“You need your beauty sleep … An hour before midnight is worth two after … You should sleep for 8 hours a night … Sleep deprivation can cause heart disease!!!” Arghhhh!
These are the sorts of messages we hear, internalise and then regurgitate repeatedly to ourselves when we wake in the early hours. No wonder we can’t get back to sleep! There is no doubt that sleep is important for resting and restoring our bodies, but worrying ourselves over not getting sufficient sleep is unhelpful and likely to exacerbate the issue, making sleep evermore elusive.
Years ago I attended a course on coping with insomnia as I’d always had trouble sleeping. I gained many useful tips from this course, but the one thing that really resonated with me was this:
“STOP worrying about not getting enough sleep! Your body will get the sleep it needs over time, and when you wake up during the night, don’t lie awake for hours on end. If you haven’t gone back to sleep within 20 minutes, get up and do something; either a relaxation technique – yoga, meditation, breathing – or simply do the ironing! Then go back to bed afterwards, if you feel like it, and when you wake up, your ironing will be done – bingo!”
Well, I didn’t do the ironing in the early hours, but I did internalise this metaphor and it certainly worked for me, helping me to stop worrying about something I felt I had little control over. I adapted my night-time routine and gave up tossing and turning from 3 o’clock onwards and when I did wake up, and couldn’t get back off again, I got up. Sometimes I pottered around, and on a few occasions, I did some yoga. This proved far better than lying awake for hours on end, and I discovered that it stopped the wandering, worrying mind and prevented those – what my friend calls – “dark nights of the soul” episodes. Eventually, my sleep pattern did improve and I managed to break the habit and establish better sleep patterns. And then … just when sleep issues were something I didn’t have to consider anymore, along came Menopause, and with it, that old friend – sleep deprivation! Great!
61% of menopausal women (peri- and post-) report frequent episodes of insomnia, according to the National Sleep Foundation, and whilst this can be due to hormonal changes relating to menopause, it can also be because of other age-related health conditions.
We all know that we pee more frequently as we get older, and this is what often wakes us up! Peeing more could be due to hormone changes or it could be because of a weakened pelvic floor. However, there may be other medical reasons, so it’s best to get checked out if your usual peeing habits have changed significantly. We all know it’s important for all sorts of reasons to drink plenty of fluids throughout the day and the NHS recommends 1.2 litres for women which equates to about 6-8 glasses. Water is, of course, a good first choice of fluid, because it hydrates you without adding extra calories or harming teeth. I now limit how much I drink in the evenings to try and reduce the number of times I wake up to pee during the night.
Aches and pains may be another reason for waking during the night. These may seem to be synonymous with aging, but again if there is a significant change for you, talk to your GP. There’s a difference between common aches and pains and those niggling pains which we can’t quite explain. Joint pain can be another menopausal symptom, but also may be an indication of something else, so, ruling out any underlying cause is important.
As our diets may be lacking in certain nutrients, vitamins, and minerals necessary for sustained and good health during and after menopause, a nutrition consultation or qualified herbalist may be able to help with addressing fatigue and sleep problems.
Menopausal symptoms such as hot flushes, itching, and anxiety could also be a reason for poor sleep patterns.
Checking in with your GP to find out if indeed your sleep disturbance is a symptom of menopause, should be first on your list.
Hot flushes affect many women during menopause, particularly during peri-menopause, and are caused by changes in hormone levels which can affect the body’s temperature control. Severe hot flushes and night sweats can be upsetting, and exhausting, especially when night-clothes and/or bed-linen have to be changed time and time again. There are, however, solutions to these.
Many women find HRT is the best treatment for reducing or stopping hot flushes and night sweats, which can then solve the insomnia issue, as well as alleviating other debilitating menopausal symptoms. It is important to make a well-informed decision about whether to take HRT or not, so speak to your GP and read information from trusted sources (not the harum-scarum articles in the media!). Kathy Abernethy’s book, ‘Menopause: The One-stop Guide’ is an excellent source of information. ‘The Wisdom of Menopause’ by Dr. Christiane Northrup is another excellent read and dip-into book, full of – yep, you’ve guessed it – wisdom worth listening to. It suggests that this time of a woman’s life, when the veil of oestrogen is lifted and when we see things differently from before, is a time to analyse and confront those important issues we have pushed under the carpet for too long; for example – is there something on your mind when you wake up night after night that you aren’t addressing, but need to? Another book I would recommend is Deborah Garlick’s ‘Menopause: The Change for the Better’. It is a user-friendly, trusted source of information with helpful tips, and solutions. Sleep deprivation is a huge issue if you’re a working menopausal woman so get in touch with Deborah and her team at Henpicked: Menopause in the Workplace for specific training and support.
There are plenty of alternative solutions to HRT and all three of these books address this.
