Linda asks: 48, perimenopause, I wake religiously at 3am every day and can't go back to sleep. I asked my doctor about options and she said as long as I have an IUD, I can't take anything. Help! Lack of sleep is impacting everything in my life right now!
My reply: I SEE YOU! Sleep wreaked havoc on my quality of life when I was your age too! Let's unpack your best next steps towards a solution that is right for you!
First--congratulate yourself for asking this question and for seeking support from your health team; too many people have a tendency to keep sleep issues on the back burner, or to wear sleep deprivation as some sort of badge of honour. Neither are good for women's health.
The root cause of sleep disruption is quite nuanced. That is one of the reasons I created this pyramid (page 25 of Feel Amazing: Your invitation to re-think perimenopause, menopause & postmenopause.) Walking through the pyramid will help you either ask or determine:
is my sleep disruption due to lifestyle (eating/drinking late, lack of movement, lack of sleep hygiene/routine)?
is there a connection to stress (cortisol is our stress hormone)?
am I missing any nutritionally? (i.e. magnesium bisglycinate)
do I have another health condition or medications that might be wreaking havoc on my sleep (i.e an insomnia or sleep apnea diagnosis)?
is there a connection between my sleep disruption/deprivation and my hormones in perimenopause?
FYI: Hormone therapy is at the bottom of this inverted pyramid--not because it's least important--but because I do not want us skipping to hormone therapy/assuming hormone therapy will be a “magic wand” solution, if the root cause of your sleep disruption is something else (that inevitably goes missed and impacts your health in other ways.)
Now, here are some “script tips” for how you can re-approach your physician to discuss your sleep health:
"Hi Doc! When I was here the other day, our conversation about my sleep disruption and how it's impacting my ability to do my job and care for my aging patents--it ended quickly. I think you may have assumed I wanted to discuss hormone therapy.
I've since been investing in my own sleep health education--this pyramid for example.
I am confident that I've done everything in the top 3 rows: my sleep routine is A+, my stress management is about a B- right now (due to taking care of my parents), I take magnesium bisglycinate and vitamin D. Now, I need to ask you to support me in the best options for ensuring I can sleep through the night again. I am open to sleep aids/medication (even if temporary), cognitive behaviour therapy, and I know the the progestin in my IUD serves as contraception, helps me to manage bleeding and protect my uterus, but it does not support my sleep.
I am open to discussing hormone therapy when the time is right. Today, I'm here to ask you to help me solve my sleep puzzle as I want to choose a therapy that will help me prioritize my sleep now--so I can function better during my daytime hours."
Learn more by watching "Sleep is the BEST medicine" in The Nest 🪺