prepared. Stash extra clothes at work, in the car, or carry some with you. You can don another layer when a cold flash strikes. If it’s a hot flash, you can change out of damp clothes, which may reduce the chances of a follow-up cold flash. At night, keep extra blankets handy. Moisture-wicking bedding and pajamas can help, too, and keep a spare pair next to your bed for a quick change if needed.
Get active. When you’re in the throes of a cold flash, hop out of your seat and start moving. This will increase blood flow to help warm you up.
Practice relaxing. Easier said than done, right? Especially if you’re thinking that it means meditating for a half hour or taking an hour-long yoga class. It is easier than that. You can start with just a minute or two. Set a timer for every hour or so and when it goes off, stop and take a few deep breaths. Before each meal, do a few stretches. Or every time you’re in your car alone, close your eyes and pay attention to how your body feels”of course, do this before you start driving or once you reach your destination. Even small steps can help to ease anxiety that may precipitate a number of perimenopausal symptoms.
Slip on socks. If cold flashes haunt you at night, keeping your feet warm may help.
Keep in mind that sometimes the things you do to survive a cold flash may trigger a hot one. If that’s your M.O., proceed with caution. Drink warm beverages instead of hot ones. Pile on one blanket at a time instead of half a dozen. Turn up the thermostat a degree or two, not 10.
If you’re having disruptive cold flashes, a trip to the doctor is recommended. Poor blood circulation, thyroid dysfunction, anemia, and low blood sugar can cause cold flashes and can be more serious than a typical hormonal imbalance due to perimenopause. If they are strictly perimenopause related, you and your doctor can discuss hormone replacement therapy (HRT),antidepressants, or low-dose birth control pills, which can offer relief.
The information on the Gennev site is never meant to replace the care of a qualified medical professional. Hormonal shifts throughout menopause can prompt a lot of changes in your body, and simply assuming something is “just menopause” can leave you vulnerable to other possible causes. Always consult with your physician or schedule an appointment with one of Gennev’s telemedicine doctors before beginning any new treatment or therapy.
As an obstetrician-gynecologist who specializes in menopause, Dr. Lisa Savage hears all sorts of questions related to the menopause journey, and what one may expect to experience both physically and emotionally. Read on as Dr. Savage shares with us the top ten questions she is asked about menopause, along with her answers.
The definition of menopause is a year without a period at an appropriate age, although it is generally preceded by months to years of menstrual cycle changes and other symptoms during perimenopause. Perimenopause symptoms can start in a woman’s late 30’s as the ovaries’ output of the hormones estrogen and progesterone starts to become variable and decline. The average age of full menopause is 51. Everything after the cessation of periods is called post-menopause. Symptoms such as hot flashes are usually worst during the transition time and do tend to taper off as time goes by.
Perimenopause and menopause can lead to major sleep disruption, not only from night sweats, but from a change in the architecture or stages of sleep. Sleep disruption can play a role in the “downstream” symptoms of menopause such as brain fog and irritability.
Why have I gained weight and what can I do to manage it? Mid-section weight gain is common and is partly an adaptation to the loss of estrogen from the ovaries, since estrogen can be “made” (converted from other hormones) in fat tissue. Sleep disturbance can also contribute to metabolic changes and weight gain. An examination of your nutrition habits is a must”¦ since what worked before may no longer work”¦ and a commitment to physical activity/exercise is more important now than ever.
Mood issues can be exacerbated or appear for the first time during the menopause transition. The varying and decreasing levels of estrogen affect brain chemistry at the same time the brain is becoming less sensitive to estrogen. Also, social, professional and inter-personal roles may be at a crossroads during this stage of life. This confluence can lead to a variety of mood issues, which can be addressed in the context of what is contributing to them.
Sexual interest in women is multi-factorial, and hormones are just one part of it. During perimenopause and beyond, decreasing estrogen levels can cause physical changes in the genitals, with less lubrication and thinner, more fragile tissue, which can lead to pain. Pain chases away desire, of course. The good news is that these physical changes can be remedied in several ways, most effectively by the use of vaginal estrogen. Once pain is relieved, the other aspects of desire can be addressed. During the reproductive years, when you are still ovulating, the hormonal waves and cycles that occur can contribute to more interest at certain times. I call this “Mother Nature’s call to reproduce.” During those years, you might have more spontaneous desire than during mid-life, when you are no longer ovulating, and receptive desire may play a bigger role in your sex life. Desire, however, can be either spontaneous or receptive at any stage; all women are different. The good news is that are ways to re-kindle and support your interest in sex.
HRT is “hormone replacement therapy”. If started during the transition timeframe/within a few years of menopause, it can treat symptoms as well as have some long-term benefits, including bone, cognitive and heart health. Gennev physicians have the expertise to help patients weigh their options and are available for telemedicine appointments.
