They were sitting in the front row of the seminar on Tuesday night. I was in Melbourne taking my last seminar for a few weeks.
I saw them all look at each other after my comment – “The ladies on my programme know that I don’t want them to do too much high intensity exercise until they are sleeping all night. If we aren’t sleeping then we aren’t recovering and all you are doing is throwing yourself into more hot flush chaos plus you’re increasing stress on your heart muscle too.”
One of them started nodding and at the end of the seminar she came and spoke to me. She was a Personal Trainer and told me that she had no idea that lack of sleep affected the heart. So I explained that when we don’t sleep night after night, our blood pressure increases. It’s one of the major changes that occur in women as they age. When women are always exercising at high intensity which is common in the fitness industry (including doing heavy weight training), then if they aren’t sleeping, they aren’t recovering. Blood pressure stays elevated not only during the session but afterwards as well. “It’s all about sleep” I explained. “And if women aren’t sleeping that’s when the exercise they love to do can become a problem. This then leads to greater fatigue, sore muscles and joints and a generation of women who are stopping doing exercise. This is reported in physical activity participation data all around the world.”
I worry about women doing lots of high-intensity exercise as they transition menopause. There’s a reason for my concern. Women in their late 50’s are the first generation of women to age within the context of the modern sports and fitness industries. But sport and exercise science research hasn’t kept up. Most research for the past 30 years has been undertaken on males and athletes, not women in menopause, hence, many exercise professionals do not understand this important life-stage and the effects of too much exercise on an ageing body going through menopause. And the key focus in terms of women in mid-life being able to tolerate harder workouts is all about how well they are sleeping. Exercise professionals are not taught about the changes that occur in the heart wall when we lose oestrogen. In women after the onset of menopause, the risk of developing hypertension is greater compared to that in ageing men and this is to do with the stiffening of blood vessels. That’s what I was talking about in my seminar when I piqued the interest of the women in the front row.
Blood pressure is well known to increase as we age. This is because our blood vessels become ‘stiffer’. It is a well known phenomenon in ageing research and is called ‘vascular stiffness’. This refers to the fact that our blood vessels are ageing and losing the lovely elastin that helps them to dilate and constrict. When women go into menopause and then post-menopause, the loss of oestrogen causes greater vascular stiffness. For women used to doing lots of harder exercise, it means that their recovery is less well tolerated. Many feel that their muscles are sore, heavy and for many, they experience greater rates of injuries.
But for women in menopause, there is another factor too. Loss of oestrogen is accompanied by an increase in the nerve signals that automatically control cardiac muscle function, so heart rate is increased along with blood pressure as a natural part of oestrogen loss and our ageing. As I mention in my seminars, if women are doing lots of high intensity exercise or they are training for events, then they need to manage and monitor their recovery strategies just as professional athletes do.
Sleep is a vital regulator of cardiovascular function, both in the physiological state and in disease conditions.
Cardiac health is driven by our circadian rhythm and sleep, so changes in sleep habits are not without consequences. If we aren’t sleeping, we aren’t recovering from all of our exercise. For mid-life women, those consequences can also be fatal. The incidence of heart attacks is higher in post-menopausal women but prior to menopause, incidence is highest in males.
When we aren’t sleeping there are considerable changes in our metabolism, immune system and blood pressure.
Shortened sleep duration is defined as less than 6 hours of sleep and when women only have this amount or less, researchers suggest that they are 30% more likely to develop high blood pressure. High blood pressure (hypertension) stresses the heart muscle. Over time, like over-trained athletes, our heart rate stays higher than it should. This results in the heart working harder to pump blood and oxygen around the body. Shorter sleep is linked to higher blood pressure.
As I’ve often say to ladies on the MyMT™ programmes, the hours between 2-4am are when we are normally in our deepest sleep. This is when our blood pressure falls. If sleep is shortened though, researchers suggest that it’s just not enough for the blood pressure to dip low enough overnight allowing for recovery. It stays higher than it should. That’s also why women end up waking up with night sweats and hot flushes too. It’s all to do with blood pressure not lowering enough overnight. Add this to a stressful day at work or stress in the home or physical stress from over-training and it’s a cocktail for ongoing health problems as women age.
Which gets me back to exercise. When we aren’t sleeping, too much exercise is dangerous. I found this myself. Whilst exercising feels good and we know it is ‘good for us’, those of us who have been regular exercisers all our life, typically ‘push through’ the effort levels – we’ve been doing this for decades. But in menopause, all this ‘go hard, go home’ mentality can be harmful as we go into menopause, when we aren’t sleeping. That’s why I could tell from the faces of the three ladies in the front row of my seminar that I had hit a sore point. They love their exercise and go hard nearly every day. But they had all put their hands up when I asked ‘Who isn’t sleeping between 2-4am?’
Heart disease in women is a global problem and it’s not being talked about in the context of exercise and our ageing as we move through menopause. This concerns me. Particularly because as a former nurse, I have seen post-menopause women lying in cardiac care units having had heart attacks in their 50’s.
Yes, we need to exercise. Yes, it’s good for our health as we age. But when we aren’t sleeping, the type of exercise we are doing matters. So too does the amount. Studies have shown that just one night of sleep deprivation decreases our endurance performance on treadmill testing and causes time to exercise-exhaustion to be reduced. It’s why I have a separate programme from my symptom reduction programmes and this is called Rebuild My Fitness. It’s for women who want to understand how their exercise needs to change as they go through menopause – and increasing cardio-respiratory fitness, strength and flexibility is paramount to our health as we age.
When we aren’t sleeping it is ‘aerobic exercise’ that needs to be prioritised over ‘anaerobic (harder) exercise’. Aerobic exercise means that you are breathing slightly harder than normal, but you aren’t completely out of breath. This type of exercise allows us to exercise for longer, which again is good for our ageing heart.
Alternatively, if we aren’t sleeping, then we may need to make the decision to rest instead. That’s the decision I had to make yesterday too. Staying in another hotel room and being on a different time zone, meant that my sleep was erratic. When this happens, the decision we make about whether to exercise or not is important. So I walked, not ran. I did gentle stretching and deep breathing, not heavy weights. And I went back to focusing on the powerful strategies that I have in the MyMT™ programmes for turning around my sleep. I just hope that I got my message across to the ladies attending my seminar too.
When you are ready to sleep all night and turn around your hot flushes, your blood pressure, sore joints, anxiety and your weight, then will you join me? Whether you are a regular exerciser or not, what you learn will change your life.
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Covassin, N. & Singh, P. (2016). Sleep Duration and Cardiovascular Disease Risk: Epidemiologic and Experimental Evidence. Sleep Med Clin. March ; 11(1): 81–89.
Oliver, R., Costa J., Stewart J. et al. (2009). One night of sleep deprivation decreases treadmill endurance performance. Eur J Appl Physiol. DOI 10.1007/s00421-009-1103-9.
Peinado, A., Harvey, R. et al. (2017). Neural control of blood pressure in women: differences according to age. Clin. Auton Res. 27: 157–165