#askDrKris pt.3 - Sleep
Right, Next topic.. Let's talk about something that's probably keeping many of you awake at night - literally! Sleep during perimenopause. And don't worry, if you're reading this at 3 am wondering why your body has seemingly forgotten how to rest, you're definitely not alone.
Sleep disruption during perimenopause affects up to 60% of women, and trust me, it's not just "getting older" - there's some serious hormonal chaos happening behind the scenes that's messing with your ability to get decent rest.
What's Really Going On With Your Sleep?
Remember when sleep used to be simple? You'd get tired, go to bed, sleep through the night, and wake up refreshed. Those were the days, right? Probably from when you were 21.. Then many of us have dealt with the broken sleep of parenting for over a decade.. and now, just when you think it's safe to get back in the water.. err.. I mean back into bed.. now we start dealing with perimenopause sleep sh*t.. hot flashes that jolt you awake at 3 am, a racing mind that won't switch off, or just lying there feeling completely wired despite being absolutely exhausted.
Here's the thing - it's not in your head, and you're not imagining it. That hormonal rollercoaster I've talked about before is wreaking havoc on your sleep in ways you probably never expected.
Oestrogen - Your Sleep's Best Friend (Until It Isn't)
Oestrogen has been quietly working behind the scenes your whole adult life, helping you get that deep, restorative sleep. It promotes REM sleep, keeps you in those deeper sleep stages, and even helps produce the brain chemicals that regulate both mood and sleep.
As oestrogen starts its erratic dance during perimenopause - some days high, some days low, remember that pattern I mentioned? - you spend more time in lighter sleep phases and wake up more frequently. This explains why you might feel like you're sleeping but wake up absolutely shattered.
Progesterone - Nature's Natural Sleeping Pill
Often called "nature's Valium," progesterone has been your secret sleep weapon. It breaks down into a compound that promotes relaxation and sleepiness. But here's the kicker - and this goes back to Dr John Lee's work - progesterone levels often drop before oestrogen starts declining, which means you lose this natural sleep aid early in the perimenopause transition.
Hey presto.. racing thoughts at bedtime and difficulty falling asleep even when you're physically exhausted.
The Domino Effect - When Everything Connects
You know how I keep saying perimenopause doesn't do isolated symptoms? Well, this is particularly true with sleep. It's like a perfect storm where each symptom feeds into the others.
Hot Flushes - The 3 AM Wake-Up Call
Hot flushes are probably the most notorious sleep disruptors, but their impact goes way beyond the momentary heat and sweating. When a hot flush hits during sleep, it triggers your body's stress response, releasing cortisol and adrenaline that can keep you wired for hours after the flush has passed. Actually a low blood sugar does this as well.. and of course the ovary and blood sugar control are closely linked (think PCOS as well as perimenopause).. Option one - have something high protein to eat an hour before bed, it'll help balance the sugars. Option 2 - get up and eat something (this has more benefits than just blood sugar.. well come back to that!)
Many women tell me they lie awake for ages after a nighttime hot flush, minds racing and bodies alert despite being physically tired. It's like your body hits the panic button and then forgets to turn the alarm off!
The Mood-Sleep Merry-Go-Round
Depression and anxiety rates spike during perimenopause, creating this vicious cycle with sleep problems. Poor sleep makes mood issues worse, while depression and anxiety make it exponentially harder to fall and stay asleep. Many women experience their first episodes of depression during this transition, often with those ruminating thoughts and worries that make peaceful sleep nearly impossible.
The brain fog and irritability from sleep deprivation then compound the emotional volatility already caused by hormonal fluctuations. It's like being stuck on a merry-go-round you can't get off!
Physical Discomfort - The Little Things That Add Up
Joint aches become more common, restless legs might develop or worsen, and frequent bathroom trips mean more nighttime awakenings. Each of these seemingly minor disruptions fragments your sleep, preventing that deep, continuous rest your body desperately needs.
The Hormone Orchestra - All Playing Different Tunes
During perimenopause, your hormones are like an orchestra where everyone's reading different sheet music. Let me break down the key players:
Melatonin Gets Confused: Oestrogen influences when and how much melatonin your body produces. As oestrogen fluctuates wildly, your melatonin timing becomes erratic, disrupting your natural body clock. Your once-reliable internal timekeeper becomes completely unpredictable.
