SLEEP, NATURAL RHYTHMS, AND CHANGING THE CLOCK
Navigating Sleep Challenges During Perimenopause Menopause: Proven Solutions for Better Rest
by Feby Maria Puravath, MD
As midlife approaches, women often find themselves navigating a complex landscape of physical, emotional, and social changes. The transition into perimenopause and menopause can bring about a profound sense of upheaval. The reflection in the mirror might not align with the youthful image once held, as bodies change and societal standards of beauty weigh heavily. Career aspirations, too, may feel unfulfilled, leading to a pervasive sense of dissatisfaction.
Energy levels may wane, and for those juggling the roles of spouse and mother, there can be a disheartening feeling of being less needed as children grow independent. Women navigate the intricate journey of perimenopause and menopause, they encounter profound emotional and physical transformations that affect every aspect of their health, including sleep. Studies show that 46% to 63% of women experience sleep difficulties during the menopausal transition1
As a physician of sleep medicine, I have many patients in midlife who struggle with sleep and are seeking medical recommendations for some relief.
What Happens in Perimenopause and Menopause?
Scientifically speaking, perimenopause marks the period when the ovaries gradually reduce estrogen production over a period of 2 to 7 years, leading up to menopause (the cessation of menstruation), which occurs for most women around the age of 51. The term "menopause" originates from the Greek words "mēn," meaning "month," and "pausis," meaning "cessation." Thus, it signifies the end of monthly menstrual cycles.
The main cause of this transition is the natural depletion and eggs in our ovaries. The depletion of the ovarian reserve causes an increase in follicle-stimulating hormone and luteinizing hormone levels in our bloodstream. Some studies suggest that higher FSH concentrations are associated with more sleep disturbances:
Increased wakefulness after sleep onset (WASO)
More awakenings
More arousals.
More trouble sleeping due to feeling too hot, which lags about 6 months behind the initial FSH rise
The symptoms accompanying perimenopause and menopause are diverse and can significantly impact daily life. Common physical manifestations include hot flashes, night sweats, and vaginal dryness, which can lead to discomfort and disrupt sleep patterns. Due to lower estrogen levels, the hypothalamus, which is responsible for body temperature regulation, becomes more sensitive and unpredictable, resulting in hot flashes and night sweats. Disorders such as sleep apnea and restless leg syndrome may also arise during the perimenopause period.
The decline in estrogen also has an impact on our emotional health. Estrogen influences the functioning of neurotransmitters like serotonin, which can contribute to mood swings, anxiety, depression, irritability and a sense of diminished self-worth. This increased anxiety and depression can cause women to experience difficulty falling asleep and/or early awakening.
How to Get Better Sleep during Perimenopause and Menopause
Addressing these challenges necessitates a holistic and individualized approach. On the physical level, women can make nutritional adjustments, emphasizing the increased intake of fiber and protein, which supports metabolic health and sustain energy. Engaging in regular weight-bearing exercises not only combats the natural decline in bone density but also enhances mood and energy levels.
On the emotional level, incorporating mindfulness practices, such as meditation, can foster emotional resilience and reduce stress. Cultivating a spiritual practice or dedicating time to meaningful causes can instill a renewed sense of purpose and community connection. For convenience, the information has been distilled into a structured, presentation of key points to enhance clarity.
Sleep Environment and Routine
Keep bedroom cool (60-67°F or 15-19°C), dark, and quiet: This optimal temperature range promotes better sleep and reduces night sweats.4
Use breathable cotton or bamboo sleepwear: Natural fabrics help regulate body temperature and wick away moisture
Establish a consistent sleep schedule: Go to bed and wake up at the same time daily to regulate your circadian rhythm.
Develop a relaxing bedtime routine: Engage in calming activities like reading or listening to soothing music before sleep.
Lifestyle Modifications
Exercise regularly, especially weight-bearing exercises: This combats bone density decline and enhances mood and energy levels.
Eat a healthy diet: Increase fiber and protein intake for metabolic health and sustained energy.
Avoid large meals before bedtime: Eating within an hour of sleep can disrupt sleep patterns.
Limit alcohol, caffeine, and tobacco: These substances can interfere with sleep quality and exacerbate menopausal symptoms.
Quit smoking: Smoking can worsen menopausal symptoms and disrupt sleep.
Stress Management and Emotional Well-being
Practice stress-reduction techniques: Incorporate mindfulness meditation and deep breathing exercises.
Consider Cognitive Behavioral Therapy for Insomnia (CBT-I): This can help address sleep-related anxiety and insomnia5.
Cultivate a spiritual practice: This can provide a sense of purpose and inner peace.
Dedicate time to meaningful causes: Engaging in purposeful activities enhances community connection and overall well-being.
