Wake-up call! 

Nutrition for a good night's sleep

 For many women in perimenopause and menopause, restless, sleepless nights and those disruptive early awakenings are the norm. Why does this happen?

The reasons are obviously hormonal in part, yet lifestyle and nutrition also play an important role. Let’s drill down to the details.

Perimenopause and menopause experts at balance say “A disruption to sleeping habits is often the No.1 complaint from women who are in the perimenopause and menopause”.

Approximately 40-60% of women will experience sleep problems at some stage in perimenopause and menopause. We women may recognise this sleeplessness from other stages in our lives. The common factor is hormonal change.

“For women – but not men – sleep is partially regulated by the sex hormones,” explains psychologist Simona Stokes. “Even before the menopausal transition, we might have noticed that during periods of hormonal changes such as puberty, menstruation, pregnancy and menopause, sleep can be more disrupted”.

The doctors at balance say “The hormones oestrogen and testosterone both have important effects on your brain, including helping the quality and duration of sleep. Low oestrogen levels can lead to sleeping problems but also cause fatigue, difficulty concentrating, headaches, weight gain, and mood changes – a lack of sleep can further exacerbate these symptoms.

The hormone progesterone can be beneficial for sleep too as it increases the production of GABA (gamma aminobutyric acid), another chemical in our brain that works to help sleep. Progesterone can also improve relaxation and mood and a drop in progesterone levels can lead to symptoms such as anxiety, restlessness and trouble sleeping, including a tendency to wake up frequently.”

Yet there are other considerations - Lifestyle and food choices, habits before bed, the timing of turning the light out, and exposure to blue light from electronic screens - these too can all affect sleep quality.

“Poor sleep can have a dramatic effect on our physical and mental health and can contribute to impaired cognitive function, increase levels of stress hormones, and increase vulnerability to depression and anxiety problems.” Simona says. We’ll return to this later.

Sunlight affects sleep. That seems counter-intuitive, yet science supports the statement. I found this explanation a real eye-opener – no pun intended:

“Given that light has strong direct effects on mood, cognition, alertness, performance, and sleep, light can be considered a ‘drug’ to treat many clinical conditions.” Says Anna Wirz-Justice and colleagues. I particularly like this illustration by Marina Roa.

Many people tell me that when they adopted the habit of getting outside in the morning, even for five minutes, their sleep quality later that day seemed to improve. Research backs up this anecdotal evidence: the positive effect of outdoor light, even on a cloudy day, is far greater than exposure to any indoor lighting, bright indoor lights included.

This is something many of us may have noticed during the long lockdowns of the Covid 19 pandemic. A study on habits during lockdown showed that less outdoor light exposure was associated with a negative sleep quality score. 

So, getting outside into the sunlight is a simple and important lifestyle change that can improve your sleep quality.

My perspective on sleep quality is obviously skewed towards a nutrition-base for support. What and when a person eats and drinks can help to support a good night’s sleep. Also how you slept last night can impact how your body responds to food the next day (see this research here).

For perimenopausal and menopausal women, changing food and drink habits can seem daunting. Let’s break it down into easy-to-swallow bites:

The timing of your last meal of the day can also have an impact. It’s a very individual thing, but I find a helpful general rule is to aim to finish eating as minimum 2-3 hours before sleep time. For some people, this doesn’t make a great deal of difference, for others its a game changer. The key is to learn more about yourself and work out whether the timing of that last meal supports or hinders your sleep quality. 

I’m often asked what supplements might also help with sleep. Nothing offers a magic solution, but in my experience magnesium and L-theanine can be of benefit. It’s very much an individual thing, but worth exploring.

I currently take two tablets of Newson Health Magnesium Plus daily – the equivalent of 250mg magnesium. Full disclosure: I sell these supplements in my UK shop, but it’s because I think they’re great! If you live outside the UK, look for a magnesium supplement that is high quality and has a similar total elemental magnesium to these.

L-theanine is an amino acid that the human body doesn’t produce. Found in black and green tea, it can affect the chemicals in the brain that regulate mood, sleep and stress. I use an L-theanine supplement as needed, depending on my day: I find it helps me feel calmer. I can recommend Newson Health Serenity capsules as a good quality L-theanine supplement. If you live outside the UK, look for a quality L-theanine supplement at about 100mg strength.

One piece of advice that comes from my practice: consider getting your iron levels checked. If you’re low in iron, it’s usually assumed you sleep more because you’re tired. In my experience, sleep can be more disturbed. A quick blood test can determine whether this is an issue for you.

Let’s not forget exercise, HRT, breathing and routine as potential helpers in establishing good sleep habits. All three have an impact on your mood and your mind.

For HRT facts, take a look at balance as there is so much great evidence-based information there to help.

Routine relates to some areas we’ve already covered: the time you eat, when you drink caffeine, establishing a time to walk away from streaming shows and turn off devices. Plus mobile phones can be set to minimise blue light emanating from screens.

Exercise also improves sleep duration and quality for many women. Exercising more than once a week – whether a walk or a workout – can release endorphins that improve sleep quality. Some forms of exercise can boost serotonin, the hormone that regulates our sleep-wake cycle. Exercise, both aerobic and resistance, can help with insomnia, with resistance exercise potentially proving to be the more helpful of the two.

How we breathe can also affect sleep quality. Dr Louise Oliver is an expert in this area; She says 'sleep disordered breathing is increasingly prevalent, and symptoms of this condition include: ​ Fatigue first thing in the morning; Snoring or heavy breathing; Disrupted sleep or nightmares; Dry mouth in the morning; Pauses in breathing whilst sleeping (apnoea) or irregular breathing; Wheezing, coughing, breathlessness, nasal congestion on waking; Night-time asthma symptoms; Needing to pass urine overnight. Listen to a podcast about this here. 

Anxiety and depression can cause poor sleep while, conversely, poor sleep can lead to anxiety and depression. That’s why seeking the advice of a psychologist can be helpful. “CBT for Insomnia has a good track record in helping to improve sleep,” Simona says. “There are two forms of CBT that are recognised as valid treatment – CBTi (Cognitive Behavioural Therapy for Insomnia) and ACTi – (Acceptance and Commitment Therapy for Insomnia).”

Here's a great podcast with Kathryn Pinkham, founder of The Insomnia Clinic, and Dr Louise Newson, all about sleep.