While, intuitively, we know that sleep is important, sometimes, no matter what we do, we can’t get enough sleep or quality sleep. Add to that the hormone fluctuations women in perimenopuase experience on top of the anxiety created because of the global pandemic. Through my podcast, Fempower Health, I’ve had the opportunity to engage with several experts on women’s health, and it seems there is a nuance women over 40 need to be aware of when it comes to sleep.

First, let’s break down what is happening to your body in perimenopause. I recently interviewed Dr Lara Briden about her new book, The Hormone Repair Manual, describes the four phases of perimenopause:

  1. Phase 1: Very Early Perimenopause: This lasts about 2-5 years, consists of regular cycles, but you are making less progesterone and more estrogen. You are also at risk of heavier periods, increased period pain, migraines, sleep disturbance
  2. Phase 2: Early Menopause Transition: This is where the onset of irregular periods begins with variation of 7 or more days. Your hormones consist of low progesterone and high, fluctuating estrogen but it drops even lower thus you experience worsening of night sweat and hot flashes.
  3. Phase 3: Late Menopause Transition: This is when you experience your first cycle of more than 60 days, thankfully, breast pain eases, but ot flashes and night sweats may intensify. You may also have 1-2 heavy periods.
  4. Phase 4: Late Perimenopause: This is the period 12 months from the final period with fewer migraines and mood symptoms.
  5. Menopause: Here, your hormones are more similar to your pre-pubescent years and why many women rave about their 50s.

Now that you have a sense of what is happening to your body, assuming you’ve visited your doctor and have no underlying conditions, what are some tips that work?

  1. Adjust Diet: Managing insulin resistance is critical at this stage of life. In a recent interview with Dr. Mindy Pelz, she (and Dr Briden) spoke about the benefits of intermittent fasting, also discussed in this article from The New England Journal of Medicine. It is important to note, however, that how you incorporate it has to align with your monthly cycle and stage. Personally, I have found also eliminating alcohol and dairy, minimizing sugar, and incorporating intermittent fasting (especially eating early) make a big difference. I also know if I cheat, I don’t sleep as well, but I do pick my battles.
  2. Take Supplements: Magnesium and zinc are critical and most of us don’t get enough from our diet, and experts like Dr. Lara Briden, are strong advocates. She suggested that magnesium oxide, carbonate, chloride or citrate are the most laxative forms. Another way to incorporate magnesium is to spray the magnesium on your feet for your night time routine. Melatonin works for some as well, but you must optimize the dose and the time you ingest it as suggested in my interview with Jenn Salib Huber, a Registered Dietitian who works with women in perimenopause and menopause.
  3. Manage your hormones: Given progesterone is decreasing in this phase, Dr. Briden suggested progesterone cream may help (1 in 10 women can’t tolerate progesterone). The cream is over the counter, and if you need a stronger version, she suggests you speak with your doctor about a prescription. Of course, talk to your doctor and take caution to use the progesterone cream as indicated on the package, which tends to be 14 days on and 7 days off (and only after ovulation and before your period).
  4. Minimize Blue Light Exposure: Now more than ever, we are using our screens. You can wear blue light glasses, set your screens to adjust color based on the time of day for all your electronics, including your reading app, or purchase screens that cover electronics. Better yet, shut off the electronics early in the evening.
  5. Create a Bedtime Routine: We’ve all heard it important to create a bedtime routine. It is important to find what works for you, even if that means switching it up based on what you need that day. Some nights, I wind down by reading. Other nights, I do yoga using my favorite app, Down Dog, where one can customize the type of yoga and the session lasts. Additionally, I rub lotion on my feet, mist lavender spray on my pillow, spray magnesium on my feet, and turn on the Breethe app for bedtime hypnosis.

Always talk to your doctor before changing your diet or taking medications and supplements to make sure the plan suits your needs. The above is not medical advice but instead a summary of information shared through experts on the Fempower Health podcast.