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How does perimenopause affect sleep?

How does perimenopause affect sleep?
Nobody seems to get much sleep through perimenopause. Discover how it affects sleep and learn effective strategies to promote better sleep during this time
When Frisca Yan-Go wakes up beside her husband at 3am in their Los Angeles bedroom, her efficient mind is likely to begin popping with creative approaches that will meet the challenges she left sitting on her desk back at the UCLA Medical Center. But unlike the rest of us, she won’t waste her energy by tossing, turning and worrying about whether or not she’ll remember all those brilliant thoughts the next morning. Instead, she’ll calmly reach over to her nightstand, pick up a voice recorder, dictate a few words, then slide gently back into sleep.
As a neurologist and psychiatrist, as well as the medical director of the UCLA Sleep Disorders Center, Frisca L.Yan-Go, MD, has a distinct advantage over the rest of us. For one thing, she knows what’s going on in her mind and why it woke her up. For another, she has a whole bag of little tricks to shut it down and send it back to sleep.
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Those tricks are particularly important during perimenopause. Some 59 per cent of women between the ages of 35 and 55 won’t get much sleep in the four- to eight-year period prior to menopause that’s generally referred to as perimenopause. In fact, researchers say that this group of women is more likely to experience insomnia than any other.
"Unfortunately, the closer women get to menopause itself, the less they sleep"
Unfortunately, the closer women get to menopause itself, the less they sleep. According to a 2007 National Sleep Foundation poll, by the time women actually stop menstruating, somewhere between the ages of 45 and 51, a full 61 per cent will report that they can’t get to sleep or stay asleep several nights each and every week.

What is perimenopause?

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Perimenopause frequently stretches over a period of ten years and includes five sometimes overlapping phases, says endocrinologist Jerilynn C. Prior, MD, scientific director of the Centre for Menstrual Cycle and Ovulation Research at the University of British Columbia. And nobody seems to get much sleep through any of them.
The first two phases begin somewhere in the forties when women are still menstruating regularly. Phase one includes increased cramping, heavier flow, more intense premenstrual symptoms, and more frequent insomnia. Night sweats will begin in about one-third of women in this age group, says Dr Prior, while severe migraine headaches and nausea are common. Phase two is more intense and may include hot flushes during the day as well as night sweats.
"Perimenopause frequently stretches over a period of ten years and includes five sometimes overlapping phases"
Phase three generally begins around age 47 and is marked by the beginning of an irregular flow. Night sweats may be better or worse, while daytime hot flushes become common for the 80 per cent of women who will get them. A heavy flow and fatigue characterise this phase, which will generally last about four years.
Phase four is when things really get wild. Its beginning is signalled by your first skipped period, and from then on, you can’t count on much of anything. Flow can be light or heavy, present or not, and appear or disappear on a whim. Cramps, night sweats and hot flushes may intensify.
Phase five is one solid year without a period. Night sweats and daytime flushing intensify. Sleep is a gift. Fortunately, postmenopausal life is just around the corner. And life after hormonal swings is good. Very, very good.

What’s going on?

Surveys indicate that roughly 57 per cent of us can’t sleep because of hot flushes, anxiety, depression and chronic insomnia, while another 43 per cent have a sleep disorder such as obstructed breathing, narcolepsy, or restless legs syndrome. Hot flushes alone cause women approaching menopause to briefly rouse 100 times a night—around three times more than a woman who is not.
Yet, as seemingly unrelated as these challenges are, new research shows that they appear to share one thing in common: They are all initiated or otherwise affected by imbalances in various hormones that are regulated by the body’s biological clock in the brain’s hypothalamus—the SNC.
"Hot flushes alone cause women approaching menopause to briefly rouse 100 times a night"
“The SNC is where you have the axis for the sleep/wake cycle and the axis for all the endocrine glands that affect monthly reproductive rhythms,” says Dr Yan-Go. “They’re all linked together like an orchestra,” so when one cycle is out of whack, it tends to sideswipe the others as well.
When perimenopause arrives with its roller-coaster ride of hormonal ups and downs, the entire orchestra gets out of sync, says Dr Yan-Go, and disrupted sleep is frequently the result. “The best sleep we ever get is between age nine and menarche,” she adds ruefully. “After that, it’s all ups and downs.”

The 3am wake-up call

Although more than half of us aren’t sleeping, studies have shown that most perimenopausal women can get to sleep, they just can’t stay that way. Instead, they wake intermittently throughout the night or in the wee hours of the morning. And sometimes women aren’t even aware of how often they wake, says neurologist Hrayr P. Attarian, MD, director of the University of Vermont sleep center.
“But if you’re falling asleep during the day when you don’t want to, or if you wake up after a good night’s sleep and feel as though you haven’t slept at all, then you should be talking to your physician.”

Getting better sleep

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While there is no one-size-fits-all remedy for a peaceful night's worth of sleep, here are some tips you can try: 
  1. The worry book: Dr Yan-Go recommends keeping a "worry book" beside your bed so you can jot down everything you're worrying about and any solutions you have thought of when you awake. Then, close the book, put it on your nightstand and go back to sleep—leave it all to the morning.
  2. Light reading: One woman shares that when she can't settle down for a good night's rest, she asks her husband to read to her when they go to bed and is out like a light before the third page. 
  3. Eating right, sleeping tight: Foods that rank high on the glycemic index will help you fall asleep in half the time you normally do if eaten four hours before bed. Be wary of this tip if you have diabetes, as these foods cause a steep rise in blood sugar. A few examples are plain bagels, corn chips, watermelon, mashed potatoes and saltine crackers. 
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