Insomnia and the menopause…. How psychology can help

The menopause is going to impact us all in some way, so it is important that we can navigate this transition in life with as much ease as possible. One of the first steps to be able to do is to understand what causes the different symptoms we are experiencing. Only then can we make decisions of how to address these and gain a sense of control, rather than feeling it is something that is happening to us.

The physical symptoms associated with the fluctuation of Oestrogen, Progesterone and Testosterone such as hot flushes, weight gain and joint pain are well known to us all. However, presenting alongside these, are symptoms that can also have a psychological element, such as sleep difficulties, anxiety, low mood, brain fog and irritability. These can be significant and impact, on our daily functioning and confidence. For a lot of us, Hormone Replacement Therapy, the recommended treatment by the National Institute for Health and Care Excellence (NICE, 2019) can reduce a lot of these symptoms through addressing the imbalance of hormones. However, for some of us, we may find we still don’t feel quite ourselves and need a little more support to get our mojo back.

Psychological strategies are also recognised as a recommended treatment (NICE, 2019) to support us to navigate this transition in life, whilst also enabling us to enhance our wellbeing in the longer term. These strategies acknowledge that the way we think, feel and behave about ourselves and the symptoms we are experiencing during the menopause, can have an influence on our mental health. Psychological strategies recognise that our past experiences as well as cultural expectations, and societies own biases around what is 'acceptable' and 'normal', will impact our menopause journey.

One of the symptoms that 30%-60% of us will struggle with during the menopause is sleep. We all know that limited sleep can have an impact on all areas of life, so understanding the biological and psychological factors that impact this, can help us to get that better night’s sleep so we feel more able to engage in the things we enjoy.

The biological factors of insomnia relate to the fluctuation in the sex hormones which triggers a level of distress in the body. Other hormones try to rebalance the system, but these also become out of sync, resulting in the stress response and an increase of cortisol and adrenaline. When our bodies are in a state of stress, this has an impact on the production of the sleep hormone, called melatonin, making it difficult for us to get to sleep. Add into the mix hot flushes and night sweats that disturb the sleep cycle and it is not surprising that we struggle with sleep!

With all these hormonal changes going on in our body, it makes sense that psychological factors are going to come into play, when we collapse into our bed and our mind starts running wild! At this time, thoughts may start to pop up about all the things that we “should” have done during our day or what we “must” do the following day, making our body go into threat mode and making it difficult to drop off. This can lead to another layer of anxiety, as we start to worry about not getting enough sleep and how this will impact on us functioning the following day.

So how can psychology help us to get a better night’s sleep???

Mental Download

We all have those times when we get into bed and our mind feels like it is running 100 miles an hour. It can be helpful to spend 15 minutes each day, to complete a mental download. This can include worries, things we need to do or other aspects that play on our mind when trying to sleep. The best time to do this is 2-3 hours before we go to bed, to allow our mind to start to calm down ready for sleep. The following day, we can revisit the list and action the things that need to be attended to or disregard the things that have been resolved.

Resetting our circadian cycle

Our internal body clock is regulated by light and darkness so getting outside first thing in the morning for a minimum of 15 minutes, without wearing sunglasses, is a good way to start our day. This is great news for us early morning runners who like to hit the pavement first thing! As soon as we go outside in daylight, the sleep hormone melatonin is inhibited and our sleep appetite, controlled by a release of adenosine starts to increase. This allows the ultimate amount of time for our body to build up our sleep drive throughout the day, ready for when we go to bed in the evening.

Acceptance

None of us want to be awake during the night, but this is going to happen to all of us at different times in our lives. After-all, a lot of us will have survived going out clubbing until the early hours (if we can remember that far back!) and the early days of parenting, with limited amount of sleep and we still managed to function! If we start beating ourselves up about how we need to get to sleep, then this is only going to prolong the time we remain awake. If we find ourselves being awake for longer than 15 minutes, it can be helpful to remind ourselves of the positive aspects that resting and relaxing in our cosy bed, regardless of whether we are asleep can have on our well-being. Dropping the struggle and self-criticism and taking a step back to notice our experience and accepting it as it is, can help us to disrupt the cycle of sleepless nights.

Sleep is an important foundation for our well-being and can impact on all aspects of our day. Using these strategies can support us in a better night’s sleep, leading to feeling more motivated, brighter in mood and starting that run with a spring in our step.

This article was written by Dr Sarah Berger, Senior Clinical Psychologist, co-owner of Stressed Out to Feeling Fabulous & long standing member of the Running Woman community