It’s the dipping that you need overnight. And generally it occurs between 2-4 am – just that time of night, that you may be lying awake, your partner is snoring and you are worrying about well, … everything really. Especially about the fact that you can’t sleep. So, you get up, make yourself a cuppa and start to read the news on your tablet, or do the ironing, or watch the tele.
So, I’ll break the bad news to you first. The longer you go without sleeping all night, the worse your blood pressure may become, your weight might climb and you not only feel exhausted, but your blood vessels age more rapidly too. I used to worry about all these things myself, especially the changes to my cardiac health and weight.
“The funny thing is” I mentioned to a lady recently who told me that she was reading a book on sleep and based on its advice, around 2am every night, she was getting up when she woke up, making a cup of tea and doing an activity – she was either doing her ironing, or housework or watching TV – “if it was our kids not sleeping, we would typically set up processes and new routines that got them sleeping all night, but instead, you are being told to get up and make a cup of tea by the author of this book. But nowhere does it talk about the effect of not sleeping on your high blood pressure and cortisol now that you are in menopause. The book is taking a ‘one-size-fits-all’ approach but we are unique … we are women going through menopause and as such, our blood pressure needs to ‘dip’ overnight. If it doesn’t, then we become ‘non-dippers’ and this leads us down the slope towards high blood pressure with age. Our changing hormones in menopause affect inflammation in our blood vessels and our changing blood pressure overnight. So the caffeine in your tea and the fact that you are often doing house-work, means that your blood pressure remains higher overnight. It’s why you may be getting hot flushes more during the day too.”
She had emailed me about the book that she was reading about managing sleep. I had the book on my bookcase and it was an excellent book, but it was telling readers that if they couldn’t sleep, then to get up and stay up for an hour or longer until they felt sleepy. She was getting up and making a cup of tea and doing household chores. Activities that increased her blood pressure.
Reading her email was like deja-vu for me. Because when my menopause hormonal changes robbed me of my precious sleep, that was what I used to do too. But that was the wrong thing to do …. the caffeine in the tea and the activity of household tasks, was keeping my blood pressure higher overnight … turning me into a ‘non-dipper’. As such, over the weeks and months, this was increasing my risk for worsening cardiac health as I moved into post-menopause and setting up the new routine for my brain of waking up every night. I know that so many women on my programmes have experienced the same night-time frustration.
In the United States, the highest rates of menopause-related insomnia complaints are among post-menopausal women at 43%–48% (Drake et al, 2019). Goodness knows what this rate is globally. I think we would be too scared to know! The report goes on to mention that menopause itself—via hormonal changes and related symptoms – often leads to sleep deterioration, thereby triggering the onset of insomnia disorders which of course, leads to higher blood pressure (hypertension), weight gain, depression and other diseases of ageing which relate to inflammatory changes. That’s why I always say that if we are going to get serious about improving our health as we age, turning around menopause-related insomnia is crucial.
Whilst there are numerous causes of high blood pressure and changing heart health in our menopause transition which I’ve talked about in my newsletter this month, one of the factors that we have to take seriously is our menopause-insomnia. However, not only has this got to do with our changing hormonal status as we age, but it’s also to do with whether you are an overnight ‘non-dipper’ or not. It’s why I always support getting your blood pressure checked as you transition menopause. It’s important to our cardiac health to understand what it’s doing – not only over the course of the day, but overnight too.
What is Overnight non-dipping Blood Pressure?
First described in 1988, the night time dip has become an accepted measure of cardiovascular risk. The ‘dip’ is defined as the difference between the mean systolic pressure in the day and mean systolic pressure during the night. Over the years, research has shown that poor sleep quality, sleep curtailment, and sleep disorders (e.g., sleep apnea) are linked with BP ‘non-dipping’ overnight and a surge in blood pressure in the morning – if you are getting extreme hot flushes in the morning when you wale up, then you might want to talk to your Doctor about getting your blood pressure checked.
When this non-dipping happens and we experience insomnia, researchers have found that there is a chain of events that may lead to chronic hypertension (high blood pressure). These events include:
- Higher activation of our nervous system (a higher arousal state whereby we worry more and become anxious – often the cause of not being able to get to sleep).
- Changes to our kidney function and sodium retention (often leading to bloating and puffiness in menopausal women).
- Changes to our immune system (leading to conditions such as fibromyalgia)
- Changes to the pituitary-thyroid-adrenal axis (HPA-axis) – this can lead to worsening sleep patterns and thyroid problems. When both our sleep and thyroid function is affected, our temperature regulation is too. Hot flushes and night-time sweats are managed with sleep and a focus on reducing your blood pressure.
Turning around your Menopause Insomnia needs a focus on Managing Blood Pressure
It has now been well established, that sleep patterns follow a circadian cycle. But so too does your blood pressure and blood vessel changes. The circadian cycle is also impacted by food and metabolic signals and I have an emphasis on the timing of eating dinner in my Sleep All Night module – especially for those of you doing shift work.
Eating 3-4 hours before bedtime is important to help to reset your circadian clock as is maintaining a lower blood pressure before bedtime.
In this weeks’ Wednesday briefing, I also spoke about the role of salt in reducing blood pressure, so reducing the amount of salt you have on your meal at dinner is important – table salt is high in sodium and increases blood pressure – and increasing potassium-rich foods will help to lower your blood pressure.
