Getting better sleep is probably the most underutilized strategy we can adopt for better health, and it’s never been more vital to tap into its power. Research scientists are spending many waking hours learning about the critical importance of sleep to our mental and physical health, including its role in immune health and fending off viruses.
But for some of us, improving sleep isn’t as simple as going to bed earlier. Many factors, hormonal and otherwise, influence how well we sleep. If you’re a woman who suffers from insomnia, know there are a number of natural health strategies to improve sleep quality.
What exactly is insomnia?
According to the Merck Manual, insomnia is “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?
Several factors that more frequently affect women may alter sleep patterns and reduce melatonin production, leading to insomnia. (Melatonin is a hormone that helps you fall asleep.) These factors include
- anxiety and depression
- shift work (common for health-care and emergency workers, for example)
- hormonal changes (for instance, during menstruation, pregnancy, or perimenopause/menopause)
- fibromyalgia (a disorder that involves widespread pain throughout the body)
- restless leg syndrome (a condition that involves uncomfortable sensations in the legs and the irresistible urge to move them)
- Other frequent causes of sleep disturbances in either sex include
- obstructive sleep apnea (a condition where breathing stops and starts during sleep; it’s often underdiagnosed in women)
- use of substances like caffeine and alcohol
How does aging affect sleep?
Sleep changes associated with aging include sleep fragmentation, lighter sleep, increased waking, reduced nocturnal melatonin secretion, and alterations in circadian rhythm. (Your circadian rhythm is your body’s “internal clock,” aka your natural sleep/wake cycle.)
The Office on Women’s Health reports that fewer than one in five men experience insomnia. Meanwhile, more than a quarter of women struggle with insomnia.
Postmenopausal women experience a desynchronized circadian rhythm that affects the normal drop in core temperature at night, possibly causing night sweats, and the early rise of cortisol (another hormone that helps control your sleep/wake cycle), causing earlier awakening in the morning.
In addition to insomnia, many women endure chronic sleep deprivation. This could happen after having a baby—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 female hormones play in sleep?
Hormones like melatonin and cortisol aren’t the only ones that affect how we sleep. Sex hormones also 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 centers in the brain. This explains why rapid changes in hormones, like those that happen during pregnancy, postpartum, and with menopause, may influence sleep quality.
The main female sex hormone, estrogen, rises and falls during each menstrual period, being lowest just before each period. This causes sleep disruptions for some women.
During perimenopause, estrogen levels naturally begin to decrease, often causing hot flashes and more sleep disruptions.
After menopause, when estrogen is at its lowest, sleep problems are common and may include obstructive sleep apnea.
The other key female hormone, progesterone, is known as the “relaxing hormone” and 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 lower again during peri- and post-menopause.
Progesterone 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 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, 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.
Growing data has also documented associations between sleep deprivation and risk of cancer (especially breast cancer), heart disease and stroke, and depression. Lack of sleep weakens the immune system, making us more prone to infections.
Natural products and approaches for sleep
Some natural health products benefit sleep by promoting relaxation, signaling sleep, and helping to reduce excessive activity of the central nervous system. These include
- hemp CBD (cannabidiol)
Tips for sleep
Build a routine
Go to bed and get up in the morning at a consistent time. Allow for at least seven to eight hours of sleep.
Exercise at optimal times
Engage in aerobic activity, such as a YouTube workout, for at least 30 minutes a day.
Exercise earlier in the day, if possible, if you have trouble sleeping after vigorous activity before bed.
Try gentle stretching exercises before bed, which may enhance relaxation.
Reduce your stress
This can be challenging given recent global events, and you may need to use strategies you’ve never tried before. Engage in soothing daily practices like prayer, meditation, and listening to peaceful music.
Avoid use of caffeine and alcohol. Enjoy chamomile or passionflower tea at bedtime instead. Alcohol before bed may increase anxiety, worsen insomnia, and decrease sleep quality.
Banish electronics at bedtime
Avoid use of tablets, smartphones, or screens directly before or in bed.
For hormonal symptoms
For women with menopausal sleep disturbance and/or hot flashes, herbs that regulate estrogen and progesterone may be helpful, including
- chasteberry (Vitex agnus-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.
For restless leg syndrome
Restless leg syndrome is more common in women and with increasing age. Symptoms are usually worst at night and when trying to rest. Women with the condition may benefit from an assessment of iron status (blood work) 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
In most cases, this should be addressed through diet and lifestyle changes to promote weight loss, as well as use of a CPAP machine, as prescribed.
Since sleep disturbances can arise from so many underlying factors, it’s essential to discuss your concerns with a health-care practitioner to determine the best treatment strategies for you.