Once women reach the transitional years of perimenopause and menopause, declining and fluctuating hormone levels can have a significant impact on their lives physically, mentally, and emotionally. The severity of the effects and symptoms can range from mild to severe and fleeting to long-term.
Two areas that can be affected are blood sugar levels and sleep. Blood sugar is the body’s main source of energy, and so it has the ability to affect the performance of virtually every part of your body. Changing hormone levels in perimenopause and menopause can trigger blood sugar levels to fluctuate, which in turn can impact processes throughout the body. One of those processes is sleep.
Sleep problems, including trouble falling asleep and difficulty staying asleep, are common among women in perimenopause and menopause. In fact, among Morphus readers, 66 percent reported they have difficulty falling asleep, staying asleep, waking up multiple times, waking up feeling tired, and more.
In this article we explore the relationship between blood sugar levels and quality of sleep in perimenopause and menopause.
What are perimenopause and menopause?
Perimenopause is the period in a woman’s life when the ovaries begin to produces less hormones, resulting in an irregular menstrual cycle and a variety of symptoms and changes in the body. It typically begins when a woman is in her late to mid 40s, although it can start earlier or later. During perimenopause, fertility declines, although pregnancy is still possible. Perimenopause ends with the arrival of menopause, which is the day a woman has had 12 consecutive months without experiencing a menstrual cycle.
Menopause is actually only one day, since every one after reaching the 365th consecutive day of being period-free is known as postmenopause.
As women go through perimenopause, estrogen levels go up and down unevenly, which can result in an erratic menstrual cycle and a variety of symptoms, including sleep problems, headache, mood changes, night sweats, hot flashes, and difficulty concentrating, among others. Progesterone levels also fluctuate, and when the difference between the two hormones is great, symptoms can be more intense. This is a time when women often report great difficulty with sleep: falling asleep, staying asleep, waking up multiple times during the night, and waking up tired. The good news is that as this hormone rollercoaster eases up over time, so do the symptoms.
Importance of blood sugar regulation
Blood sugar (glucose) is your body’s main energy source. The glucose in your bloodstream is either used immediately for energy or stored the liver and muscles for later use. The body needs the hormone insulin to use or store glucose for energy. Without sufficient insulin, glucose remains in the bloodstream and results in elevated blood sugar levels.
Maintaining a balanced blood sugar level is essential for overall health and preventing metabolic disorders. Generally, healthy blood sugar levels are 80 to 130 mg/dL before a meal and less than 180 mg/dL two hours after the start of a meal.
If you don’t take steps daily to keep your blood glucose level within a specific range as much as possible, you open yourself up to many potentially serious health problems, including type 2 diabetes and its associated complications, such as loss of vision, kidney disease, poor wound healing, heart disease, and more. It’s also essential to stay within a target range to maintain healthy mood and energy.
Understanding the importance of sleep
Every living creature needs sleep. In humans, consistent, quality sleep is absolutely essential for physical, emotional, and mental health and well-being. Virtually every cell, tissue, and organ in your body depends on you getting restful sleep most of your life. The consequences of not doing so can be enormous. For adults, the general accepted amount of sleep needed nightly is seven hours or more.
From your head to your toes, sleep matters. Adequate sleep is necessary for optimal brain function and mood, lower stress, better immune system function, healthy heart and blood pressure, and good hormone balance. It’s been noted, for example, that lack of sufficient sleep is ten times more likely to have depressive symptoms and 17 times more likely to have symptoms of anxiety. Among women in menopause, researchers have reported a greater need to focus on sleep to reduce suicide among women 45 to 64, the highest risk age group.
Sleep occurs in four stages. Stages one, two, and three are non-REM (not involving rapid eye movement) sleep, and stage 4 is REM (rapid eye movement) sleep. Each cycle through all four of the sleep stages takes 90 to 120 minutes. Every time you start a new cycle, you spend more time in REM sleep.