The short answer is no, although a woman’s individual and family history must be taken into account. There is not one-size-fits-all regimen. Not all women need HRT and not all women can use it or wish to use it. As with any medication, risk can be related to dosage and duration of use. In many women, the short and long-term benefits far outweigh any potential risk.
The term bioidentical takes us back to chemistry class. If a hormonal therapy is molecularly/structurally just like what your ovaries make, it’s considered bioidentical. There are conventional, FDA-approved products that happen to be bioidentical, but this does not mean they are safer or more effective than products that are not bioidentical. This term is sometimes confused or conflated with “compounded”, which means it’s made at the pharmacy according to a certain recipe. Compounded products are not FDA-approved and can be inconsistent in dosing and absorption, which is why we at Gennev don’t prescribe them. A product can be compounded AND bioidentical”¦or not. For the most part, these two terms are used in marketing, and are not interchangeable.
Lifestyle modifications such as a healthy diet, adequate exercise and social connections can go a long way towards feeling your best. Practical considerations such as dressing in layers and avoiding any identifiable hot flash triggers are also helpful. At Gennev, our health coaches can address these issues and offer support along the way.
Sister, you are not alone! Every woman will go through menopause and many of your peers/friends/co-workers can relate. At Gennev our mission is to support you in your experience, whether it’s physical, emotional, social or professional. We are an online clinic and resource, ready to make you part of an educated and empowered community of women. Welcome to our tribe!
Speak to a Gennev board-certified physician to get your questions about menopause answered, and connect with other women just like you in our private community on Facebook to share experiences and offer support to one another.
The information on the Gennev site is never meant to replace the care of a qualified medical professional. Hormonal shifts throughout menopause can prompt a lot of changes in your body, and simply assuming something is “just menopause” can leave you vulnerable to other possible causes. Always consult with your physician or schedule an appointment with one of Gennev’s telemedicine doctors before beginning any new treatment or therapy.
Sleep is a precious commodity. Between menopause and our 24/7 world, getting a good night’s sleep can be tough, and the health consequences of poor sleep keep piling up. Everything from your body weight and mood to your memory and disease risk is influenced by sleep. Even your strong bones may not be immune to the dangers of poor sleep, according to the latest research. That’s why it’s essential to find out if your sleep habits are jeopardizing your sleep in menopause”and your health”and take steps to fix them.
If night sweats, anxiety, or dozens of other unknown factors are keeping you up at night, you probably want to scream every time you hear the recommendation to get seven to eight hours of sleep a night. So, we’re not going to focus on quantity here. Instead, let’s work on improving some sleep habits that may be affecting the quality of your sleep. As you improve those habits, you may naturally get more Zzzzs”bonus!
Here are 10 habits that can negatively impact your sleep and what to do about them.
You may feel better, but your body isn’t noticing a difference on a cellular level. Adverse effects of poor sleep like decreased insulin sensitivity, which contributes to diabetes, aren’t improved with a few extra hours of sleep here and there. The more erratic your sleep patterns are, the higher your risk of heart disease. And when you sleep in, it can disrupt your ability to fall asleep that night and reinforce an irregular sleep pattern.
The fix: Keep a consistent wake time. This is one of the most important steps to set yourself up for more and better sleep, according to Andrew Huberman, Ph.D., a neuroscientist at Stanford University School of Medicine. Melatonin is your body’s sleep hormone. It shuts off when you wake up and turns on again at night to prepare you for sleep. A key factor that regulates melatonin’s production cycle is your wake-up time. Melatonin production ramps up 12 to 16 hours after you awaken.
Quantity isn’t the only factor when it comes to getting quality sleep, according to Michael Breus, Ph.D., a clinical psychologist and sleep expert. Even if you’re getting the recommended number of hours, going to bed after midnight can rob you of precious deep sleep. Deep, restorative sleep happens during the first part of the night, while lighter REM sleep (both are important) happens more during the second part of the night. Turning in after midnight increases heart disease risk. In a five-year study, those burning the midnight oil had a 25 percent greater risk of heart disease than those who were lights out between 10 and 11 o’clock. The risk was 12 percent higher for those who hit the hay between 11 p.m. and midnight. And women seemed to be more susceptible to the dangers of staying up late, according to the research published in the European Heart Journal Digital Health.
The fix: Shift your bedtime before midnight to set yourself up for the best possible sleep. Having a consistent wake-up time (see #1) and getting an early dose of sunlight will help you to be able to fall asleep earlier.
Stop! New research from Northwestern University found that even a little light when you’re supposed to be snoozing raised heart rate and glucose levels, which can increase risk for heart disease and diabetes.
The fix: Resist the temptation to reach for your phone, even to check the time. The darker your room remains, the easier it will be to fall back to sleep and the better you’ll sleep. Invest in a low-light clock if you want to check the time. Red light doesn’t affect your body clock, waking you up, like blue or white light from your phone. If you struggle to fall back to sleep, check out the strategy in #4.
