Occasional problems with sleep are common at midlife, often secondary to hot flashes and night sweats, or anxiety and depression—which often occur together in midlife women. Between 20 and 40 percent of women have sleep disorders, and women in perimenopause often need more sleep and suffer from insomnia more often than do men of the same age. When we don’t get sufficient sleep, we not only become tired and irritable, but we are more accident-prone and exhibit decreased concentration, efficiency, and work motivation. Our rate of errors in judgment is higher, and our stress hormones rise, which over time can disrupt our hormonal balance and depress our immune system. Sleep is also critical for consolidation of learning and memory, and it serves as a way to help us sort out in our minds and bodies the things we have learned and experienced during the day.

Hot flashes and night sweats are by far the most common reasons for sleep deprivation during menopause. Insomnia and hot flashes are exacerbated by underlying unresolved and unprocessed emotions (including stress, anxiety, sadness, and anger) and the unfinished business that fuels these symptoms. The brain chemicals that are important for sleep undergo changes in many women at menopause, and they are also profoundly affected by our feelings. Persistent sleep problems are often messages from our inner guidance system that something is off balance in our lives. Unless this imbalance is addressed directly, even safe, natural sleep aids will eventually lose their effectiveness.

Avoid prescription and traditional over-the-counter sleep medication. Prescription sleep aids are all habit-forming and lose their effectiveness over time as the brain builds up tolerance, so that you need more and more to get the same effect. If you do use them, make it no longer than 7 to 10 consecutive days. Over-the-counter sleep remedies are troublesome, too, because they interfere with the production of the brain chemical acetylcholine, which is very important for memory. The use of these drugs over time can cause serious memory problems and confusion.

Try natural sleep aids. Even natural substances can lose their effectiveness over time, however, because they bind to the same place in the brain as prescription sleep drugs. So use these aids when you need them, but use them sparingly. Also, consult your physician before taking any of these natural alternatives.

• 2% progesterone cream: Use one-quarter to one-half teaspoon at bedtime on skin. Progesterone binds to the GABA receptors in the brain, and has a calming effect.¹
• Amantilla and Babuna: These natural medicines originate from the valerian plant (Valeriana officinalis) and the flower of the manzanilla plant (Matricaria recutita, commonly known as chamomile) respectively. In a double-blind, randomized, placebo-controlled multicentered study, Amantilla was 82.5 percent effective in helping patients sleep, while Babuna was 68.8 percent effective. On nights when you’re keyed up, try 15 drops of Babuna thirty minutes before going to bed, followed by 15 drops of Amantilla at bedtime. These tinctures have no side effects.
• Valerian (Valeriana officinalis): Look for valerian in capsule form, as it has a bad taste. The dosage is 150–300 mg of a product standardized to 0.8% valerenic acid. Use one hour before bedtime.²
• Melatonin: Melatonin is secreted by the brain’s pineal gland in response to cycle of light and darkness. It produces drowsiness. Natural melatonin secretion is affected by depression, shift work, seasonal affective disorder, and jet lag. Melatonin supplements can be helpful for sleep in these situations. The usual dose is 0.5–3.0 mg, taken one hour before bedtime.³
• 5–HTP (5–hydroxytryptophan): 5-HTP increases serotonin, which is converted to melatonin. This is why 5-HTP may be helpful for sleep pattern disruption, as well as PMS and seasonal affective disorder (SAD). The starting dose is 100 mg, three times per day. Gradually increase over several months to 200 mg, three times per day.⁴

Take a good multivitamin/mineral daily. In addition, take an antioxidant supplement twice a day.

Avoid alcohol.

Avoid caffeine: Even one cup of coffee each morning can affect sleep quality that evening, and women metabolize caffeine much more slowly than men.

Get regular exercise—but not right before bed: Vigorous exercise within three to six hours of bedtime is counterproductive.

Sleep in a dark room.

Follow a low-glycemic diet: High blood sugar and insulin are often associated with poor sleep.

Do not go to bed on a full stomach, although a light snack (one high in protein and low in refined carbohydrates) before bed can be helpful.

Follow a winding-down routine at night before bed: Such a routine helps signal your mind and body that it’s time for sleep. Change into your sleep clothes and get completely ready for bed at least half an hour before you climb between the sheets.

Stay calm. Don’t watch the news (or disturbing movies) before bed—it activates the sympathetic nervous system. For the same reason, try not to have emotionally distressing conversations near bedtime, and try not to stew over things. (If you find you are turning things over and over in your mind, get out of bed and do something else relaxing, such as taking a bath and reading a good book for a while).

Get a good quality mattress that supports you. It’s worth the investment—you spend a third of your life asleep!