Sleep and the Menopause: reflections on the Reimagining Sleep online workshop

A blog post by Dr James Rákóczi, Research Assistant

On Friday 3rd March 2023, the Understanding and Reimagining Sleep and Its Disorders project held an online workshop for people experiencing difficulties with sleep associated with the menopause. The workshop was hosted by Project Lead, cultural theorist Dr Diletta De Cristofaro, and Professor in Psychology Jason Ellis, Director of the Northumbria Centre for Sleep Research.

Issues with sleep are amongst the most commonly recorded symptoms of menopausal transition, reported in up to 45% of perimenopausal and 60% of post-menopausal stages. There are all sorts of reasons for this. Perhaps most well-known are the shifts in hormonal activity associated with the menopause, such as decreases in oestrogen and progesterone levels, but there are also significant shifts in serotonin and dopamine levels at play in the dynamics of bodily change. The upshot of this can be devastating: a range of sleep-affecting symptoms such as hot flushes at night, mood disorders and anxiety, sleep disordered breathing, and therefore sharp increases in the likelihood of insomnia.

The tone of the workshop was informal. Participants were invited to engage in whichever ways they felt comfortable – asking questions in the chat or voicing them through microphones. Cameras could be turned off or on. Technical difficulties meant we were a little late in starting, slightly thrown by an ill-timed software update, but everyone attending nevertheless stayed until the end. Diletta De Cristofaro greeted us with a warm-up exercise where we voted for which animal we most associated with when waking in the morning. (Yawning monkey won, whilst restful bear received no votes.) Then, she invited participants to engage with a passage from Marina Benjamin’s Insomnia, a memoir about the author’s sleep difficulties:

When I think of insomnia’s wayward rhythms what I picture is this: gaudy insomnia with its wide lapels and toothy grin is the last groover on the dance floor, still going at it after everyone else has collapsed in a heap or gone home. […] Bleary-eyed, your body leaden, you hanker for nothing more than to sleep, and yet you must endure this thing—this coked-up arriviste!—who on top of everything else (the clowning, the nagging insistence, the manic glare) has no freaking beats.

Neither do I, as it happens. In menopause I have grown accustomed to having no rhythms to speak of, neither hormonal nor lunar, and certainly not circadian.

Marina Benjamin, Insomnia (2018)

Though not everyone related with this description as representative of their own experience, participants were interested by how Benjamin both personifies insomnia as a rebellious figure and draws the disruptions of menopausal and circadian rhythm together. It was suggested that her description of ‘wayward rhythms’ could stand in for a broader sense of incapacity, of not being able to function, experienced by many during the menopause.

After this, Jason Ellis presented his talk ‘Managing Sleep During Menopause’, outlining a range of treatment and management options. He discussed three pharmacological possibilities: hormone replacement therapy, the use of SSRIs (more typically used as antidepressants), and hypnotic drugs used to directly induce sleep. He also talked us through the evidence bases connected with the consumption of phytoestrogen in food, as well as with yoga, acupuncture, and cognitive behavioural therapy for insomnia (CBT-I).

Next, Jason talked us through a range of self-management strategies for disordered sleeping (which, since the 1970s, has been commonly described in sleep science as ‘Sleep Hygiene’). These included when to avoid spicy foods, how to reduce nocturia, recommending warm baths and stretching exercises about two hours before bed, offering tips for ‘sweat management’, endorsing natural fibre bedding and pyjamas, and keeping the bedroom cooler than normal.

The conversations that surrounded and followed this presentation were thoughtful and probing. We discussed dreams and lucid dreaming, delta waves and pink noise, and whether the “problem” of screens in bed was an overhyped factor of sleep deficit.

A repeated assertion amongst participants was that, sometimes, the sleep difficulties manifesting during menopause actively subvert the possibility for self-management. The experience of waking up very suddenly, without apparent cause, was one key example. Waking up suddenly bears a relation to cortisol (a steroid hormone active when the body wakes up but which can surge at the “wrong time”) as well as to the feeling of being engulfed with anxious thoughts at 3am. Such anxious thoughts are hard to manage because they feel so separate from wakefulness. Jason suggested using distraction techniques – such as counting down from 1000 by 7 – to deal with this, though he noted an alternate theory that advocates for overloading the brain emotionally (for example, through journaling).

The purpose of this workshop was not to be “therapeutic” nor to dictate ways of improving sleep. Instead, it was to acknowledge such ambivalences. We wanted to lay the groundwork for a further workshop held later in March, led by artist Chiara Dellerba, where participants were given space to build from these conversations and engage creatively with sleep practices and living with the menopause and the menopausal transition.

A picture of the creative workshop. Design and pictures in this post all by Chiara Dellerba.

Chiara led participants through a sensory reflection on the properties of plants – in particular, ashwagandha, valerian, and passion flower – to ease menopausal symptoms. The results of this creative workshop, co-produced by participants with Chiara, will be exhibited later this year. Stay tuned for updates!

Understanding and Reimagining Sleep and Its Disorders is a public engagement project led by Dr Diletta Cristofaro and funded by the Wellcome Trust (Research Enrichment – Public Engagement grant). Hosted by Northumbria University and run in partnership with The Sleep Charity, the project consists in a workshop series, an online art exhibition, and resources.