A Year of Wellness Series: Feb 2021-Ways to Sleep Better
Part two in my year of wellness series is all about how to manage insomnia and sleep issues during perimenopause and menopause. I’ll specifically talk about two medically proven ways to sleep better by improving your sleep quality and quantity. And no, it doesn’t involve medication!
This year I am continuing my path to improving my health through small improvements each month of 2021. Part one of my year of wellness series is about assessing your health and lifestyle and then using that information to make a list of small and attainable goals throughout the next year that are specific and tailored to you and your needs. You can find that blog article here.
Do you struggle with issues such as inability to wind down at bedtime, so it takes FOREVER to get to sleep, waking in the middle of the night and unable to get back to sleep, tossing and turning, or being unable to get into a deep sleep throughout the night? If so, I completely feel your pain!
I never used to have any problems falling or staying asleep until I was in my 40’s. Then, it was like someone flipped a switch in me and suddenly sleep started eluding me. And it became worse over several years! I used to have troubles getting settled and falling asleep at first. And then when I finally did get some rest, I would wake up 3-4 hours later and couldn’t fall back to sleep. Occasionally, I still have issues with insomnia to this day. It’s super frustrating- and it can make us physically and psychologically unwell!
I’ve been doing a lot of research over the past few years about sleep disturbances in an effort to help myself. Here are two ways to sleep better that I have researched, and that is evidence based.
The Canadian Longitudinal Study of Aging has released reports indicating that 40-60% of peri and post-menopausal women have a sleep disorder that negatively impacts their quality of life and can lead to physical and psychological conditions such as cardiovascular disease, diabetes, depression, anxiety and chronic pain (1). Insomnia is the predominant complaint among these women women according to the study. The study also found that sleep disturbances often began a few years before and after menopause, indicating a definite relationship between the two.
While hormone replacement therapy, over the counter and prescription medications have long been the recommended treatment for insomnia related to menopause, I looked at finding alternative therapies for help before I would use medication as a last resort.
There are two proven remedies for insomnia related to menopause that I found. These are Cognitive Behavioral Therapy for Insomnia, and following the Mediterranean diet, and are two ways that you can try to help you sleep better.
Cognitive Behavioral Therapy for Insomnia (CBT-I)
CBT-I has shown large improvements in sleep disruption in menopause. Some studies have shown as high as 84% of women have improvements in their sleep quality using CBT-I (2).
CBT-I works with a trained professional to identify thoughts, feelings and behaviours that are contributing to insomnia, then reframe these challenges and establish interventions to promote better sleep. The Sleep Foundation is a great resource for more CBT-I information.
Typically the CBT-I is done in person with the trained professional; however there is evidence that shows it can successfully be done through digital means. This is important during the pandemic as many in-person therapy sessions have moved to online, phone, email or text methods.
CBT-I includes:
Stimulus control therapy:
Using the bedroom only for sleep and sex and if you are unable to sleep after 20 minutes, you are to get out of bed and do something until you are tired again. This rewires the brain to expect sleep (or sex 😉!) when you head to the bedroom.
Sleep restriction therapy:
This technique limits the time in bed at the start to the typical amount of time that you currently spend asleep, plus 30 minutes. The time is then increased slowly over time to encourage a longer resting cycle.
Biofeedback:
This uses equipment to observe signs such as heart rate, body temperature, and muscle tension and how it relates to your sleep. The device monitors you while you doze and the results teach you how to make changes to improve your sleep.
Paradoxical intention:
This is avoiding any intent to fall asleep, or worrying about being unable to properly rest, which can make things worse.
Relaxation techniques:
You are taught deep and focused breathing techniques, progressive muscle relaxation, mindfulness, and guided self-meditation to encourage relaxation.
Education regarding good sleep hygiene:
This is changing basic lifestyle habits that influence sleep and education regarding how diet, exercise, and the sleeping environment can affect our rest. It includes these tips:
- Have a quiet room- use earplugs or “white noise” if needed (ie: fan).
- Keep the bedroom dark and cool. Ensure room is decluttered and restful.
- Take a warm bath or shower 1-2hrs before bed.
- Have a consistent sleep schedule if you can- this keeps our circadian rhythms in check.
- Create a nightly routine to unwind. Whatever works for you (read, dim lights, etc).
- Hide the clock face from view.
- Avoid eating at bedtime- undigested food can disrupt sleep.
