Posted on Dec 28, 2020, 9 p.m.
One of the more common symptoms of peri-menopause and menopause that patients complain of is difficulty sleeping. There is a significant amount of research showing how hormones affect healthy sleep.
Progesterone affects GABA receptors which are responsible for non-REM sleep, the deepest of the sleep stages. Progesterone also affects breathing. It’s been shown to be a respiratory stimulant and has been used to treat mild obstructive sleep apnea.
The role of estrogen in sleep appears to be more complicated than that of progesterone. Estrogen is involved in breaking down norepinephrine, serotonin, and acetylcholine in the body. It has also been shown to decrease the amount of time it takes to fall asleep, decrease the number of awakenings after sleep occurs, and increase total sleep time. Low estrogen levels may lead to hot flashes, which can also affect sleep.
Cortisol is a hormone produced by the adrenal glands in response to stress. It normally peaks in the early morning followed by a slow decline throughout the day and night. However, chronic stress can alter healthy cortisol production and lead to sleep problems if cortisol is low in the morning and increased in the evening and at night.
Melatonin is a hormone produced by the pineal gland in the brain that regulates sleep and wakefulness. Normally, melatonin levels begin to increase in the mid to late evening, remain elevated throughout the night and drop in the morning. In general, melatonin levels decrease with age and melatonin production can be shut off by bright light. If melatonin levels are disrupted, sleep may be disrupted as well.
In addition to hormones, sleep can be affected by a number of external factors. It is important to maintain proper sleep hygiene as follows:
- Avoid napping during the day
- Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime
- Exercise can promote good sleep, but avoid vigorous exercise too close to bedtime
- Food can be disruptive right before sleep
- Ensure adequate exposure to natural light during the day
- Establish a regular relaxing bedtime routine
- Associate your bed with sleep
- Make sure that the sleep environment is pleasant and relaxing and free from light pollution, e.g., lighted alarm clock faces, street lights through open windows, and cell phones/tablet devices
As with anything you read on the internet, this article should not be construed as medical advice; please talk to your doctor or primary care provider before making any changes to your wellness routine.
Written by Gina Besteman, RPh and Michelle Violi, PharmD – Women’s International Pharmacy
Reviewed by Carol Petersen, RPh, CNP – Women’s International Pharmacy
Carol Petersen, RPh, CNP, CEO and founder of The Wellness By Design Project is an accomplished compounding pharmacist with decades of experience helping patients improve their quality of life through bio-identical hormone replacement therapy. She graduated from the University of Wisconsin School of Pharmacy and is a Certified Nutritional Practitioner. Her passion to optimize health and commitment to compounding is evident in her involvement with organizations including the International College of Integrated Medicine and the American College of Apothecaries, American Pharmacists Association, and the Alliance for Pharmacy Compounding. She was also the founder and first chair for the Compounding Special Interest Group with the American Pharmacists Association. She serves as chair for the Integrated Medicine Consortium. She co-hosts a radio program “Take Charge of Your Health” in the greater New York area. She is also on the Medical Advisory Board for the Centre for Menstrual Cycle and Ovulation Research (CeMCOR.ca).
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Eichling PS. Evaluating and Treating Menopausal Sleep Problems. Menopause Management. Sept/Oct 2002