This is the latest section I’ve written for the Wellness, “The Rest of the Well” part of PosPause.
Brought on by a series of conversations with my bestie, it is yet another example of how the Milestone effects each of us differently and potentially deeply.  Sleep disturbances are a “common” yet profound issue in perimenopause and yet seem to be just another factor that most women just grin and bear.  Granted, many of the “symptoms” or physically and emotionally and pervasively experienced effects of post-fertility (the Milestone) are things women just grin and bear.  In fact, the whole process (only viewed in terms of wide-ranging symptoms) used to be referred to as hysteria or mental illness.

Perhaps no other set of human reactions and manifestations of a common hormonal fluctuation condition better exemplifies the uniqueness of each human system.  No one perimenopause, menopause or indeed hormonal phase is the same or experienced the same way in all women.

Science appears to be catching up to understanding some parts of these mysteries and it’s important to understand what’s going on, why (as much as we can) and not minimize or marginalize the vastness of this change in a woman’s life, and be proactive about and persistent about not permitting suffering to become acceptable.

Let’s face it, we all deserve, want and need to get our snooze on.  So wake up and read the post.  With any luck, it will put you to sleep.  🙂

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Sleep is critically important. Quality sleep, getting enough of it at the right times, is as essential to survival as food and water.  Without sleep, you can’t form or maintain the pathways in your brain that let you learn and create new memories, and it’s harder to concentrate and respond quickly.

Sleep is important to a number of brain functions, including how nerve cells (neurons) communicate with each other. In fact, your brain and body stay remarkably active while you sleep.  Scientific findings suggest that sleep plays a housekeeping role that removes toxins in your brain that build up while you are awake.

Everyone needs sleep, but its biological purpose remains a mystery.  Sleep affects almost every type of tissue and system in the body – from the brain, heart, and lungs to metabolism, immune function, mood, and disease resistance.  Research shows that a chronic lack of sleep, or getting poor quality sleep, increases the risk of disorders including high blood pressure, cardiovascular disease, diabetes, depression, and obesity.

Ok, so here’s how sleep works: in the brain (in the hypothalamus), the suprachiasmatic nucleus (SCN) which is receiving signals about light exposure from the eyes, acts as your circadian pacemaker. It regulates circadian timing, including sleep/wake rhythm through the nervous system. The SCN directs the pineal gland to activate melatonin synthesis.  The hypothalamus and the brain stem also produce the chemical GABA which helps relax and inhibit muscle movement.

Circadian rhythms are light-influenced.  Light turns off the pineal gland’s secretion of melatonin. Light/dark and dark/light transitions determine the phasing of the circadian pacemaker via mechanisms of resetting.  Light at night can directly and immediately suppress melatonin secretion. 

In the absence of light and in the appropriate circadian phase, the pineal gland is no longer inhibited and starts secreting melatonin. This rise in melatonin may be blunted in cases of dysphased circadian rhythm (3rd shifters can relate!). From the pineal gland, melatonin is secreted into the bloodstream to all body tissues and into the brain.  Melatonin is believed to enter all cells.

Aging is typically associated with both impairments of the circadian system and decreases in melatonin secretion, these changes are highly variable by individual. Changes in melatonin levels and circadian phasing are, in fact, not uncommon in aging itself related to the timing of melatonin release.   Melatonin levels decrease (especially at nighttime) with age, particularly during the peri-menopausal period. This observation has led some to speculate that melatonin may play a role in the menopausal transition. Although melatonin probably doesn’t play any role in vasomotor (hot flash) symptoms.

Melatonin has a positive effect on bone density and strength – perhaps through synchronization of bone turnover. Therefore, the lack of or decrease in melatonin in some Milestone women may play a role in the development of postmenopausal osteoporosis. In support of this, peri-menopausal women taking 3 mg melatonin nightly for 6 months showed improvement in markers of bone turnover (decreased bone resorption, increased bone formation) resembling the bone turnover of young pre-menopausal women.

Interestingly, in studies, decreased melatonin levels are associated with increased risk of breast cancer and in vitro, melatonin counteracts the proliferation of cancer cells.

Some other causes of decreased melatonin secretion can include neurodegenerative diseases such as Alzheimer’s and diseases and disorders that affect melatonin formation and secretion, such as obstructive sleep apnea, COPD, fibromyalgia, some psychiatric disorders including bipolar disorder and other subtypes of depression, pain- and stress-associated pathologies, heart diseases, inflammatory responses, diabetes type 2, and forms of cancer.  