Physical Comfort
Keep a glass of ice water nearby for night sweats: This can provide quick relief during nocturnal hot flashes.
Use lightweight, breathable bedding: This helps maintain a comfortable sleep temperature. Consider cotton or bamboo sheets
Technology and Light Exposure
Avoid electronic devices in the bedroom: The blue light from screens can disrupt melatonin production.
Minimize light exposure before bed: Use dim, warm lighting in the evening to signal your body it's time to wind down.
Professional Support
Consult physician about treatments: Discuss both hormonal and non-hormonal options for managing menopausal symptoms and sleep issues.
Additional Recommendations
Avoid napping, especially late in the day: This can interfere with nighttime sleep patterns.
Foster emotional resilience through mindfulness practices: Regular mindfulness can help manage stress and improve overall well-being
Overall, prioritizing sleep hygiene is essential; and establishing a consistent sleep schedule can mitigate insomnia and night sweats. By embracing these strategies, women can navigate this life stage with greater empowerment and well-being.
Resources:
Salari, N., Hasheminezhad, R., Hosseinian-Far, A., Rasoulpoor, S., Assefi, M., Nankali, S., Nankali, A., & Mohammadi, M. (2023). Global prevalence of sleep disorders during menopause: a meta-analysis. Sleep & breathing = Schlaf & Atmung, 27(5), 1883–1897.
Baker FC, Lampio L, Saaresranta T, Polo-Kantola P. Sleep and Sleep Disorders in the Menopausal Transition. Sleep Med Clin. 2018 Sep;13(3):443-456. doi: 10.1016/j.jsmc.2018.04.011. PMID: 30098758; PMCID: PMC6092036.
Zak R, Zitser J, Jones HJ, Gilliss CL, Lee KA. Sleep symptoms signaling the menopausal transition. J Clin Sleep Med. 2023;19(8):1513–1521.
Woods NF, Mitchell ES, Percival DB, Smith-DiJulio K. Is the menopausal transition stressful? Observations of perceived stress from the Seattle Midlife Women's Health Study. Menopause. 2009 Jan-Feb;16(1):90-7. doi: 10.1097/gme.0b013e31817ed261. PMID: 18725864; PMCID: PMC3842691.
Drake CL, Kalmbach DA, Arnedt JT, Cheng P, Tonnu CV, Cuamatzi-Castelan A, Fellman-Couture C. Treating chronic insomnia in postmenopausal women: a randomized clinical trial comparing cognitive-behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education. Sleep. 2019 Feb 1;42(2):zsy217. doi: 10.1093/sleep/zsy217. PMID: 30481333; PMCID: PMC6369725.
Dec 23, 2024
Written By Feby M. Puravath-Manikat & Dr. Deepak Chopra
As the days grow shorter and the winter solstice passes, the debate over changing the clocks resurfaces, like clockwork. Every year, Americans dutifully make the transition from Daylight Saving Time (DST) to Standard Time and back again. But the ritual, which once promised energy savings and a better use of daylight, has become a relic of a bygone era. Should we retire this outdated practice for good?
In recent years the call to adopt Permanent Standard Time (PST) has gained considerable momentum. Such a shift transcends mere convenience: it represents a meaningful alignment with the natural rhythms of the Earth. Far from being trivial, changing to PST has profound implications for our health, well-being, and even our consciousness. The American Academy of Sleep Medicine (AASM), the nation’s leading authority on sleep and circadian health, has long advocated for eliminating DST in favor of PST. Backed by decades of research, the AASM argues that aligning our clocks with natural planetary rhythms would promote better sleep, reduce inefficiencies, and improve public health.
The Science of Circadian Health
Our bodies are governed by circadian rhythms, internal clocks that regulate sleep, mood, metabolism, and overall health. These rhythms are deeply influenced by exposure to natural light, particularly in the morning. Our circadian systems are finely tuned to the rising and setting of the sun. This synchronization with solar time has evolved over millennia, but the shift to DST disrupts a delicate balance, delaying sunrise by artificially turning the clock forward.
Standard Time, which aligns closely with solar time, supports the natural rhythm our bodies respond to by ensuring that the sun is highest in the sky around noon, but DST misaligns this natural cycle, leaving many of us deprived of the critical morning light that is essential for maintaining circadian health. The consequences of this misalignment are far-reaching. Studies have shown that the spring transition to DST increases the risk of heart attacks, strokes, and car accidents. It also contributes to what researchers call “social jetlag,” a chronic state of circadian disruption that can lead to long-term health issues such as obesity, diabetes, and depression.
By adopting Permanent Standard Time, we could minimize these disruptions and restore a natural balance to our lives. A simple shift in how we measure time could have profound benefits for our physical and psychological well-being.