Cortisol - The Stress Hormone That Won't Quit: Perimenopause often coincides with peak life stressors - aging parents, challenging teenagers, career pressures, plus processing this major life transition. The hormonal chaos amplifies your stress sensitivity, leading to elevated cortisol levels, especially at night.
High nighttime cortisol directly opposes melatonin, making it nearly impossible to wind down. It's also responsible for that lovely abdominal weight gain, which can contribute to sleep apnoea - something that becomes more common after menopause.
It's a Vicious Cycle - Poor sleep raises cortisol, which further suppresses your already declining sex hormones, worsening perimenopause symptoms and creating even more sleep disruption. It's a self-perpetuating cycle that can feel impossible to break without addressing multiple factors at once.
What Can You Actually Do About It?
Understanding why your sleep has gone haywire helps explain why those simple sleep tips that worked in your 20s and 30s might not cut it anymore. During perimenopause, better sleep often requires a more comprehensive approach, so…
1. Make Your Bedroom Your Cool, Calm Sanctuary
Keep it cool - ideally between 18-20°C. Temperature regulation becomes much more challenging during perimenopause, so invest in breathable, moisture-wicking sleepwear and bedding. A fan, cooling pillows, or mattress toppers can be game-changers. Have lightweight layers you can easily remove during night sweats - anything to minimise sleep disruption.
2. Stick to a Schedule EVEN When You Don't Want To!
Maintain consistent sleep and wake times, even on weekends. Your body's internal clock needs all the help it can get during this transition. I know it's tempting to sleep in when you've had a rough night, but consistency really does help.
3. Watch the Triggers
Avoid spicy foods, caffeine, and alcohol in the evening - they can trigger hot flushes and disrupt sleep quality. I know, I know - giving up your evening wine or coffee isn't ideal.. but we're talking quality of life here and sometimes sacrifices need to be made!
Coffee!! In the evening!! Who on earth manages to drink coffee in the evening and expect to get any sleep!? Caffeine has about a 6 hour half life - that means half of the caffeine is gone in the first 6 hours then half of the remaining half is gone in the next 6 hours. You can see that substantial amounts of caffeine are still left in your system 12-18 hours after consumption. Caffeine needs to stop by 1pm to be down anywhere low enough to not impact sleep by 10pm. Now there are some fast metabolisers who can drink coffee right up until bed time but they are few and far between.. and it's worth a trial for everyone to stop coffee after lunch, or at least switch to a decaf option. And Expresso Martinis? Well I guess it's just a good excuse for a lunch time drink isn't it 😉
4. Get That Phone Out of the Bedroom!
Remove your phone from your bedside table - keep it in another room overnight, or at minimum, across the room in airplane mode. Beyond avoiding late-night scrolling and blue light exposure, there are concerns about electromagnetic frequencies from devices potentially interfering with sleep quality and melatonin production.
While research on EMFs and sleep is still evolving, many sleep specialists recommend creating an "electronics-free zone" around your bed. This is particularly relevant during perimenopause when your sleep is already fragile and your body's working harder to produce adequate melatonin. Use a traditional alarm clock instead of your phone, and charge devices outside the bedroom when possible.
Establish a "digital sunset" at least one hour before bedtime - avoid all screens or use blue light filtering glasses if you absolutely must use devices.
5. Manage the Mental Mayhem
Racing thoughts and anxiety are incredibly common during perimenopause. Develop a toolkit of relaxation techniques - deep breathing, progressive muscle relaxation, meditation, or gentle yoga. Remember, increased anxiety during this transition is normal and not a personal failing - your brain chemistry is literally changing!
6. Move Your Body (But Time It Right)
Regular exercise helps with both sleep quality and mood, but finish workouts at least a couple hours before bedtime to avoid stimulating your system when you're trying to wind down.
