Sleep (or lack thereof) in Perimenopause
Up to 67% of women reported having trouble sleeping at least a few nights over the past month (National Sleep Foundation Survey)
Some research suggests that the lifetime risk of insomnia is 40% higher in women than in men.
YOU ARE NOT ALONE.
I’m one of those women. I’ve experienced YEARS of insomnia — mostly in my 40s. Let’s sit down for tea sometime if you’re interested in the full rundown, because it’s extensive. From night sweats to hot flashes to low blood sugar to heart palpitations to full blown panic attacks … and as simple as my body just saying “aaaaaand … you are AWAKE now.” It’s exhausting just thinking about.
If you’re reading this, you likely have your own insomnia story (again, 67% of us just in the last month). And you likely have a million responsibilities that don’t stop because you didn’t get a good night’s sleep.
THE FOUR FOUNDATIONS
Yoga philosophy says that there are four basic needs that form the foundation of our health (or lack of health):
Food
Self-preservation / Pro-creation
Elimination
Sleep
According to Swami Rama of the Himalayan Institute, “These fountains will help you in knowing and understanding your actions. You can find out the source of any problem that you have.” If any (or several) of these pillars are compromised, we experience imbalance in our body / mind.
Swami Rama was quite direct in his teachings. He is quoted as saying, “If you are not sleeping well, if the quality of sleep is not good, you will have stress. And nothing can help you. Doctors can help you only so much. They can only cure a few diseases which are called infectious diseases, they cannot help you with 70-80% of diseases that are called psychosomatic diseases, created by your own mind. The whole world is sick and the sick are treating the sick. Hospitals are built by neurotics and psychotics live in them! And who collects the rent? Doctors. We are all groping in darkness. The time has come, awareness has expanded. Therefore we should learn the art of living, the art of joyful living. I have not seen a person who perennially smiles and claims, “I am happy in the world.” Anyone you ask, says, “I have a problem.” There is an art of sleeping, knowing how to sleep.”
Swami Rama often criticized Western society for relying on modern medicine for ailments that have their root cause in our own lifestyle choices and mindsets. Western medicine has its place, and a very important place and purpose … and we as self-aware adults are tasked with discerning how and when to use the vast resources of modern Western medicine for our health and well-being.
WESTERN MEDICINE IS CATCHING UP TO PERIMENOPAUSAL WOMEN … FINALLY
To that end, Western medical research is coming out by the day, reminding us that sleep is crucial for our well-being … and studying the physiological and psychological mechanisms by which our sleep can be enhanced or hindered.
A population that is just now being studied is women in their perimenopausal years — that 5-10 year window before one’s last period. Just in the last 20 years or so has there been a focus on those of us in our perimenopausal years.
And it’s like we are FINALLY being believed that our very real sleep issues are not “all in our heads.”
Oh, I’m sure you’re with me when I say I could scream about how many times I’ve been dismissed or coddled or explained away about my insomnia symptoms during this time.
YOU ARE NOT ALONE.
And FINALLY the research … and the women doing it … are being given the air time they (and we all) deserve.
From Dr. Stacy Sims:
Rising and falling levels of estrogen and progesterone during the menstrual cycle can cause physical and emotional changes that alter your sleep architecture and can lead to sleep disruptions. Research shows that women with premenstrual syndrome (PMS) report poorer sleep quality that is linked to higher levels of anxiety.
Once women hit the menopausal transition, sleep really hits the skids. As your hormones decline, sleep disturbances, including trouble falling asleep, frequent awakening, and/or early morning awakening increase. And that’s not even taking into account the sleep-wrecking effects of common symptoms like hot flashes and night sweats.
Estrogen (specifically estradiol, see previous blog post) receptors are present throughout the body, and estrogen provides a multitude of protective benefits — including helping our bodies regulate temperature, cortisol levels and even insulin sensitivity. “Estrogen withdrawal,” or declining levels of estradiol in the perimenopause years means that our bodies don’t have these “cushioning” benefits — so we need to help our bodies and minds through this transition until our body recalibrates and moves forward into post-menopause life.
For me, this information was both enlightening and empowering. Again, it confirmed that I’m not making this up – that there is a very real CHEMICAL transformation going on in the perimenopausal brain and body. With this new understanding, I felt like I could offer myself compassion and be more confident in seeking the support that I needed.
So, I’ve come to appreciate both Yoga’s call to take responsibility for what I can and use my inner resources … while also appreciating the discoveries and knowledge from modern science, and the resources offered by modern medicine.
WHERE TO BEGIN? PRACTICAL SLEEP SUPPORT FROM YOGA
There are a MULTITUDE of ways to support your body / mind during perimenopause and specifically to support your sleep. For most of us, including myself, a multi-modal approach is most often needed – through nutrition, lifestyle habits, relationship audits, work-life balance, possibly medical interventions, etc.
I teach Yoga, so I’ll “stay in my lane” here. I’ll offer practical advice from Yoga practice and philosophy that you can experiment with. Please remember that Yoga has never claimed to be a “cure” for anything — traditionally, Yoga was / is a holistic, science-based system of:
1) getting to know yourself better, your strengths and challenges and
2) working with the practices to reveal your best self in this life you’ve been given so you can
3) bring your gifts to the world and make it a better place.
