Help! I can’t sleep anymore.
When I was much younger and in practice, my patients in their 40’s would tell me, “You wait. When you turn 45, you won’t be able to sleep.” I didn’t entirely understand and I surely didn’t think it would happen to me! I was wrong! It DID happen to me and it’s annoying.
Sleep is CRITICAL to us as humans. It’s where we rest (literally), repair, detox our brains, and regenerate. In fact the ‘detox our brains’ is part of the glymphatic system. It’s like our lymphatic system…with the letter G in front of it. That system kicks in when you sleep.
The production of melatonin and sleep also seems to help us with blood sugar regulation and insulin sensitivity the next day. If you’ve ever had a bad night of sleep and then felt like your hunger, cravings, or overall blood sugar control was a hot mess the next day, you’re not wrong!
Why do we suddenly develop insomnia as we hit perimenopause?
There are a few ideas around it. Let’s start with the why.
First, you don’t produce the hormone known as progesterone like you used to. Progesterone is made in the ovaries after you ovulate (release the egg). As you age, so do the cells around your eggs which means their ability to produce hormones isn’t as robust like before. And in many cases, you just aren’t ovulating anymore thus you won’t produce progesterone that month.
This matters because progesterone really helps with calmness, relaxation and reducing anxiety. Thus if you’re not making quality levels of progesterone, you might struggle to fall or stay asleep because you can’t relax!
Second, your potent estrogen known as estradiol becomes more erratic in perimenopause, especially in middle to late stage perimenopause. Estradiol plays a major role in every system of your body! It can affect how you fall or stay asleep. It plays a role in magnesium getting into your tissues (and magnesium can affect brain hormones, pain, stress response, and more). It can stimulate the hormone known as oxytocin which is your ‘bonding hormone’ that can make you feel loved and connected. It can also affect the thermoregulatory center in your brain to determine your body temperature thus hot flashes or night sweats. Healthy levels of estradiol also positively impacts your joints, tendons, and muscles. When estradiol levels start to fall or are a lot lower longer than you expected in your cycle, your sleep can become elusive especially if you’re now struggling with getting magnesium into your tissues, not feeling mentally connected, experiencing hot flashes or night sweats in bed, or are having joint or muscle aches and pains.
Third, perimenopausal women are less resilient to stress due to the changes in our hormones at this time. This is really unfortunate (and I would like an body-wide iOS update to combat this please and thank you!) especially as your stress might be pretty high right now. The body is making a big, prolonged transition. It’s possible you have kids graduating high school or college OR you have young kids due to timing in life. You are likely really hitting that peak in your career (if that’s your path) and your parents are probably aging. When the body perceives higher stress, it can take its toll on your sleep.
Fourth, your blood sugar (glucose) may be swinging more than it did when you were younger. With the increase in actual or perceived stress coupled with the changes in your hormones, you can become less insulin sensitive or just notice your blood sugar may feel more erratic. If your blood sugar drops too low in the night, your cortisol will rise as a countermeasure and you will wake up. I noticed this after observing several women using a continuous glucose monitor in their arm AND simultaneously taking a test known as the DUTCH Complete test. This test allows you to collect a urine sample for cortisol if you wake up in the middle of the night. These women saw that their cortisol levels were higher when they woke up at an that ungodly hour and they also reported their blood sugar had dropped too low. If they were still cycling, they noticed more in the luteal phase as they got closer to their period.
Of course there can be other extraneous factors interrupting your sleep! If you or your sleeping partner have sleep apnea, maybe you co-sleep and the kids are waking you, maybe your animals wake you, it could be that your partner has to get up for work (or come home) in the night, etc. And of course don’t forget about alcohol before bed. Women tend to find they are way less tolerant of alcohol as they get into perimenopause and this greatly interrupts their sleep.
Phew!
What can you do?
Start with the basics and be diligent about them. I know it can feel unfair if you always slept well no matter what you put your body through and now you can’t. This is the time to double down on your sleep routine as your body is making these changes.
Wind down before bed (not wine down) - relax, drink calming tea like Tulsi (my favorite is Tulsi Rose by Organic India) or Chamomile. Take a bath, read a book, do a quick meditation, journal, or hang out with your family. Consider reseting for the next day by picking up your space and setting your to-do list.
Minimize or reduce the bright technology screens! I try to be off my phone about 60 minutes before bed. I don’t always manage this but I do change my screens to an orangey hue (google how to do this - I have a short cut on my iPhone set years ago) and/or wear blue light blocking glass (just be sure they really do block blue/white-hued lights!)
Be careful what you watch before bed! Are you into horror documentaries or crime related podcasts? Action adventure shows that get you hyped up and excited? Consider switching to something more easy-going and warm-hearted.
Sleep in darkness. Is it time to invest in black-out curtains? There are some cute ones now! Or what about a sleep mask?
If snoring is an issue, please get evaluated for sleep apnea (same goes for your bed partner). Snoring and sleep apnea means less oxygen is getting to your brain! That’s not good. Consider mouth taping at night (I’m trying out Hostage Mouth Tape - it’s REALLY sticky so definitely balm up the lips before using it. I also cut them in half. I do have a link that gets you 10% off but again, I’m still in the trial phase).
If blood sugar is your reason, consider some protein/fat before bed! A scoop of your protein powder in water, a few bites of something high protein, a little spoonful of your favorite nut-butter are a few examples.
Get in some magnesium! I have a whole guide on magnesium here but I love a blend with magnesium glycinate in it as glycinate contains glycine which is calming.
Extra support: L-theanine, magnolia, skullcap, passionflower, GABA, and lavender are each calming ingredients that are often found in sleep blends or individually to help.
I personally take Cort-Eaze by NuEthix at night with my magnesium. When I travel and switch timezones, I add in 1 dropperful of Relax-liposomal too. Code DRJONES gets you 10% off too.
Of course, if you need and are a candidate for body-identical hormones, now is the time! I do take oral micronized progesterone at night. It is prescribed through your pharmacy under the trade name Prometrium (warning - it does have peanut oil in it if you’re allergic). You can also see if your practitioner will have it compounded at a compounding pharmacy. The oral form is the best form for sleep support compared to progesterone cream FYI. I do not yet take estrogens as I am not there yet.
My actual nighttime routine looks like this most nights.
We do our last walk with our dog somewhere around 7pm. Then I make the Tulsi Rose tea by Organic India (not sponsored, it’s literally what I do). I usually clean up or finish up work-related stuff such as emails. If it’s football season and football is on, we usually watch it. I don’t watch a lot of tv otherwise. In the summer, I like to sit outside and enjoy the evening sometimes with my computer, sometimes not. Before heading to bed, I take about 400mg of magnesium, 1-2 Cort-Eaze, my progesterone and depending how I feel, extra support mentioned above. Between 8-9pm (depending on the night) I close our black out curtains, wash my face, brush/floss the teeth, slather on my favorite castor oil, lay on my PEMF mat set to “Relax,” listen to relaxing music and read. I like to be lights out by 10pm and usually use a large sleep mask, sometimes I’ll use earplugs. I’m a total creature of habit on how I start and finish my day. Even my best friends whom I’ve traveled and shared a room with know this about me.
Hopefully if you’ve been struggling this will give you some nuggets on how to adjust your routine and sleep peacefully again.