First, don’t reach for your phone (see #3). Second, don’t panic. The more you stress out about being awake and not getting enough sleep, the harder it will be to fall back to sleep. Instead relax. Even if you don’t fall back to sleep, it’s OK. Early research on non-sleep deep rest (NSDR) shows it can be rejuvenating. NSDR is a hyper-calm state induced through meditation or hypnosis.
The fix: When you panic or stress out because you’re wide awake at 3 a.m., you set off your body’s flight-or-fight reaction, which is not conducive to sleep. Instead, you want to remain or get back into your body’s relaxed, resting state. To help you chill out and improve your chances of falling back to sleep, try yoga nidra, a form of meditation to bring on deep rest. Even if you don’t fall back to sleep, you’ll still be getting some quality rest. You can practice yoga nidra to reduce stress and feel more refreshed any time of the day.
Your sleeping position has been blamed for back, neck, and shoulder pain and snoring, but research to back this up is inconclusive.
The fix: Based on preliminary evidence, sleeping on your side with your legs stacked appears to be the safest position unless you have shoulder pain. Try sleeping on the opposite side if you wake up with shoulder pain. The one side position you should avoid is throwing your top leg over your body which twists your back and may contribute to both back and neck pain. Back sleepers may be more prone to snoring and waking up with a stiff, achy back. Sleeping on your belly may also aggravate back and neck pain.
You may feel like it’s helping, but alcohol-induced sleep isn’t the best quality. While you may fall asleep faster, alcohol decreases deep sleep and causes you to wake up more throughout the night. It may also contribute to nightmares and snoring, which increases your risk for sleep apnea (see #10).
The fix: Try a glass of tart cherry juice on the rocks or sip a cup of chamomile tea instead. Both have been found in studies to improve sleep. If you must imbibe, cut yourself off four hours before bedtime.
While this may counteract your body’s natural decline in body temperature that occurs in the evening, some research shows that the dramatic post-soak dip in body temperature may enhance sleep. However, the studies didn’t specifically look at women in midlife, for whom hot water may trigger hot flashes and night sweats.
The fix: If a dip in the hot tub isn’t disrupting your sleep, enjoy! For the best impact on your sleep, time your soak for about 90 minutes before bedtime, so your body temperature has time to lower before you crawl under the covers. If hot water triggers hot flashes for you, try a warm foot bath instead. A 20-minute soak an hour before bedtime not only helped menopausal women sleep better, but it also reduced disruptive menopausal symptoms like hot flashes and night sweats, according to research in the journal Research in Nursing & Health.
Frequent nighttime bathroom visits are a classic sign of an overactive bladder. While it’s great that you’re falling back to sleep, every trip to the bathroom disrupts restful sleep. The fewer bathroom breaks at night, the better
The fix: You can take steps to curb an overactive bladder and improve your sleep. Start by making sure that you’re well-hydrated during the day”yup, it sounds counterintuitive, but it prevents bladder irritation that can send you to the bathroom more frequently. And cut back on other bladder irritants such as caffeine, alcohol, carbonated beverages, citrus, tomatoes and tomato-based foods, and spicy foods.
This is a wake-up call that you need more sleep. And 15, even 30, minutes of fragmented sleep isn’t going to help. These short bouts of snoozing aren’t restorative and can make you feel more stressed in the morning.
The fix: Get a better night’s sleep by going to bed earlier or improving the quality of your slumber. Or, set your alarm later to enhance the quality of those extra minutes, and then get out of bed when it goes off.
Factors like alcohol, weight gain, sleeping position (see #5), or uncontrollable allergies can contribute to snoring. Declines in estrogen during perimenopause and menopause make women more prone to snoring.
The fix: If addressing these factors doesn’t help, talk to your doctor. Snoring can be a sign of sleep apnea, a breathing disorder that increases your risk of high blood pressure, heart problems, and diabetes.
Now that you know how your habits might be affecting your sleep”and your health”take action! Even small changes can improve your sleep. The result: you’ll have more energy, be more productive, be better able to concentrate, react more quickly, manage your emotions better, and improve your overall health. You may even notice a decline in some menopausal symptoms, such as anxiety, mood swings, irritability, and forgetfulness. A win-win-win!
If you are experiencing changes in your sleep pattern associated with menopause symptoms (especially if body temperature instability is part of the problem), consider an appointment with a Gennev doctor to address the role that hormonal shifts can play in your sleepless nights.
The information on the Gennev site is never meant to replace the care of a qualified medical professional. Hormonal shifts throughout menopause can prompt a lot of changes in your body, and simply assuming something is “just menopause” can leave you vulnerable to other possible causes. Always consult with your physician or schedule an appointment with one of Gennev’s telemedicine doctors before beginning any new treatment or therapy.