- Stage 1 is when you are first falling asleep. Your brain and body begin to slow down, although you are not yet fully relaxed. Stage 1 usually lasts for one to seven minutes.
- In stage 2, your muscles are relaxed, breathing and heart rate are slowed, and temperature drops. The first time you reach stage 2 during the night usually lasts 10 to 25 minutes, but it becomes longer each time you return to it at night. Individuals typically spend about 50 percent of their sleeping time in stage 2 sleep.
- When you are in stage 3 sleep, breathing, heart rate, and muscle tone are slower than in stage 2. This is the time you get restorative sleep, which helps boost immune function, contributes to memory and creativity, and aids in bodily recovery. The first time you reach stage 3 at night it usually lasts 20 to 40 minutes, but this time gets shorter every time you reach it again.
- Stage 4 is REM sleep, which is so named because the eyes move rapidly from side to side. It is also referred to as active sleep and dream sleep. REM sleep is characterized by irregular breathing, temporary loss of muscle tone, and accelerated heart rate. Brain waves are also more varied, unlike the slower, less active brain waves seen in the other three stages of sleep. Memory consolidation, brain development, emotional processing, and dreaming also occur during REM. Your first time through REM sleep at night usually lasts 60 to 90 minutes.
Sleep problems during perimenopause and menopause
Let’s face it: if you aren’t getting enough restful sleep, you can’t function at 100 percent and your overall health suffers. The sleep problems that are preventing women from experiencing good sleep include trouble falling asleep, difficulty staying asleep, waking up often during the night, night sweats, snoring, having to pee often during the night, and sleep apnea.
Some of these challenges may improve by practicing relaxation techniques immediately before bedtime and when waking up at night. Deep breathing, progressive relaxation, and meditation are a few suggestions. Monitoring fluid intake before bedtime can reduce nighttime urination, and talking with your doctor about snoring and sleep apnea may improve your sleep.
Blood sugar imbalance and sleep problems
Blood sugar imbalance is not uncommon in perimenopause and menopause. More specifically, both hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) can have an impact on how well you sleep.
Insulin helps deliver sugar from the blood to your cells, where it can be utilized for energy. When insulin is unable to adequately move sugar into the cells or the body can’t make enough insulin, high blood sugar occurs. Low blood sugar can result if you have diabetes and take too much insulin, don’t eat enough carbs for the amount of insulin you take, drink alcohol, or have changes in your exercise or eating schedules. Whether your blood sugar is too high or too low, it can affect your sleep.
For example, both blood sugar conditions can contribute to insomnia. Hyperglycemia can result in more kidney activity, which can lead to having to urinate more during the night. High blood sugar also can make you experience greater thirst, restlessness, and headaches, which can make it more challenging to fall asleep and stay asleep. Low blood sugar has been associated with sweating, irritation or confusion when you wake up, and nightmares.
Research is ongoing concerning a link between high blood sugar and hot flashes. Sharon Dormire, PhD, has noted that fluctuating estrogen levels result in a decline in the amount of a sugar-transporting protein produced in the blood-brain barrier. When these changes occur, sugar enters the brain at a slower rate, which can result in a decline in energy reserves and in turn triggers the autonomic nervous system and a hot flash. When this occurs, sugar is released in the brain.
Generally, insulin resistance in the brain means brain cells have a more difficult time moving glucose into the brain to make energy. That means that if you have insulin resistance and higher levels of sugar in your blood, that extra sugar may not be able to get to the brain. The best strategy to help ward off hot flashes and other menopause symptoms such as sleep problems is to maintain stable blood sugar levels with regular exercise and a healthy diet.
Here’s another thing that changing blood sugar levels can do: impact your mood. The brain runs primarily on glucose, so when levels are on a rollercoaster ride, emotions can be too. Researchers have shown that variability in glucose levels “may be associated with lower quality of life and negative moods,” such as anger, irritability, and feeling tense, depressed, and grumpy. These feelings can make it challenging to get quality sleep.