- Try to exercise during the day, but not within 4 hours of bedtime.
- Avoid alcohol before bed- it increases wakefulness during the night.
- Try to decrease/manage your daytime stress.
- Avoid caffeine after lunch.
- Do not use electronics at least 1 hour before bedtime. The blue light they emit prevents us from getting a good night’s rest.
Resources for finding a CBT-I provider in are through recommendations from your primary care provider, which you may need for insurance purposes. I have also found some online resources. Please note that I do not guarantee results from these links, I am simply providing you with some resources that I have found in my research:
https://mysleepwell.ca/ (not for profit initiative through Dalhousie University)
https://www.psychologytoday.com/ca/therapists/sleep-or-insomnia/sk/regina
https://www.tuck.com/best-online-cbt-programs/
Following a Mediterranean Diet to Sleep Better
Several studies report that following a Mediterranean Diet has a positive influence on menopausal symptoms (3,4, 5), including insomnia.
The Mediterranean Diet is endorsed by many medical organizations as a heart healthy way of eating and is proven to prevent chronic disease and improve people’s health. The diet is high in fruits, vegetables, whole grains and healthy fats. The diet includes moderate amounts of seafood, fish, poultry, eggs, dairy, beans and nuts, and very limited amount of red meats. It emphasizes eating plant based, and not meat based.
We have been hearing a lot lately about the health benefits of eating a plant-based diet. For those of you not ready to give up meat entirely, the Mediterranean diet is a great option. I’ve been trying to eat this way for some time now, and while I still go through bouts of occasional insomnia, I do think that it has helped. I definitely feel though that eating this way has improved other perimenopause symptoms such as hot flashes (they’re pretty much gone!), night sweats, and mood swings.
Some great resources for information about the Mediterranean diet are:
https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/mediterranean-diet
https://myhealth.alberta.ca/health/healthy-living/pages/conditions.aspx?hwid=aa98646&aa98646-sec
https://www.diabetes.ca/managing-my-diabetes/webinars/diabetes-and-the-mediterranean-diet
Now please note that these tips will not work if you have underlying issues such as restless leg syndrome, sleep apnea, etc. Please see your medical professional if you have, or suspect you have an underlying condition that is causing your sleeplessness. Also, please note that while I am a Registered Nurse, I am not your nurse and all opinions in this article do not constitute or replace medical advice. Please be sure to discuss any questions or concerns with your physician or healthcare provider. Also, see my disclaimer here for more information.
I hope that these two ways to sleep better will help you with your insomnia during menopause and perimenopause. If they don’t please see your doctor or healthcare professional for assessment and help, sooner than later. It helps if you can bring a sleep log to your appointment, to help your healthcare professional understand when you sleep, and how you are feeling during and after you rest. If these ways to sleep better do help you, please let me know by leaving a comment! Sign up for my newsletter and get notifications of blog posts and access to my free resource library- sign up is below! Good luck and sleep well!
Take care,
Resources:
- Zolfaghari S, Yao C, Thompson C, Gosselin N, Desautels A, Dang-Vu TT, et al. (2020). Effects of menopause on sleep quality and sleep disorders: Canadian Longitudinal Study on Aging. Menopause, 27, 295-304.
- Drake CL, et al. “Treating chronic insomnia in postmenopausal women: a randomized clinical trial comparing cognitive-behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education.” Sleep 42.2 (2019).
- Sayo´n-Orea C, Santiago S, Cuervo M, Martı´nez-Gonza´lez MA, Garcia A, Martı´nez JA. Adherence to Mediterranean dietary pattern and menopausal symptoms in relation to overweight/obesity in Spanish perimenopausal and postmenopausal women. Menopause 2015;22:750-757
- Herber-Gast G-CM, Mishra GD. Fruit, Mediterranean-style, and high-fat and -sugar diets are associated with the risk of night sweats and hot flushes in midlife: results from a prospective cohort study. Am J Clin Nutr 2013;97:1092-1099.
- Soleymani M, et al. “Dietary patterns and their association with menopausal symptoms: a cross-sectional study.” Menopause 26.4 (2019): 365-372.
Photo#1 by Anna Nekrashevich from Pexels
Photo#2 by Lina Kivaka from Pexels
Photo#3 by Rachel Claire from Pexels Photo#4 by Pexels from Pixabay