Try changing a few habits to see if that will help …
- cut out or reduce coffee and tea
Enjoying a cuppa of first thing in the morning, and a couple of times during the day, might be fine, but cutting out a night-time drink could reduce those frequent trips to the loo!
- stop smoking
Nicotine disrupts sleep, as well as causing a myriad of other health issues. Here is a link to the NHS website and ’10 self-help tips to stop smoking’. An old habit can take a long time to break but a new habit only takes about 66 days to form! Try taking up a new healthy hobby or pastime, or join an exercise class or gym as we know that exercise is fundamental in contributing to a good night’s sleep.
- keep the bedroom as cool as you are!
Turn the radiator turned off or turn it down if you have a thermostat on your radiator. Turning the temperature to low is a good alternative if you like it cool but not cold. Fluctuating hormones levels makes it difficult to regulate temperature so extreme cold may also trigger hot flushes. Find a comfortable temperature for you. If you’re sleeping partner likes it hotter, consider a fan – there are silent ones.
- or a cold gel pack or take a cold water-bottle to bed
Throwing off the covers and sticking a leg out can become ‘the norm’ but doesn’t aid sleep! I had a wonderful tip from a woman once who told me about taking two ‘cold’ water bottles to bed with her. She filled them up each morning and kept them in the fridge all day. She then slept with one cold water bottle on her chest and one between her knees during the night. She had severe hot flushes and night sweats and said that this trick worked wonders.
- wear cotton or silk pyjamas
Light cotton or silk PJs or nothing! I would advise against synthetic materials; they can cause or make itching worse. Find what’s most comfortable for you. Itching can be another symptom at menopause, but there are solutions for that too.
- layers – sheets and blankets – rather than a duvet
If you have a sleeping partner, they may love a duvet and yes, it is so much easier to make the bed when you haven’t got sheets and blankets to faff about with. So it could be compromise – thin duvet over a sheet – as body temperature can fluctuate between hot and cold for many women – or get your partner to wear more and pile on the covers. It’s not forever, just until your symptoms are under control or your sleep is improved. Separate beds is an option, but those hugs, sex and intimacy are often conducive to wellbeing and positive relationships, so think things through carefully and weigh it all up. It might be a separate bed occasionally, when you really need a good night’s sleep, but make sure you have a comfortable bed and don’t move out to an old spare and unfamiliar bed. That could make things even worse. Supportive partners are crucial at this time.
- cut down on alcohol
A small glass of wine two or three times a week, especially to accompany a good meal might be fine for you and relaxing. However, it can have the opposite effect! It’s common to go off to sleep like a light after a couple of glasses, but then at about 2 or 3 in the morning, be wide awake and consequently, feel absolutely dreadful for the duration of the next day. Take charge of when you have a drink and when it doesn’t matter if you don’t sleep well – if alcohol is a trigger for you. You may need to accept that your body just doesn’t process alcohol like it used to, and for symptoms and long-term health, you may decide it’s not a good idea anyway. ‘Click here for the Drinkaware’ website, which has research, facts, and advice on alcohol and related issues.
- sip cold or iced drinks*
Keep a glass of water on the bedside table, as many women feel thirsty during the night. Try to sip though, rather than gulp, to alleviate that dry mouth and quench that thirst, thus avoiding more frequent trips to the loo! It may sound disgusting, but just swilling some cold water around your mouth can help.
- take a lukewarm shower or bath
Don’t have the bath water too hot and don’t have a bath directly before bedtime either so that you completely cool down beforehand. If you’re not sleeping, and your restless and hot, you might want to get up in the night and take a luke-warm shower, which can be refreshing and soothing and help you to sleep better. Throw in a handful of epsom salts to relieve muscle and joint pain. If you are already wide awake, why not if it helps?
You may like to try a short Yoga routine before bedtime. ‘Yoga with Adriene’ on Youtube is a great and free. Listen to my podcast with Paula Stevens where she talks about the “legs up the wall” pose to relax and aid illusive sleep! It’s also wise to check out whether Yoga is right for you, either with a Yoga teacher or your GP before you start. You may prefer to join a Yoga class with guided support, if you are a beginner, to avoid injury – there are lots currently online, but Yoga classes differ hugely, so look into this carefully, choose a class that’s right for you and be well-informed.
- Cut down on screen time
There is a lot of research telling us that our gadgets are keeping us awake! Apparently, the blue light suppresses melatonin, the hormone which controls our sleep /wake patterns. Reading emails or scrolling through social media sites only gets our minds working and not always in a good way either! Try turning off your devices at a set time during the evening or at the very least set your screen to night mode where the blue light is turned off.
Whether it’s Pilates for core and back strength, and balance, yoga for body and mind, a brisk walk, a bit of dance exercise or a bit of cycling, exercise definitely makes us feel good and it helps us to sleep better when we exercise regularly. Although don’t exercise for a couple of hours before you go to bed, unless it’s a calming yoga routine, as this can be counter-productive. Other benefits of exercise include weight control, muscle toning, cardio health, and bone strengthening and because our bodies release endorphins when we exercise – which trigger a positive feeling in the body – exercise can lift your mood and help with depression which can also enable restful sleep.
