Menopause metamorphosis: Sleep + Hot flashes

Welcome back to our last episode in our menopause metamorphosis series. Today we are talking about sleep.For the past few weeks we’ve been talking about how menopause and perimenopause affects our bones, our muscles,our pelvic floor, our gut, our brain, our metabolism and more and perhaps you’ve already noticed some of the connections between all of these areas. Sleep is one of those integral connections. How we sleep no matter what season of life we’re in is the canary in the coal mine. If we don’t sleep well we don’t function well and it’s an indicator that we aren’t functioning well. In perimenopause and menopause it’s the number one complaint for women. Not that we can’t get to sleep but that we can’t stay asleep. And the culprit is often the dreaded hot flash. What is going on here and what can we do about it? That’s the question for today’s Work IN.

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Transcript

Ep 175 Sleep

Welcome back to our last episode in our menopause metamorphosis series. Today we are talking about sleep.For the past few weeks we’ve been talking about how menopause and perimenopause affects our bones, our muscles,our pelvic floor, our gut, our brain, our metabolism and more and perhaps you’ve already noticed some of the connections between all of these areas. Sleep is one of those integral connections. How we sleep no matter what season of life we’re in is the canary in the coal mine. If we don’t sleep well we don’t function well and it’s an indicator that we aren’t functioning well. In perimenopause and menopause it’s the number one complaint for women. Not that we can’t get to sleep but that we can’t stay asleep. And the culprit is often the dreaded hot flash. What is going on here and what can we do about it? That’s the question for today’s Work IN.

Up until today we’ve been discussing everything but the hot flash. And the reason is because, well, multiple reasons . First reason is because the experts aren’t 100% sure about why and how hot flashes happen, why some women have them and some just don’t. All they know for sure is that when they give estrogen replacement they go away. But that’s not the only thing that can influence hot flashes. In fact the more I talk to women my age the more I see the correlation between what we eat and drink, how we move and how we handle stress and the mighty hot flash. So if we get those things dialed in there may be no reason to worry about hot flashes at all. But let’s not get ahead of ourselves here.

Hot flashes are one vasomotor symptom but they aren’t the only one.  They can include night sweats, palpitations, skin crawling, and scalp sensations as well. Now think about how some of those symptoms might be interpreted: Anxiety, fear, panic. 

Let’s talk about what we know. During perimenopause and menopause estrogen levels start to drop. But not in any kind of nice organized predictable way. There can be big swings month to month and that can feel very chaotic because we have those estrogen receptors everywhere throughout the body and in the brain. Particularly in the Hypothalamus.

The Hypothalamus, if you remember, is part of the HPA axis that directs and regulates our stress response, it’s also a part of the HPG axis that we talked about earlier in this series AND it also happens to be the area of the brain responsible for body temperature and homeostasis. So the theory is that as estrogen levels decline or swing up and down like a drunken monkey, the hypothalamus becomes more sensitive to slight temperature changes in the body. Why? Because we each have a kind of a range of body temperature, a window of normal for us that is regulated by the hypothalamus. Estrogen buffers it just like it buffers everything else, but as levels decline without that buffer, the range of temperature that the hypothalamus thinks is ok shrinks. In other words the Hypothalamus becomes more sensitive. Theoretically.

So when the hypothalamus notices a slight increase in body temperature it triggers a hot flash to cool you down. That’s the purpose of sweating and flushing, to bring blood flow to the surface of the skin to cool off. That’s it’s job.

When it happens during the day it’s annoying, embarrasing and irritating but when this happens at night and disrupts your sleep it can feel like torture. Sleep is the one uniting factor that we all need to protect for long term health and resilience and it can affect quality of life in pretty much every aspect including mental health. 

So this begs the question: what causes those subtle changes in internal body temperature? Because it doesn’t matter what you do every day to improve your sleep, getting morning sunlight, avoiding blue light, etc. if you are also still doing the same things that actually trigger the problem.

Outside of fever in response to infection, the body’s temperature fluctuates throughout the day for many reasons. External temperature(weather), hot shower/bath, cold plunge, exercise, stress (fight or flight), hot or cold beverages, spicy foods and eating in general. And that’s what I want us to focus on today. 

