Insomnia in Menopausal and Post Menopausal women

Many women experience sleep disturbance and insomnia during the menopause transition and beyond. The symptoms associated with declining oestrogen levels include hot flushes and night sweats, increased anxiety and depression, joint aches and pains, and bladder problems. These may lead to non-restorative sleep and early morning wakening which can further increase symptoms of anxiety and depression.The value of a Medical Herbalist’s approach to treatment of insomnia around the menopause is that herbs can be selected and combined to treat both the symptoms and cause of poor sleep. There are a wide range of herbs that are relaxing and sedating acting via the neurotransmitter GABA. Increasing the levels and action of GABA in the brain promotes sleep onset and maintenance. Herbs that have this action include Valerian, Passionflower, California poppy, Ziziphus, Lemon Balm, Hops, Skullcap and Nutmeg.To address the cause of insomnia herbs are selected with phytoestrogen action to help reduce the decline in oestrogen levels and include Black cohosh, Wild yam, Red Clover, and Shatavari. The adrenal glands become a source of oestrogen during the menopause, so it is very important to support adrenal function with herbs such as Ashwagandha, Korean ginseng, Eleuthero, Rhodiola and Liquorice. The herbs selected will depend on each individual and treatment may include others to reduce depression, improve cognition and support bladder function.Advice on how to manage sleep and sleep hygiene is widely available. Behavioural changes can be very helpful in tackling menopause associated insomnia. Of particular importance are regular times for going to bed and getting up to synchronise the internal circadian clock. The internal clock is maintained by the pineal hormone melatonin which conveys information about the light/dark cycle to the body and controls the sleep/wake cycle. During the menopause melatonin levels gradually decrease in association with declining oestrogen levels and as part of the ageing process. Changes in melatonin release may therefore contribute to poor sleep patterns. The herb Vitex or Chaste berry helps regulate ovarian hormonal changes during the perimenopause but has also been shown to directly increase melatonin secretion. This direct action of vitex can used to increase night-time melatonin levels as part of treatment for insomnia.Diet can be important in preventing insomnia. The evening meal should be eaten several hours before bed to ensure digestion does not disrupt sleep. Some foods contain tryptophan and can be beneficial for sleep such as pumpkin seeds, walnuts, chickpeas, almonds, turkey, chicken, and eggs. Any food intolerances may disrupt sleep and it is useful to keep a food sleep diary.If you have taken a sleep medication such as Zopiclone for severe insomnia this should ideally only be for a short period to minimise any side effects and addiction. Herbal sedatives can be very helpful in the withdrawal from sleep medication. Medication dosage should be reduced very slowly and combined with herbal treatment such as nutmeg which can be slowly increased over the same period to prevent withdrawal symptoms such as rebound insomnia.​Treatment with herbal medicine in combination with diet, exercise, reducing stress levels, sleep hygiene and regular bedtimes can be very effective in combating insomnia and reducing the symptoms associated with the menopause transition.Reference sourcesMenopause and Insomnia https://www.womens-health-concern.org/wp-content/uploads/2022/12/17-WHC-FACTSHEET-Menopause-and-insomnia-NOV2022-B.pdfSleep, Melatonin, and the Menopausal Transition: What are the links?https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611767/#:~:text=As%20a%20woman%20approaches%20menopause,in%20a%20more%20gradual%20course.The Seven-Day Sleep Prescription (2022) Aric Prather, Penguin Random House UKWhy We Sleep (2017) Matthew Walker Penguin Random House UKSleep The Elixir of Life (2021) Christine Herbert Aeon UK