Issues and Challenges

Hormonal Changes and Sleep Patterns as Women Age

Sleep is the golden chain that ties health and our bodies together.
                                                                        — Thomas Dekker 

Sleep forms an integral part of a person’s bodily health and overall wellbeing leaving them refreshed and alert. Often, when we are physically and mentally drained or exhausted, a good nap boosts our energy and helps our brain function. Thus, we are able to concentrate, think clearly and process our thoughts. Adults require at least 7 to 9 hours of sleep at night while children and adolescents need more than that. Sleep patterns are affected by a number of factors which include both physical and psychological variables such as diet, lifestyle habits, daily stressors, work schedules, environment, emotions, illness as well as different physiological processes taking place in the body. These factors bring about hormonal changes in our body that affect sleep in one way or another. In other words, sleep patterns are subject to change with changes in hormonal regulation. 
In this regard, I would like to talk about some of the physiological processes that women go through, their impact on the hormonal regulation in the body and the effect of these hormonal changes on the sleep patterns of women at various stages of life. These processes include puberty, pregnancy and menopause. 
Hormones That Regulate Sleep in Women
In order to understand the role of various sleep hormones in women, we should first be aware of the term ‘circadian rhythm’. Circadian rhythm or cycle is a biological clock that consists of a number of mechanisms, which regulate the sleep-wake cycle over the course of 24 hours. It is influenced by physical, mental and behavioral changes. Although a number of hormones are involved in sleep-wake cycle, there are three important ones when it comes to women.
This hormone is often called the sleep hormone. It functions to promote rest and regulate the circadian cycle. Any kind of disruption or disturbance in sleep negatively affects the production of melatonin in the body, which further affects the regulation of the circadian rhythm. Many individuals often take melatonin as a supplement to maintain good sleep. 
Apart from their role in reproduction, estrogen and progesterone are involved in processes which affect emotions, appetite and sleep. Progesterone is involved in muscle relaxation, decreasing wakefulness at night and the amount of time needed to fall asleep. 
It is involved in the metabolism of serotonin as well as some other neurotransmitters (chemical messengers in body) that impact our sleep-wake cycle in different ways. Another interesting fact is that our body temperature is kept low at night as a result of the activity of estrogen. This leads to a more restful sleep. In addition to this, estrogen is known to have an antidepressant effect. Thus, decreased estrogen levels in body can lead to higher temperatures, poor sleep quality, and depressive state of mind.
Next come the various sleep changes at different stages in life of a female — puberty, pregnancy and menopause — and some advice for individuals going through each of these.
At the time of puberty, when a woman first begins to experience her menstrual cycle, sleep pattern is subject to a lot of changes due to hormonal fluctuations such as rise and fall of estrogen and progesterone. This is the reason why sleep differences do not appear between girls and boys before this. Now you might understand, why men get better sleep as compared to women! 

A week before the menstrual cycle starts, progesterone and estrogen levels rise in order to prepare the uterus for pregnancy. If the woman does not conceive, progesterone and estrogen levels drop dramatically, leading to a poor mood and sleep quality in premenstrual syndrome (PMS) days before menstruation.
Advice: One should include exercise in daily routine and avoid nicotine or caffeine. 
If pregnancy occurs during the female reproductive cycle, estrogen and progesterone levels do not drop, instead they increase drastically to create all the right conditions in the uterus for the conceived baby. This is the reason why women are drowsier and sleep more frequently at daytime, especially during the first trimester. This effect wears off by the end of the pregnancy, particularly during the third trimester. However, sleep at this stage is also disturbed due to increased pressure on the bladder and frequent trips to the washroom during the night. It may also be due to other factors such as difficulty in breathing as well as anxiety or fear as the woman is near the stage of delivery. 
Advice: Sleep with your head elevated; this prevents snoring and subsequent awakening at night. Seek cognitive and behavioral therapies as well as relaxation techniques. Pregnancy yoga is extremely helpful in relaxing the mind.
Menopause is the time when the sleep-wake cycle of a woman gets affected the most. This occurs in a number of ways. First of all, progesterone and estrogen that are known to protect against sleep apnea, are at their lowest during menopause. As a result of this, older women are more likely to experience sleep apnea. Secondly, as women are approaching their menopause, they experience hot flashes and night sweats due to fluctuating hormone levels, which can wake them up from sleep, making them more irritable and much less likely to be able to relax. 
Advice: Include soy-rich foods in diet. They are rich in phytoestrogen, a chemical which imitates the effect of estrogen. Avoid spicy food and wear light clothing, especially at bedtime. HH

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