Reducing your activity before going to bed is another strategy to help you to lower your blood pressure. Go on, put your feet up – especially if you’ve been on them all day. This improves the return of blood in your lower legs to your heart and helps to improve your blood pressure.
As more and more of us become pressed for time in our day to get everything accomplished, we forget that our body needs to have time to relax and unwind at the end of the day. Too many of us are doing housework and other types of work in the evening, (I was studying and working on my computer until the small hours) and some of you are rushing off to the gym to do your evening workout, but this isn’t helping your blood pressure to lower before you go to bed.
However, a heavy workout or weight training can keep blood pressure elevated for hours – if your blood pressure doesn’t return to normal resting levels, at least 2-3 hours after heavy exercise, then please get it checked out by your Doctor – I’ve come across numerous mid-life Personal Trainers, Exercise Instructors and gym-members who are racing to the gym after dinner to do more vigorous exercise, thinking that it is ‘good for them’. Then they complain that they aren’t sleeping. Yes, the two issues are related!
Remember that as we transition menopause, our blood vessels lose elasticity and acquire inflammatory changes. Hence, it’s no surprise to me that the American College of Sports Medicine (2004) recommends exercise programmes that primarily involve endurance activity to prevent the development of hypertension and to lower blood pressure. I’ve written a lot about how we need to implement lifestyle strategies to reduce stiffness of our blood vessels as we age – and I talk a lot about this in my 12 week online Rebuild My Fitness programme, which numerous women do after one of the other foundation programmes (read about these HERE).
We must remember that our menopause transition opens the door to our Blood Pressure changes because we are ageing. This is natural. However, we become more vulnerable to cardiovascular changes with age, because our arteries (and lymphatic vessels) are losing the role of oestrogen, which in the past has kept our blood vessels elastic. Hence, we need to adjust our lifestyle to accommodate these changes. Lifestyle modifications are advocated for the prevention, treatment, and control of hypertension with exercise being an integral component.
Exercise programs that primarily involve endurance activity prevent the development of Hypertension in adult women with both normal blood pressure and those with hypertension. The Blood Pressure lowering effects of exercise are most pronounced with those who engage in endurance exercise at least 3-4 times a week, but again, if your joints are sore, or you aren’t sleeping or you are overweight, then as I mention to women who join me on my 12 week programmes, you need to address these other issues first.
Insomnia is endemic to women transitioning through menopause, but it doesn’t need to be. Un-raveling the science of not sleeping as we transition into our new hormonal environment in menopause took me hundreds of hours of study. But I was so determined to understand why I wasn’t sleeping, because I knew from the emerging weight loss science, that sleep and fat loss go hand in hand. Even more than exercise and different dieting regimes. Add to this, our changing hormonal environment in menopause and the subsequent loss of muscle as we age (called sarcopenia) and it becomes a ticking time-bomb for un-necessary cardiac and metabolic health changes that our mother’s generation have already discovered.
Although we kind of get by on a day-to-day basis without sleep, the issue for me and millions of women, is more about the accumulation of loss of sleep and the effect this has on our weight and our health. Not sleeping leads to ongoing inflammation in our muscles, joints, liver, gut and heart. What’s more, the increasing inflammation can send us into the cascade of chronic health changes that hit us in our post-menopause years, including auto-immune health problems.
In women, vascular ageing appears to be accelerated during the menopause transition, particularly around the late perimenopausal period, presumably
related to declines in ovarian function and oestrogen levels. Many women go on HRT which helps them enormously (and I don’t interfere in any medications women are on, because this is between you and your Doctor), but I am passionate about you understanding the lifestyle-science solutions that you can put into place as well.
For example, what women on the MyMT™ programmes discover, [as I did myself], is how to turn around their Circadian Rhythms to match their changing hormonal levels during menopause. The term ‘Circadian’ means “about a day.” This internal clock, which gradually becomes established during the first months of life, controls the daily ups and downs of biological patterns, including body temperature, blood pressure, and the release of hormones. Circadian rhythms make people’s desire for sleep strongest between midnight and dawn, and to a lesser extent in mid-afternoon.
Our changing menopause hormones cause disruption to our normal circadian rhythms and this affects the stiffness in our blood vessels too because the cardiovascular system has a strong circadian rhyhm: blood pressure should be lowest when we are sleeping but it rises sharply upon waking up. These circadian variations are important to our health as we age, so as we transition into or through menopause, then it’s really important to restore this biological rhythm and make adjustments to get us back sleeping all night. Whilst a lot of information about sleep has emerged recently, much of this is not focused on mid-life women specifically nor on the specific gut hormones that also become affected in menopause.
If we don’t turn around our sleep in mid-life, then I’m always telling women, that this will then become their ‘new normal’, because over time, our brain and body start to read this 3am ‘awake’ period as routine. When this happens, your other hormones start to adjust and you accumulate more fatigue, muscle soreness, headaches, weight gain and more. Your immune health suffers and you keep stacking on the belly-fat – despite all the exercise you are doing or any new diet that you are on. That’s because your Circadian Rhythm affects nearly every organ in your body.
PS: If you are in post-menopause then don’t forget to check your emails from me for my July post-menopause weight loss special. Women are already underway and loving what they are learning.
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