If it’s truly low estrogen that awakens us during the night from sleep, and not the hot flashes themselves, then what are we to do about that as women who want to get our sleep? The answer to this question is indeed a complex one, and one that bears looking into, one piece at a time.
Simply replacing estrogen is not the answer it seemed to be since the 1970s when hormone replacement therapy was widely used by doctors treating women who had menopausal symptoms, including hot flashes and night sweats. And why not, you say, could all these doctors be wrong? In 2001, and again in 2004, we learned from two large studies conducted by the Women’s Health Initiative, that the simple addition of estrogen and progesterone could pose health risks that none of us had anticipated.
Millions of women stopped their hormones as a result, and many physicians prescribing those also experienced confusion about what to do with the study results, since no alternative had been proposed.
To select a single hormone for study is a confusing and at best inaccurate, approach in itself, since all the hormones – estrogen, progesterone, testosterone, cortisol, DHEA and melatonin are all interconnected parts of the sleep cycle. To increase one is to affect the balance of another, so it makes better sense to look at the whole picture, although this makes it nearly impossible to achieve viable research conditions.
How do these hormones interact? This is the subject for endocrinology textbooks, but to summarize briefly here:
When estrogen begins its gradual decline at perimenopause, cortisol rises in direct proportion to the declining estrogen. As cortisol is the stress hormone, it can directly disrupt sleep as well as speeding up bone loss and contributing to the development of many other symptoms. External life stressors at middle age – the management of adolescent children, care of or for aging parents and work/home responsibilities all have their role in escalating the degree of the stress hormone cortisol. It’s a wonder that anyone gets sleep at midlife!
Several things are needed to manage just this one hormone imbalancing interaction – stress reduction techniques such as meditation/mindfulness (more about this later), attention to and decisions about how to manage the declining estrogen, and good medical advice and education about natural alternatives to hormone replacement therapy. Mindfulness living and meditation help disconnect the stress from the body, lowering the cortisol level to help promote natural sleep. Deep breathing at times of added stress, and mentally scanning the body for places where stress is held, also activate the parasympathetic or calming part of the nervous system.
What’s your biggest external stressor and what are you doing to keep that stress from imprinting itself on your sleep cycle? What have you done to study the decline of your natural hormones at midlife and how to make intelligent choices for your own self-care? Keep up with this series and learn more about how to care for your all-important sleep from the inside out. We’ll be looking at all those topics here. Or sign up for my Four Weeks to Great Sleep Series.