7. Food for Thought (and Sleep)
Avoid large meals close to bedtime, but don't go to bed hungry either. Some women find a small snack with tryptophan (turkey, warm milk) or protein and complex carbohydrates helpful for promoting sleepiness. Milk also contains protein - good option if you're not lactose intolerant.if you are, it'll just add to the wake ups!!
8. Treatment Options - The Big Guns
When lifestyle changes aren't cutting it, don't suffer in silence! Like the other perimenopause symptoms we've discussed, sleep problems can be addressed with mainstream hormonal, bio-identical hormonal, or non-hormonal approaches.
Both mainstream and bio-identical hormone therapy can be highly effective for sleep problems caused by oestrogen and progesterone deficiency. Sometimes it's as simple as a trial of bioidentical progesterone - often the most minimalist treatment that can make a huge difference.
Cognitive Behavioural Therapy for Insomnia (CBT-I) is particularly effective for the racing thoughts and sleep anxiety common during perimenopause. Sleep aids, when used appropriately and temporarily, can help break the cycle while other treatments take effect.
Non-Hormonal Options
Interestingly, certain blood pressure medications and some antidepressants can reduce sleep disruption significantly and not just by reducing hot flushes! This crossover effect shows how interconnected these symptoms really are.
Since depression and anxiety significantly impact sleep during perimenopause, addressing mood symptoms often dramatically improves sleep quality. This might include therapy, antidepressants, or other interventions. There's absolutely no shame in seeking this kind of support.
The Connected Web
We've said many times how interconnected perimenopause treatment is - how addressing one symptom often improves others. I've had patients come in for sleep problems and find their mood improves dramatically too, or vice versa. This makes sense when you realise it's all part of the same hormonal system.
When you address sleep, you're often addressing the underlying hormonal imbalance that affects multiple aspects of your health. It's all connected!
When to Get Help?
Don't wait until you're at breaking point! If hot flushes are disrupting your sleep, if racing thoughts are keeping you awake, if you're waking up exhausted despite spending 8 hours in bed - please talk to your doctor.
Sometimes sleep problems aren't just about perimenopause either. Sleep apnoea becomes more common as we age, and other conditions like thyroid issues can masquerade as perimenopausal symptoms. That's why I'd do those blood tests I mentioned - full blood count, kidney and liver function, thyroid (but not hormones - they wouldn't guide our treatment anyway).
The Bottom Line - The most important thing I want you to know is this: you're not alone, you're not imagining things, and effective help is available. The sleep disruption you're experiencing is real - it's a physiological consequence of the complex hormonal changes occurring during this transition.
Sleep problems during perimenopause aren't a character flaw or something you just need to grin and bear. We're looking for quality of life here.. it's not worth living forever if it's like hell on earth (and I'm sure you've worked out the pun there.. hell.. hot)
Remember, perimenopause is a transition, not a permanent state. With proper support and treatment, most women can achieve significant improvements in their sleep quality. The key is recognising that effective treatment often means addressing the whole picture - hormones, stress, mood, and sleep - rather than trying to fix sleep in isolation.
As always, we've probably generated more questions than we've answered! If there's something specific about sleep and perimenopause we haven't covered, go ahead and DM us via SM or send us an email - aislinn@bostonbaycollective.com.au.. we'll cue it up for future posts.. and please, please read the disclaimer below (again 😎)
Dr Kris xx
**DISCLAIMER**
We've been planning to write some health discussions for a while now. There's a need for good, unbiased information that shows both/all sides of the story - but that's just what this is.. information. Please don't think it's medical advice. Please do not stop any medications or change your treatment plan without discussing it with your own doctor first. We are just helping you find the right questions to ask to get greater control and understanding of your own health and wellbeing. Please feel free to ask us anything of a general nature - we'll endeavour to get a post up on that topic.. whatever you want to know, we're pretty sure there's 100 others want to know it also! But we can not answer specific personal questions for you and we can not give you specific medical advice.. that's for your own doctor.
Please be aware that any negative or argumentative comments will be removed. We are aware that some people have totally opposite views to what we discuss here. Everyone has their own opinions - heck we've seen that emerge in bucket loads since the pandemic. This is simply a general education chat where we present a broad brush picture - you are free to research further as much as you like.