That said, your yoga practices can complement any Western medical approaches you are using. I highly encourage you to be in conversation with a trusted healthcare provider — with the reality check that most doctors just don’t know what to do with us because they’ve not been educated on menopause, let alone perimenopause.
Tips from Yoga for Supporting Your Sleep
1) Self-responsibility and agency: Take responsibility for what you can. Honestly assess your current life situation, stressors you can control (and what you cannot), and how your lifestyle may be affecting your sleep quality. Commit to doing what is within your locus of control to address your sleep quality.
2) Grace and faith: Give yourself grace - unconditional positive regard - as you take on the process of addressing your sleep quality. Some folks make a few changes and they’re good to go in a few weeks. For most of us, myself included, cultivating quality sleep is a lifelong process. When we look at something as a process rather than a project, I think we tend to be kinder and more compassionate with ourselves (the yogic concept of ahimsa, or non-harming) … and we are also more open to possibilities.
In addition, trusting in yourself — cultivating faith that you CAN improve your sleep — goes a long way in this process. Yoga philosophy states that we inherently have the resources we need to move toward our “best selves,” we’ve simply forgotten this fact. Yoga practices can help us remember.
3) Daily Routine or Dinacharya: Often the quality of our sleep will be determined by what we do or don’t do 24-48 hours BEFORE our heads meet the pillow for the night! Having a simple morning and evening routine can support the body (nervous system) and mind in switching out of go-go-go mode to rest-and-digest mode more effectively and efficiently.
For example, if you wake up and go to bed at relatively the same time each morning/night, your body’s systems literally begin to work according to this schedule.
If that sounds impossible, try creating a bedtime routine — about 30 minute to 1 hour before bed, start shutting down electronics, dim lights, let go of screens … do some restorative yoga postures or simple diaphragmatic, relaxed breathing.
Anything you can do to create rhythm and routine in your daily schedule — getting sunlight in the early morning, regular mealtimes, an afternoon walk or mental break, evening bath, etc. — brings your nervous system out of “what the hell is happening next that we have to be on alert for?!” and into “ok, I know what’s coming next … we got this” mode.
4) Supportive Yoga Postures and Breathing Techniques:
Anything called “Restorative Yoga” - a style of yoga using props to fully support the body; with the body fully supported, the nervous system begins to re-regulate and is nourished.
Specific Postures: Legs Up the Wall Pose, Crocodile Pose, Child’s Pose,
Simple, Diaphragmatic, Effortless Breathing (Note: please don’t fall for the fancy breathing practices being tossed around on the internet. Your body knows how to breathe. Sure, there are other supportive breathing practices from traditional yoga … you can treat yourself to working with a teacher as you’re interested. And, nothing beats the good ol’ inherent wisdom of YOUR body.) - When you’re ready to set aside a few minutes, either sit or lay down so you’re comfortable and fully supported. Take a few moments to settle in, get quiet and let yourself be present. Once you’re ready, let your mind REST (notice I didn’t say “focus”) on your breathing in your abdomen. Nothing to do — the mind may wander, that’s fine, and when you notice, you simply invite your mind to REST on your inhale / exhale in your abdomen. Let the breath be effortless. Continue to relax your effort, observe your breath, and remain there as long as you like. When you’re ready to close your practice, notice your whole body and gradually let your senses notice the environment around you.
SMALL THINGS OFTEN
Sleep is foundational to our mental and physical health. Both Yoga science and Western science provide evidence of the negative effects of poor quality and/or insufficient quantity of sleep. And while the list of detrimental consequences of poor sleep is long … Yoga reminds us that we have access to limitless inner resources and agency to move toward our highest state of well-being. YOU ARE NOT ALONE … and you CAN improve your sleep.
Any journey toward our best selves is a process. The journey begins with a single step, as Lao Tzu said, so that’s all that’s required: Take a single step. Don’t try to do it all at once, get burned, and give up.
Pick ONE practice that appeals to you that you WILL PRACTICE. Then pick 1-2 more that would be nice bonuses if you’ve got the time. Practice your 1 practice daily (or most days of the week) for at least 3 weeks. Cultivate awareness of how your practice is affecting your mind and body. Note that the holistic practices of Yoga require consistent practice over an extended period of time to experience the benefits. You can always adjust, pick up and /or let go of practices. Rather than relying on the latest trend, a self-proclaimed expert’s advice or marketing ads, Yoga is a practice of self-awareness and self-responsibility.
Finally, ENJOY your practice! Yoga is ultimately a practice of cultivating JOY and EMPOWERMENT, which results in more peace within ourselves and in our world. And that’s a recipe for some sweet dreams.
Sources:
Save Your Sleep https://www.drstacysims.com/newsletters/articles/posts/Save_Your_Sleep
Sex Differences in Sleep https://pubmed.ncbi.nlm.nih.gov/26833831/
Sleep During Perimenopause, A SWAN Story https://pmc.ncbi.nlm.nih.gov/articles/PMC3185248/
Menopause and Sleep Disorders https://pmc.ncbi.nlm.nih.gov/articles/PMC9190958/
Can’t Sleep? How Menopause Can Contribute to Sleep Disorders https://mcpress.mayoclinic.org/menopause/cant-sleep-how-menopause-can-contribute-to-sleep-problems/
Four Primitive Fountains https://swamij.com/swami-rama-four-fountains.htm