Women’s Health: Physician Julie Brack Discusses Insomnia and Perimenopause

The Women’s Health series is presented by AdventHealth

When women think about aging, one of the first things that comes to mind is menopause. Although it’s identified with mood swings and hot flashes, insomnia is also a common perimenopausal symptom women experience.

“I think the media, movies, and sitcoms like to focus on the more dramatic symptoms like hot flashes or night sweats so those get more attention, but a lack of sleep makes all of us feel more tired, more irritable, and less productive the next day,” says Julie Brack, a family medicine physician with AdventHealth Medical Group Primary Care at Prairie Star.

According to Brack, 60 to 80 percent of women experience some symptoms during perimenopause that include sleep issues. A woman reaches menopause once a full year has passed since her last menstrual period. The blocks of time before and after that one-year mark are known as perimenopause and postmenopause, and women experience the most symptoms during perimenopause.

During perimenopause, the ovaries begin producing lesser amounts of estrogen and progesterone, and as those hormone levels fall, symptoms of perimenopause increase. Insomnia is a common symptom because progesterone is a sleep-producing hormone, and dwindling hormone levels can make it trickier to fall asleep and stay asleep. Hot flashes and night sweats can also contribute to insomnia.

“Declining levels of estrogen can cause hot flashes, and night sweats can soak the nightclothes and subsequently make a woman shiver,” says Brack. “It can create a hamster wheel of throwing the covers off only to shortly put them right back on. Sleep is a funny thing most of us take for granted, but when we are not getting good quality ‘z’s,’ we can quickly start blaming anything negative on our poor sleep. It’s also common to get into a cycle of anxiety that we are not getting restorative sleep to function best the next day, which then also can further hinder the ability to fall asleep.”

Improving Sleep Naturally vs. When To Get Help from Your Doctor
Most women need seven to eight hours of sleep, but during perimenopause, it can be hard to obtain the amount of sleep the body needs.

Symptoms of insomnia include taking 30 minutes or longer to fall asleep, getting six or fewer hours of sleep, waking too early, not feeling rested after sleep, feeling tired throughout the day, and worrying about sleep. This can lead to feeling more anxious, irritable, or stressed; having a hard time paying attention; and experiencing gastrointestinal issues.

So, if you are experiencing insomnia during perimenopause, how do you get back on track? Brack suggests practicing good sleep hygiene. “Follow a consistent, regular sleep schedule, avoid caffeine after lunch, avoid alcohol near bedtime, don’t smoke, get regular exercise but avoid exercise two hours or less before bedtime, keep the room quiet and dark (sometimes white noise machines or blackout shades can help), and avoid eating too close to bedtime.”

Family Medicine Physician Julie Brack

If those natural fixes don’t work for you, and you find insomnia affecting your relationships or your ability to function at work or at home, speak with your physician about your struggles. Your doctor will likely ask you about your sleeping habits—what time you go to sleep, when you wake, how many times you wake in the night, etc., so they can help you find a solution that works.

Solutions to insomnia may include over-the-counter medications, such as antihistamines and melatonin-containing remedies, or prescription medications that can help you get the sleep you need.

Also, speak with your doctor about any other perimenopausal symptoms you’re experiencing.

“If a woman is miserable with hot flashes, night sweats, insomnia, or mood swings, sometimes hormone replacement therapy may be considered for a limited time—typically less than five years—depending on an individual’s health and family history and other risk factors,” says Brack. “It is best to have a discussion with your provider to see what the best options or course of therapy are for you if you are dealing with perimenopause. You might gain some much-needed sleep!”