A woman in midlife suddenly starts waking up with intense anxiety and asks whether this is due to perimenopause or something else. Jessica discusses the common causes of insomnia in midlife and then offers tips on how to stop insomnia for taking over one’s life.
Ask Jessica is an advice column for women in midlife. We cover all things related to midlife from changing bodies to career transitions to parenting teens to sandwich generation challenges to shifts in marital or life partnerships and everything in between. My hope is that in sharing these questions and answers I can women as we face the midlife journey together. Got a question or challenge you would like me to address? Fill out this form to submit your issue! Want to see the answers to other questions, check out our archive here.
How to Stop Insomnia From Taking Over Your Life
HEY JESSICA: What’s with this insomnia nonsense?! I have always been a good sleeper until recently, when it feels like all hell has broken loose. Sometimes I have night sweats, but mostly I am just waking up with intense anxiety in the middle of the night and then can’t get back to sleep. Is this perimenopause or some other nightmarish issue? And can you talk about how to stop insomnia so I can get my life back? ~I’m So Tired
DEAR TIRED:
I’m so sorry to hear that insomnia has come for you. As someone who struggled with insomnia for years, I am super familiar with the frustration and exhaustion. It is miserable. So, first, I want to talk about some different reasons why you could be experiencing insomnia at this stage of life (some related to perimenopause and some not) and then I want to make some suggestions that might help you to stop insomnia and sleep better.
First, let’s start with how perimenopause could be impacting your sleep. You mentioned that you have gotten some night sweats, which is the most common sleep interrupter that shows up during perimenopause. But, from the way you describe it, it sounds like this isn’t the main reason for your trouble sleeping. Another issue that can form during perimenopause is sleep apnea. This is because the hormones which drop during perimenopause are actually protectors against this condition. So, when those levels drop, sleep apnea can begin. In women, signs of sleep apnea can include heavy snoring, periods of not breathing during sleep (this would be reported by a partner sleeping in the same bed as you, if you have one), waking up gasping for air, waking up to a morning headache, feelings of depression, or trouble sleeping. And, finally, another common reason for trouble sleeping during perimenopause is the onset of more intense anxiety.
But, as I said, there are also reasons outside of perimenopause that could be leading to the insomnia, which are more directly related to the anxiety that you are reporting. The first is that midlife is a tough time for many people, men and women alike. We are often managing a lot at work, aging parents, kids in transition, and more. It is enough to make anyone anxious! The second is that the world is a very stressful place right now and your worries about that may be interrupting your sleep.
Given what you described, I would consider sleep apnea or anxiety as the likely trigger for your sleep issues. If you think sleep apnea might be an issue for you, then I would definitely go to the doctor to discuss the symptoms you are experiencing as this is a sleep issue that is due to a physical issue. Then, to rule it out, you will likely need to do a sleep study. If you don’t think that sleep apnea is your issue, then I would think about ways you might be able to address the anxiety you are experiencing. This could include talking with your doctor; seeking out a therapist (if you don’t already have one); dealing directly with major stressors in your life, especially if new ones have recently arisen or existing ones have increased in intensity; and using techniques to reduce anxiety, especially around bedtime.
And now, I want to shift and talk about some things that I would recommend considering as you try to get rid of this unwelcome insomnia. First, again, I would recommend making an appointment with your doctor. S/he can help you to determine what the source of your insomnia is. If you’re having additional perimenopausal symptoms, it may be that hormone replacement therapy (HRT) could help. If you aren’t, then ruling out sleep apnea or discussing interventions for your anxiety might be helpful.
Then, there are lots of steps you can take to make your sleeping situation better. Here are my tips on how to stop insomnia, all of which are things that been very helpful for me personally:
- Make your bed a place that is just for sleeping and sex. This helps your brain to separate the things you are worrying about from the bed.
- Stop looking at screens ideally an hour, but at least 30 minutes, before bed. This will help your brain to start to slow down and let go of the day’s stressors.
- When you do wake up in the middle of the night and can’t get back to sleep quickly, get out of bed, go to a couch or chair, and bring a quiet or boring book to read. Read until you can’t keep your eyes open anymore, and then return to bed. This will, again, help your brain to separate the anxious thoughts from your bed and will also distract you for the ruminations that are keeping you awake.
- Don’t keep your phone near the bed (I know, this is an unpopular one). This will do two things: 1) keep you from picking up your phone and starting to doom scroll in the middle of the night, and 2) keep you from exposing yourself to blue light which will wake you up further.
- Get exercise during the day. This helps your body to get more tired, which will help with sleep.
- Keep your room cool. All humans sleep better in a cooler room, but for women at our age and stage, this is even more important as it can help to reduce the risk of night sweats.
- Use an eye mask. As a light sleeper, this one was a game-changer for me. This will reduce the opportunities for things to wake you up in the middle of the night.
- Consider trying melatonin. Try your best to take a very low dose, like .25mg, as this is really all you need and some sleep studies have shown that small doses actually work better than larger ones.
- Consider cutting back on or eliminating alcohol. As we get older, our bodies have more trouble metabolizing alcohol, which can lead to night sweats and wakefulness.
- Use breathing techniques to return to calm. Two of my favorites to use in the middle of the night are the simple: circle breathing (breathe in for four, breathe out for four) and progressive muscle relaxation (breathe in and scrunch up your face as tightly as possible, then as you breathe out relax your face completely. Then, breathe in and tighten your face and the rest of your head, and, again, as you breathe out relax your head completely. On the next breath, tighten your head and your neck and shoulders, then relax as you breathe out. Continue following this pattern as you tighten and release more and more muscles in your body, moving from the head down to the feet – you will be astonished by how relaxed your body can feel!).
I know this list is long, but please don’t let it overwhelm you. You don’t have to do everything on here all at once! Maybe start by picking a few that sound promising to you, give them a shot, and then go from there. Figuring out your magic sleeping formula may take a while, but don’t give up – you deserve a good night’s rest!