Core body temperature in a circadian rhythm is also important, sleep occurs when the core temperature is dropping. Sleep usually begins when the rate of temperature change and body heat loss is maximal.  The wake cycle coincides with changes in light and rising core body temperature. From your peak in body temperature in the early evening to the lowest point just before waking up, you experience a decrease in core body temperature of 2 degrees Fahrenheit.  The temperature of both the brain and the body fall during NREM (dreamless) sleep.  The longer the NREM-sleep episode, the more the temperature falls (the whole body relaxes and slows). By contrast, brain temperature increases during REM sleep. The control of body and brain temperature is closely tied to sleep regulation.

Specific to Milestone women, vasomotor symptoms commonly include a feeling of intense heat, with sweating and tachycardia (racing heart rhythm), which usually lasts minutes to half an hour. A decline of estrogen blood levels is thought to be the causative factor. These vasomotor symptoms usually accompany menstrual irregularities in premenopausal and postmenopausal women.  These hormonal and sleep disturbances are more common in perimenopausal women than premenopausal or late postmenopausal women. Vasomotor symptoms are a major causative factor in sleep disturbances in perimenopausal women. 

To help influence the body temperature portion of the circadian rhythm, coolness prior to sleep helps (cooling off after a warm bath an hour before bed) and warmth (non-shivering, non-sweating balance – breathable fibers, less heavy bedding, less heat-trapping mattress, mid-60 degree temp in the bedroom) during sleep help sustains sleep.  Exercise during the day is shown to help too.

Circadian rhythm and homeostasis also work together to regulate when you are awake and asleep.  The homeostatic drive keeps track of your need for sleep, reminds the body to sleep after a certain time, and regulates sleep intensity.  This sleep drive gets stronger every hour you are awake and causes you to sleep longer and more deeply after a period of sleep deprivation.

As you age, you sleep less of your time in REM sleep.  Most adults need 7-9 hours of sleep a night, but after age 60, nighttime sleep tends to be shorter, lighter and interrupted by multiple awakenings.  Elderly people are also more likely to take medications that interfere with sleep.

Treating insomnia during the Milestone: it is suggested that supplemental melatonin can help with the falling asleep part and supplemental hormones (topical or otherwise) can likely help with the staying asleep and the vasomotor (hot flash) issues that affect perimenopausal sleep, as long as breathing (sleep apnea, COPD) is not causing the issue. 

Forms of depression can be common in Milestone women – from feeling “off,” to much deeper and pervasive forms of clinical depression.  The brain and all of the body systems are carefully managed and activated with chemical hormone signals – including the hormones, like estrogen that effect and govern many body systems but especially fertility, and those that regulate brain chemical balance and mood.  All of these hormones (like melatonin, serotonin, cortisol) affect sleep, affect one another, have further widespread effects, and are affected by age and other physical factors. 

If you are experiencing any form of depression or psychological/emotional imbalance that is debilitating or disturbing, please seek help.   The Milestone itself as a life phase is not one and the same as angst, sadness, darkness, hopelessness or apathy but is a result of hormone change throughout the body and brain that can cause shifts in brain chemistry and be experienced as these things.  Therapy and medication can be life-saving if you struggle with these emotional or psychological effects.

Persistent sleep deprivation, disruption and insomnia should also motivate a discussion with a trusted physician.  We all know that we shouldn’t exercise, stare at blue light (screens), eat fatty foods or drink caffeine right before bed and that we can cool our rooms, take a bath, relax the brain, drink some chamomile tea to help induce sleep, but if it’s more than that and is ongoing, please seek help,  Especially if it interferes with your life.

Sometimes, simple solutions are worth a try.  Melatonin (which can be taken as a supplement for the brain chemical) is known most for its beneficial effects on sleep through its resynchronization of circadian rhythms to align more with the light/dark cycle without harmful side effects.  The studies regarding the optimal dose of melatonin for induction and maintenance of sleep show low doses (0.3-1.0 mg) or  0.5-5 mg are effective. The administration of more than 5 mg is probably ineffective. Some information suggests that women treated with melatonin have also reported a considerable improvement in mood disturbances and in depression.

A natural source of melatonin is said to be tart cherries (and it’s squeezed sister, natural cherry juice).  Yum.  Would it be inappropriate to mix it with vodka?  Perhaps not if simply occasional.

(Please note: talk to your physician about taking anything and what to take.  Melatonin can have side effects and interact negatively with alcoholism, increase bleeding risk if taken with Coumadin and increase the effects of antidepressants, and antidiabetics and can be lowered through the use of NSAIDs like ibuprofen.)

Talk to your doc and your friends, don’t let disruptions go on and on.  Sleep, GOOD sleep, is terribly important to healing, recovery, function, and well-being. 

Bring on the zzzz’s.