While our sleeping bodies may appear to be still and inactive from the outside, they’re actually getting to work. As we snooze, our bodies restock hormones, repair the immune system, repair damaged tissue, process toxins, and process emotions. On the flip side, lack of sleep is associated with greater risk of heart disease, kidney disease, diabetes, stoke and depression.

In fact, sleep impacts every aspect of our physical and emotional well-being, so it’s a big deal.

Sleep disturbances are one of the most bothersome symptoms of menopause and are reported by 40–60% of menopausal women. And in general, postmenopausal women are more likely to experience difficulty falling asleep compared to premenopausal women.

There are many reasons for this. For one, we know that sleep declines with age, regardless of menopausal status. Specific to menopause, sleeplessness is often associated with nighttime hot flashes and trips to the bathroom. In addition, the risk for sleep-disordered breathing (SDB), such as sleep apnea and snoring, increases with the transition through menopause, contributing to next-day fatigue or excessive daytime sleepiness. Finally, many menopausal women experience depression. There’s actually a bi-directional relationship between mood and sleep disturbances, meaning women are more likely to experience depression when they’re not sleeping well, and, inversely, depression can impact sleep.

So what can you do about it? Well, there are ton of factors that can impact our sleep—meaning we all have plenty of room for improvements and easy wins.

Here are some quick tricks and interventions you may want to add into your routine to catch better z’s.

1. Menopausal hormone therapy (MHT): MHT is an effective treatment for disturbed sleep in menopause, especially if you experience vasomotor symptoms (VMS) like night sweats and hot flashes.
2. Cognitive behavioral therapy (CBT): CBT can improve both sleep and vasomotor symptoms in perimenopausal and postmenopausal women. A specific form targeted towards improving insomnia (CBT-I) is effective and is a great alternative to medications for those who cannot or do not wish to use them.
3. Cooling down: Ambient temperature significantly affects sleep quality, with some experts recommending 60 to 67° F (15 to 19° C) as the ideal temperature range for sleeping. What you sleep in can also help regulate your body temperature during the night. Try cotton, merino wool, bamboo, or other breathable, moisture-wicking fabrics.
4. Regular exercise: Regular exercise promotes sounder sleep and daily movement is good for your overall health, as well. For some women, exercising too close to bedtime can disrupt sleep. However, others may find exercising later in the day or evening may help them sleep better if they. Experiment and find what works best for you.
5. First-morning sun exposure: Viewing sunlight within the first hours of waking increases early-day cortisol release and prepares the body for sleep later that night. Morning sunlight helps regulate your circadian rhythm, the body's mechanism for anticipating when to wake up and go to sleep.
6. Aromatherapy: Through our sense of smell, essential oils can actually stimulate the limbic system (often referred to as our “emotional brain” and associated with sleep). The inhalation or application of aromatherapy affects sleep quality and can suppress your stress response. When it comes to sleep, the most effective essential oils include lavender and rose (Rosa damescena)
7. Establishing a routine. Try to keep a consistent bedtime and wake time every day of the week. The more your body can anticipate when sleep will occur, the easier it will be for you to fall and stay asleep.

Here are some things you may want to dial back on if you want to practice better sleep hygiene.

1. Nighttime bathroom trips: If you’re someone who wakes up multiple times per night to use the bathroom, consider front-loading your hydration earlier in the day and avoiding lots of fluids close to bedtime.
2. Screen time: The use of light-emitting electronic devices before bedtime may contribute to sleep problems. Reduce exposure to blue light before bed by powering down electronic devices. If you can’t avoid screens in the evening, consider using blue-light-blocking glasses and/or the Night Shift feature if available when using digital devices close to bedtime.
3. Lighting: If your bedroom isn’t dark enough, consider blackout shades or wearing a sleep mask. You might also want to look for sneaky light sources like the power indicators on electronics.
4. Winding up instead of down: Avoid anxiety-provoking activities close to bedtime. If you habitually watch the news, check your stock portfolio, get into heated discussions or arguments, or reply to work emails late at night, see if you can rearrange your day to make evenings more restful rather than stressful.
5. Alcohol: Alcohol can exacerbate sleep problems such as difficulty falling asleep, frequent awakenings, and poor sleep quality. This is because alcohol, while initially sedating, disrupts the sleep cycle and reduces time spent in restorative rapid eye movement (REM) sleep: the part of your sleep cycle when your body is in significant repair mode.
6. Caffeine: Even if consumed early in the day, caffeine can impair restful sleep. Plasma levels of caffeine peak approximately 30 minutes after ingestion, and the half-life of a single dose of caffeine is between 3-7 hours, depending on the woman. That means if you have a cup of coffee at 2PM, half the caffeine could still with you at 9PM.
7. Medications: Be aware of medications that may disrupt sleep and cause nighttime awakenings, including anti-inflammatory corticosteroids, SSRI antidepressants, beta blockers to treat blood pressure, and cold and allergy medications. It’s a good idea to discuss all the medications you take, including over-the-counter medications and supplements, with your healthcare provider.

Mindfulness refers to “focused attention on the present moment without judgment.” Practicing mindfulness techniques has been shown to improve sleep quality. Mindfulness techniques may include:

• Creating a relaxing bedtime ritual.
• Stretching or doing some light yoga for 5-15 minutes before bed
• Listening to calming music before bed
• Practicing deep breathing
• Journaling thoughts that are troubling you.
• Listening to a guided sleep meditation or try yoga Nidra, a form of yoga that involves lying down and moving into a deep state of conscious awareness sleep
• If you cannot fall asleep within 20 min, get out of bed. Read or listen to soft music in another room until you are tired, and then return to bed.

While we don’t have the same degree of data for sleep supplements as we do for prescription medications, some supplements have enough evidence of safety and efficacy behind them to make them worthy of consideration.

Melatonin

Melatonin is a hormone naturally produced by the body that helps regulate sleep-wake cycles. Healthcare providers recommend Melatonin supplementation (commonly 2-3mg extended release formula) as a safe and effective treatment to help normalize disrupted sleep patterns. In randomized controlled trials, it’s been shown to improve objective measures of sleep without negatively impacting sleep architecture or morning alertness as some sleep drugs do.

Melatonin has also demonstrated promise in improving depression and anxiety and subjective sleep quality in perimenopausal and postmenopausal women. It’s also generally considered safe and very well tolerated, though some people can have paradoxical reactions (effects opposite to what would usually be expected)or vivid dreams. Melatonin is best taken 1-2 hours before bed.

Valerian

Valerian root has long been used as an herbal supplement to aid with both sleep and anxiety, and is generally considered safe with few side effects. Though overall evidence is difficult to evaluate because, as with many herbal products, the doses and extraction methods aren’t consistent, systematic reviews suggest a likely overall benefit. There’re also some evidence that Valerian improves sleep quality in postmenopausal women specifically.

L-Theanine

L-theanine is an amino acid found in tea leaves that’s been shown by a few studies to improve anxiety symptoms and sleep quality when taken as a supplement—without the sedative effect common to many sleep remedies.

As you take stock of your own sleep hygiene and incorporate new habits and tools, remember: You don’t have to overhaul everything all at once! Choose a starting point that feels doable for you. Nothing will solve your sleep problems right away, but with consistent attention, small changes like these will add up and you’ll be back on your sleep game in no time.