The Efficiency Myth
One of the primary arguments for DST has long been its purported energy saving. Proponents argue that by turning the clock forward, we reduce the need for artificial lighting in the evenings, saving energy and cutting costs. However, the evidence supporting this claim is weak at best. A 2008 report from the Department of Energy found that the energy savings from DST were negligible, and more recent studies have shown that any benefits are offset by increased energy use for heating and cooling systems.
The actual inefficiencies of DST extend beyond energy consumption. A 2017 study estimated that the spring clock change costs the U.S. economy $434 million annually due to lost productivity. The disruptions caused by changing the clocks twice a year ripple through industries, affecting everything from transportation to healthcare and technology. Permanent Standard Time would eliminate these unnecessary costs.
The Winter Solstice and Morning Light
With the winter solstice, which marks the shortest day of the year, it’s easy to conflate the challenges of dark winter and the effects of timekeeping under discussion. Under Standard Time the sun rises earlier, offering precious morning light that helps regulate circadian rhythms. Morning light is essential for human health; it signals the brain to stop producing melatonin, stabilizes mood, and sets the stage for a productive day.
DST, however, delays sunrise, depriving many Americans of this critical morning light during the darker months. This exacerbates the challenges of winter, leaving people groggier, more fatigued, and less equipped to face the day. By adopting Permanent Standard Time, we could maximize exposure to morning light, mitigating the effects of seasonal darkness and supporting better health. The winter months would no longer feel like an endless slog, as people’s natural rhythms would align more closely with the sun’s cycle.
The debate over timekeeping is ultimately about more than just clocks. It’s about how we structure our lives and prioritize our well-being. Time is the one resource we can never reclaim, and the way we measure it shapes everything day and night. Adopting Permanent Standard Time offers a chance to rethink how we approach consciousness itself. The concept of time is intimately connected to our awareness of the world around us. If we act now, we can foster a deeper sense of connection to the environment and to our own bodies. This alignment could be a step toward a more mindful, balanced existence, one that is pivotal to well-being and even our collective consciousness. As the solstice reminds us of the inevitability of short days, it also invites us to rethink the systems we can change. The clock is ticking, let’s make the change.
Written by:
DEEPAK CHOPRA MD, FACP, FRCP, founder of The Chopra Foundation, a non-profit entity for research on well-spirituality, is a world-renowned pioneer in integrative medicine and personal transformation. Chopra is a Clinical Professor of Family Medicine and Public Health at the University of California, San Diego, and serves as a senior scientist with Gallup Organization. He is the author of over 90 books translated into over forty-three languages, including numerous New York Times bestsellers. Chopra has been at the forefront of the meditation revolution for the last thirty years. He is the author of the forthcoming book, Digital Dharma: How to Use AI to Raise Your Spiritual Intelligence and Personal Well-Being. TIME magazine has described Dr. Chopra as “one of the top 100 heroes and icons of the century.” www.deepakchopra.com
Feby Maria Puravath-Manikat, MD is a Stanford Sleep Medicine specialist and member of the American Academy of Sleep Medicine (AASM) Political Action Committee. She also serves as an Adjunct Lecturer, Stanford University.
It’s Time to Reconsider Daylight Saving: Our Health Depends on It
October 30, 2024
By Feby M. Puravath, MD
On November 3rd, 2024, millions of Americans will set their clocks back an hour, returning to what is called “standard time”—or as we should call it, real time. For a few months, until April 2025, we’ll finally be living by the natural rhythm of the sun, rather than the artificial construct of daylight saving time (DST). But why are we doing this back-and-forth at all? The truth is, daylight saving time is not good for our health.
Let’s be clear: this isn’t just about whether you get a little extra sleep one weekend in
November. The impact of daylight saving time on our bodies is far more profound. From heart attacks to mental health, from workplace injuries to missed medical appointments, the evidence is mounting that this practice is doing more harm than good.
You see, when we shift our clocks forward in March, we’re not just losing an hour of sleep.
We’re disrupting the natural connection between our bodies and the solar cycle. Our biology is tuned to the rising and setting of the sun, not the whims of policy makers. And when we throw that connection out of balance, there are consequences.
Studies show that heart attacks increase by nearly 24% in the days following the spring transition to daylight saving time. Suicide rates rise. Depression worsens. Medical errors spike.
These are not minor inconveniences. These are real, measurable harms caused by an outdated practice that no longer serves us.
So, when we “fall back” this November, let’s not treat it as just a temporary return to normal.
Let’s use this time to reflect on why we keep up this ritual in the first place. It’s time we prioritize our health and well-being over tradition. Let’s stay on standard time permanently—the time that aligns with the natural world and with the rhythms that keep us healthy.
Because in the end, living by the sun’s time isn’t just better for our clocks. It’s better for our hearts, our minds, and our future.