There is something called the Thermic Effect of Food. Basically TEF is how much energy it takes for your body to metabolize whatever you consume. A side effect of metabolism is heat. How much heat depends on the nutrient makeup of the food. Digestion is a thermogenic process and it changes our internal body temperature slightly. 

Foods that are high in protein, like red meat, high sugar, simple carbohydrates, and alcohol (red wine) and generally high calorie meals tend to raise the body temp more.Perhaps because the gut has to work harder.  The study I found in relation to sleep showed this but because it was done on 20 year old men there of course there were no sleep disruptions noted. Notably the fasted group had almost no change in body temperature during sleep. 

We can intuit some things here. And before I do I just want to say that not everything in the human body is intuitive. But sleep quality is critical to our physical,mental and emotional health and so it’s worth it to put on that kitchen chemistry lab coat and experiment here.

If we understand that our internal temperature range is shrinking during peri and post menopause and that how and what we eat can raise our body temperature why wouldn’t we pay attention and make some changes. 

This may be the reason why so many women no longer tolerate alcohol like they once did.  It’s worth a question isn’t it?

It might also be why so many women report feeling better overall doing keto, low carb or other fasting mimicking diets.

It’s so easy for me to sit here and say give up all sugar and processed carbs, ditch the alcohol, and cut all the red meat. But it isn’t realistic because in the real world if you eat a standard American diet, you and your brain are addicted to sugar and coming off of that will be at best challenging. And it may be you don’t  actually have to give everything up, just cut back. But once you know you know and the next time you have a heavy meal with a glass of red wine at 7:30 and wake up in the middle of the night with sweat soaked sheets you’ll know why.

Here are the things that I noticed and that made a big difference for me. 

1. Eating lighter dinner earlier in the evening.
2. Front loading my day with the good stuff, breakfast salads and protein (double breakfast) getting complete nutrients (vitamin D)
3. Limit limit limit alcohol.

I’m not saying any of these are hard and fast rules for me and I don’t expect that of anyone but they come from a lot of trial and error on my part and made a significant impact on my experience with all of those vasomotor symptoms. 

Now maybe that’s not your issue. Maybe you’re like me and you don’t get hot flashes or night sweats anymore but you are still just popping wide awake in the middle of the night. 

Matt Walker the author of Why we sleep  theorizes that that might be an evolutionary sleep pattern. Something that’s completely natural to do. After all, it wasn’t that long ago in our history that it was  pretty dangerous for us to be completely vulnerable to sleep for 8 hours every day. That’s one of the reasons humans are so tribal. Someone needs to keep watch. But aside from that how and when we eat affects hormone release and digestion. All of those processes have their own circadian rhythm. They all work better during the day and so if you’re eating late or dehydrated that may be triggering cortisol release in the middle of the night or affecting melatonin levels in detrimental ways. So if that’s happening changing that eating pattern can make a difference. 

Maybe  not overnight but over time. Because as with all good relationships the body is looking for consistency. It wants to trust you.  

Listen, none of us are perfect. I still enjoy a glass of wine or 2 and I am a sugar addict so…cake and chocolate and all the things. But I know what the consequences could be and usually are. And even though I may not have hot flashes anymore this stuff still affects my sleep. Body temperature affects sleep with or without menopause.  Just like everything else when it comes to how we take care of ourselves we need to weigh the cost and benefit. I hope that through this series you can see  the benefits of the benefits. You are certainly worth taking care of in the same way that you care for others. 

I know women who have completely eliminated hot flashes and never have sleep disturbances simply by changing their eating habits. You can too. This question is how much is a good night's sleep worth to you?

For me it’s everything.

Thanks for listening! If you’re looking for ways to handle that midlife menopausal stress, physically, mentally and emotionally head over to savagegracecoaching.com/theworkin you’ll find all the show notes for this and other episode in the menopause metamorphosis series plus lots of free resources. And if you’re in a place where you are ready for more and you live in the Dayton Ohio area I’m taking private clients for trauma informed yoga and trauma release exercise. So you can book a discovery call and we can have a real life conversation. And of course I’d be ever so grateful if you would take a moment to like and subscribe to this podcast wherever you’re listening. 

Thanks again everyone and as always stop working out and start working IN.