- eat well
Having a healthy attitude to food and nutrition is, in my opinion, a good thing, at any stage of your life, standing you in good stead for long-term health and well-being. As a general rule, try to eat fresh, plant-based food and steer clear of sugary drinks and too many carbs. I don’t hold with dieting personally, and it’s fine to indulge from time to time. Chocolate for example does have health benefits, but it is full of sugar which can pile on the pounds, disrupt the balance of our hormones and wake us up at 4 in the morning! A small bedtime snack, such as a couple of oatcakes can help to keep sugar levels stable.
Having a massage can be extremely relaxing and helpful for inducing sleep. It is important to drink plenty of water afterwards to rid the body of any toxins that have been released through the process. And if at the moment you don’t have someone who can give you a massage, learn about self-massage which can be remarkably calming and healing.
Try these self-massaging techniques – you can even do them in bed but stop if anything hurts:
- Foot massage – Sit cross-legged, right leg over left to start with, and gently massage the soles of your right foot with your hands, one foot at a time. Press your thumbs gently into the instep of your foot and work slowly through the sole of your foot. Now, change feet – cross your legs with your left foot on top, and do the same to your left foot.
- Shoulder massage – In a sitting position, stretch your arms out in front of you, cross them over and bring them back to hug yourself, reaching your hands around your shoulders and back as far as is comfortable and use your fingertips to gently massage around your shoulders and shoulder-blades or as far as you can comfortably reach.
- Neck massage – In a sitting position, stretch your right arm out in front of you, bring it back to the left side of your neck. Use your hand to gently cup round your neck and then use your fingertips lightly to massage your neck, starting at the top near your ear, and moving down to the base of your neck.
- meditation, mantras, breathing and positive thinking
There are many, many, many thousands of self-help books, mindful and sleep apps, which can be useful, but there is also a good number which you may find to be just a load of old tosh! Find ones which work for you. But again, don’t look at your screens before bedtime, whatever you do, and leave your phone/laptop etc., out of the bedroom! It can make a big difference.
Short daily mindful meditations can help to keep you calm and fully in the present, which is particularly helpful at night-time when thoughts can race in the dark silence and set you off on a downward, sleepless trajectory. Everything seems worse at night-time, so practising mindfulness where we learn to let thoughts come and go and not hold on to them, can simply be a life-changer.
And if you like reading and mindfulness is your thing, before you go to sleep read Eckhart Tolle’s ‘The Power of Now’ or ‘Stillness Speaks’ helps to reinforce positive thoughts and focus on the ‘now’.
- and breathe
Following the breath is a helpful technique for bringing the mind back to the breath when it insists on going for a wander in the middle of the night! There are lots of breathing exercises which simultaneously relax the body and help induce sleep, found in good books, trusted websites, and some good apps (read the reviews first).
- bedtime stories!
Reading novels at night can stimulate our brains and get our minds busy. Positive and calming wellbeing magazines and even poetry books can be a good alternative. Choose material that you enjoy and that soothes, but definitely stay away from the news! Keep copies of your favourite reads by your bed. Have a good pile so going to bed is a treat-read time!
And the list goes on … reflexology and acupuncture can also be very effective and helps many women with sleep issues. If you decide to try these alternative therapies out – make sure you go to a properly qualified and experienced practitioner.
What is important is finding out what works best for you.
Adopt a routine that suits. Try and stay in ‘the now’ when you wake in the early hours to stop racing thoughts and remember you’re not alone. Years ago, when I was breastfeeding my children in the middle of the night, I used to consciously call to mind all the other mothers who would be doing the same as me. Connecting in this virtual, and empathetic way can be reassuring and reminds us that we are not alone, even though it may feel like it at 3 in the morning.
Talk to people if lack of sleep (or anything else for that matter) is getting you down, or if your mood is low. Either talk to a sympathetic friend or family member, Visit your GP or speak to a nurse at your GP surgery. You could also seek out a specialist menopausal nurse. There are NICE guidelines your GP should follow when diagnosing menopausal symptoms and they will then hopefully be able to support you appropriately, but it helps to do a bit of your own research first.
Remember, nothing lasts forever, and your sleep patterns will improve eventually. It just feels like forever when you’re in it doesn’t it? But it isn’t.
Here’s a little mantra for you to try next time you wake and can’t switch your brain off …
“Close your eyes and say to yourself, ‘I wonder what my next thought is going to be.’ Then become very alert and wait for the next thought. Be like a cat watching a mouse hole. What thought is going to come out of the mouse hole? Try it now.”
From ‘The Power of Now 50 Inspiration Cards’. Eckhart Tolle