Dear Dr. Murray:
I’m 48 years old and beginning to have some problems sleeping. I have always slept well, but now my periods are changing and I feel hot a lot of the time. I wake up to throw off the covers, and then in a few minutes I’m cold. This goes on all night and I feel so tired the next day. Help! Sleepless in Syracuse
This is such a common problem in perimenopause – we see it every day. At this time of life many hormones are changing, showing up as hot flashes, night sweats, and very often sleep problems. One major issue can be an imbalance between estrogen and progesterone causing menstrual cycles to be erratic and temperature regulation to be disrupted. Most perimenopausal women have relatively high estrogen levels and low progesterone levels, which can cause all the symptoms we have mentioned, plus an increase in cortisol (one of our major stress hormones). There are also often deficits in brain serotonin levels – an important neurotransmitter that helps both sleep and mood.
When a person is not sleeping well many other hormonal problems occur, especially with inadequate adrenal recovery during the night, which can then affect thyroid function, thinking ability, mood and energy.
SO, what’s a girl to do? A first step might be to take a good complex B vitamin daily, especially B6 (50-100 mg), B12 (500-1,000 mcg) and folic acid (800 mcg). These nutrients help your body make more serotonin. Adding an over-the-counter amino acid called 5-HTP (5-hydroxytryptophan) can also help you sleep, as it is the actual building block of the serotonin molecule.
Balancing your hormones by adding a small amount of progesterone can be helpful too, especially for helping the temperature regulation issue. Progesterone taken as an oral capsule (by prescription) often helps significantly with sleep, and the breakdown products of progesterone act like brain tranquilizers.
A diet high in nutrients – lots of colorful fruits and vegetables – and low in sugar and processed foods also gives your body the basics upon which to build healthy cells and the ability to manufacture hormones and neurotransmitters.
Regular aerobic exercise early in the day (not right before bedtime), avoiding caffeine and alcohol, and drinking plenty of water also assist in achieving better sleep quality.
If needed, you can work with your health practitioner to see if testing your hormones, neurotransmitters, nutritional status or presence of toxins could be contributing to your symptoms.
Very best wishes to you in your health journey!!