Cover A women’s health specialist and consultant obstetric gynaecologist at Pantai Hospital Kuala Lumpur unpacks the changing sleep patterns for women approaching menopause (Photo: Getty)
A women’s health specialist and consultant obstetric gynaecologist at Pantai Hospital Kuala Lumpur unpacks the changing sleep patterns for women approaching menopause (Photo: Getty)
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Women’s health specialist and consultant obstetric gynaecologist at Pantai Hospital Kuala Lumpur, Dr Premitha Damodaran unpacks the changing sleep patterns for women approaching menopause
A woman’s brain is wired very differently from a man’s. There’s a lot of overthinking that happens. Many times we are actually already sleeping less compared to men due to different reasons—from periods to pregnancy to perimenopause, and much more besides. Because of all that, there comes a time when we will need to sleep more.
Also, a woman’s sleep cycle changes throughout her life.
As babies, we sleep more. We become more awake and active as we age. Then we start having our periods. Just a day or two before our period—our hormones dip. These hormones, oestrogen and progesterone, actually dip in preparation for the period, and that itself can cause sleep disturbances. PMS (pre-menstrual syndrome) symptoms come in—the mood changes, leaving many of us feeling grumpy, tired and moody the day before our period.
So we know there is this lag that happens when a woman’s hormones are changing. Her mind works overtime (again, as women, we tend to be over-thinkers). For us, everything has to be right around us for us to sleep well—the children are fed, the husband is okay, the accounts are done for the day, tomorrow’s plans are ready—and only then can we go to sleep. Women tend to prioritise everybody else before themselves. But we need to prioritise what’s important for that day and then let it be. And one of the priorities for that day has to be ourselves.
Read more: It’s time we learnt that menopause usually isn’t a time of poor mental health
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Oestrogen and progesterone are very important to help us sleep. As we get older, the PMS symptoms we experience can get exaggerated because our hormones actually dip earlier and earlier. That interrupts our sleep cycle.
So, when we start to lose oestrogen during perimenopause, what happens most often is you will probably still sleep well at night, but you may wake at 1am or 3am and not be able to go back to sleep easily. Oestrogen also plays a role in temperature control, which is why many women experience night sweats and constantly adjust their blankets, fans or air-conditioning.
When our oestrogen levels are really good, we can cope better with all the multitasking we do. But, when oestrogen is lost, we find it harder to cope. Everything becomes exaggerated—the worry, leading to palpitations, bloating, acidity reflux, for example. This can then cause more sleep issues.
If you don’t sleep well, you get more irritable in the morning. Then come the headaches, the tiredness, the joint pains, all of which get worse the next day. Many times, we put on more weight as we age, because we’re not sleeping. That then predisposes us to diabetes, high blood pressure, and a lot whole lot of other issues.
So, by sleeping itself, your body rests—your body heals for those few crucial hours and then everything becomes much better in the morning. You awake refreshed and feeling better.
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For me, the quality of sleep matters more than the quantity of sleep. Textbooks and sleep specialists would say six to eight hours of sleep is a must. You might have someone who sleeps well for just six hours but her sleep is actually far better than someone who is supposedly sleeping eight hours but having strange dreams and other issues.
Sleep hygiene is very important—and knowing a woman’s lifestyle and personal history. If someone has always been a light sleeper or has always had a certain amount of sleep, we can’t change that. What we can change is certain elements in her lifestyle.
Caffeine should be avoided at least 10 hours before bedtime. Our tolerance for coffee changes with age, and even a cup after 6pm can keep us awake. Alcohol at night is a no-go, and eating heavy, spicy food before bed can lead to bloating and discomfort.
Exercise is great, but high-intensity workouts too late in the day can be overstimulating. Instead, winding down with a quiet walk, reading a boring book, or watching a relaxing movie can help. Supplements like magnesium can stimulate melatonin, which helps us relax and sleep better, but they work differently for everyone.
I always tell everyone it is multifactorial. What’s more important is that your mind has to rest.
If you have a hundred things on your mind, or if your job requires you to work or be online in different time zones, you are by definition going to wind down differently, because you can’t shut your computer at midnight and believe you’ll be asleep by 12:30am.
Above In 2022, Dr Premitha Damodaran spearheaded Malaysia’s first Clinical Practice Guidelines for Menopause Management (Photo: Courtesy of Premitha Damodaran)
In 2022, Dr Premitha Damodaran spearheaded Malaysia’s first Clinical Practice Guidelines for Menopause Management (Photo: Courtesy of Premitha Damodaran)
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Generally, we tell women who have sleep issues in their premenstrual phase that they have a higher chance of having sleep issues at perimenopause. There are of course exceptions to this but they may have a higher chance of having more problems during menopause or perimenopause.
It’s not only perimenopause that affects our sleep, by the way. Again, what’s on that woman’s mind may not only be coming from a hormonal change but also spousal relationships, family problems, financial goals or children overseas calling at 1am in the morning. These things affect women more as we age compared to when we were young.
For some women, hormone replacement therapy (HRT) can improve sleep, mood and overall well-being. However, HRT isn’t for everyone. What’s most important is understanding what’s happening in our bodies and making lifestyle changes that support better sleep. At the end of the day, we need to prioritise ourselves. Sleep is essential, and taking care of our health is not selfish—it’s necessary.
Dr Premitha Damodaran is a women’s health specialist, a menopause health advocate and a consultant obstetrician and gynaecologist at Pantai Hospital Kuala Lumpur. She is also the first Malaysian board member of the International Menopause Society, spearheading a mission to put Malaysia at the forefront of menopause care in Asia.
This story is part of Front & Female’s series She Speaks, through which we aim to drive open, inclusive and unfiltered conversations tackling the sensitive topics that impact women. Do you have a burning question that you’d like our experts to answer? Email us on frontandfemale@tatlerasia.com.
