Sleeping for Better Health

According to the Merck Manual, insomnia is defined as “difficulty falling or staying asleep, early awakening, or a sensation of unrefreshing sleep.” It’s a common problem, and even more so for women.

What might cause insomnia?

A number of factors that more frequently affect women may lead to alterations in sleep patterns and reduced melatonin production, leading to insomnia. These include

• anxiety and depression
• shift work (health care and emergency workers, for example)
• hormonal changes (menstruation, pregnancy, perimenopause/menopause)
• fibromyalgia
• restless leg syndrome (more common in women and with increasing age)

Other frequent causes of sleep disturbances in either sex include

• obstructive sleep apnea (often underdiagnosed in women)
• use of substances such as caffeine and alcohol

How does aging affect sleep?

Sleep changes associated with aging include sleep fragmentation, lighter sleep, increased waking, alterations in circadian rhythms, and reduced nocturnal melatonin secretion, among other things.

Postmenopausal women experience “desynchronized” circadian rhythms affecting the normal drop in core temperature at night, possibly causing night sweats, and the early rise of cortisol, causing earlier awakening in the morning.

In addition to insomnia, many women endure chronic sleep deprivation, such as during postpartum when adjusting to an infant’s erratic sleep/wake schedule, as well as later in life, with sleep getting sliced as women juggle work and home-life responsibilities.

What role do hormones play in sleep?

Sex hormones appear to have a direct effect on sleep patterns. Due to hormonal fluctuations during a woman’s life cycle—from puberty to menopause—women’s sleep quality can be dramatically altered.

Estrogen and progesterone receptors are found in the sleep/wake regulatory centres in the brain, so rapid changes in hormones such as those that occur during pregnancy, postpartum, and menopause may influence sleep quality.

Estrogen

The main female sex hormone, estrogen levels rise and fall during each menstrual period, being lowest just before each period, causing sleep disruptions for some women.

During perimenopause, estrogen levels naturally begin to decrease, often causing hot flashes and more sleep disruptions.

And after menopause, when estrogen is at its lowest, sleep problems are common and may include obstructive sleep apnea.

Progesterone

The other main female hormone, progesterone, known as the “relaxing hormone,” has a mildly sedative effect. Its levels are usually lowest during the week before a woman’s menstrual period, rising toward the end; highest during the first trimester of pregnancy; and lowered again during peri- and post-menopause.

Progesterone is a ventilatory stimulant that also stimulates the muscles maintaining the upper airways, so it’s thought to have protective effects against sleep apnea. Indeed, airway resistance during sleep is lower during the luteal (final) phase of the menstrual cycle, which is characterized by high progesterone levels.

How does insomnia affect our health?

Reduced sleep is associated with glucose intolerance, insulin resistance, reduced acute insulin response to glucose, and increased hunger signals, “thus predisposing individuals to type 2 diabetes,” according to a 2017 review.

In a large cohort of more than 22,000 women with an average age of 72 years, sleep debt (defined as a self-reported difference of at least two hours between weekday and weekend sleep duration) was associated with significantly increased risk of obesity and hypertension.

The inevitable health implications of insomnia and chronic sleep deprivation are vast. Growing data has documented associations between sleep deprivation and risk of cancer, especially breast cancer; heart disease and stroke; obesity; diabetes; and depression.

Natural health products for sleep

For relaxation

Some natural products benefit healthy sleep by promoting relaxation, signalling sleep, and helping to reduce excessive activity of the central nervous system:

• melatonin
• magnesium
• valerian
• passion flower

For hormonal symptoms

For women with menopausal sleep disturbance and/or hot flashes, herbs that regulate estrogen and progesterone may be helpful:

• flaxseed
• chaste tree berry (Vitex angus-castus)
• black cohosh (Cimicifuga racemosa)

Women with severe menopausal symptoms may wish to consult a licensed health care practitioner about low-dose bioidentical hormone therapy.

"Due to hormonal fluctuations during a woman’s life cycle—from puberty to menopause—women’s sleep quality can be dramatically altered.”

For restless leg syndrome

Women with restless leg syndrome may benefit from an assessment of iron status (bloodwork) and magnesium.

For mental health

According to Dr. Philip Rouchotas, ND, whose practice focuses on mental health, insomnia that is associated with stress, anxiety, or depression is best addressed by better management of the mental health condition; however, some of the natural products discussed above, such as melatonin, may be helpful.

For obstructive sleep apnea

This should be addressed through diet and lifestyle changes to promote weight loss, and use of a CPAP machine, as prescribed.

Since sleep disturbances can arise from so many underlying factors, it is essential for women to discuss their concerns with a health care practitioner to determine the best treatment strategies.

Dr. Heidi Fritz, MA, ND, is a practising naturopathic doctor at the Bolton Naturopathic Clinic and the Springdale Medical Centre in Brampton, Ontario. boltonnaturopathic.ca

This article was originally published in the May 2020 issue of alive Canada, under the title "Sleeping for Better Health."