Hormone changes in menopause and blood sugar regulation
Fluctuations in hormone levels during perimenopause and menopause, especially estrogen and progesterone, have an impact on blood sugar regulation. When it comes to estrogen, pre-menopause levels of estrogen (as estrodial) can range from 30 to 400 picograms per milliliter (pg/mL). This drops to less than 30 pg/mL after menopause. For progesterone, pre-menopause levels are typically 1.5 nanograms per milliliter (ng/mL) and as high as around 150 ng/mL during pregnancy. After menopause, however, progesterone declines to less than 0.5 ng/mL. Thus the body’s ability to stabilize and control blood sugar levels declines as hormone levels change and drop.
Another hormone that plays a significant role in blood sugar control in perimenopause and menopause is insulin. Both estrogen and progesterone impact the activity of insulin, a hormone that helps the body use glucose. Prior to perimenopause and menopause, estrogen tends to help the body use insulin effectively, which means insulin sensitivity is good. When estrogen levels drop, however, insulin resistance can develop, which means the body doesn’t respond well to insulin and blood sugar levels rise. Dropping progesterone levels also impact insulin and reduce insulin sensitivity.
All of these hormonal fluctuations and declines and their effects on blood sugar ultimately affect a woman’s ability to get quality sleep. At the same time, sleep deprivation can make it more challenging to control blood sugar. One reason is that when you are experiencing poor sleep, levels of the stress hormone cortisol tend to rise. When cortisol rises, it provides the body with more glucose to help handle the stress. However, if cortisol levels remain high for a while, the hormone will keep producing glucose and cause an increase in blood sugar.
Something else can be going on at the same time. The elevated blood sugar levels related to cortisol can make your kidneys work harder to help eliminate sugar in your urine. This can result in getting up multiple times a night to pee. If you urinate a lot, you can then become dehydrated.
Here’s yet one more role cortisol may play in sleep problems in perimenopause and menopause. If you go to bed hungry or your blood sugar levels are low, you may wake up when your adrenal glands send out a burst of cortisol to raise your blood glucose levels.
Therefore, changes in the hormones estrogen, progesterone, and cortisol in perimenopause and menopause can have a significant effect on blood sugar and thus your sleep.
Tips to manage blood sugar and improve sleep
You can take a variety of steps to manage blood sugar levels through lifestyle changes.
- Exercise regularly. A combination of aerobic and anaerobic exercise at least five days a week can help keep blood sugar levels in balance. You may want to consult with your physician or an exercise therapist or professional to help you develop a program that best suits you.
- Eat a balanced diet. Focus on whole, natural foods such as fruits, vegetables, whole grains, legumes, and low-fat dairy. Foods high in soluble fiber (fruits, beans, dried peas, oats) are especially helpful for lowering blood sugar and maintaining insulin sensitivity. Greatly minimize or eliminate processed foods, fried and fast foods, added sugars, and alcohol.
- Get a continuous glucose monitor. This small device can help you track your blood sugar levels throughout the day and night and help you better plan your food intake and exercise activity. Discuss this option with your healthcare provider.
- Manage stress. To help keep cortisol levels under control, practice stress-reduction daily. Start the day with a short meditation or visualization; engage in deep breathing, tai chi, yoga, or brief brisk walks during the day to bring down stress levels.
- Adopt better sleep tips. Make some of these menopause sleep tips a part of your nightly (and daily) routine.
- Seek professional advice. If sleep problems continue despite all of your best lifestyle efforts, consult with a qualified professional. In some cases, hormone therapy may be helpful, and you may need to undergo a sleep study to determine if there are other factors affecting your ability to get quality sleep.
We know there’s a lot going on in your life, especially once perimenopause and menopause arrive. That’s one reason why understanding the intimate connection between hormonal changes, blood glucose balance, and sleep is so important. The bottom line is that if you don’t achieve good sleep, your quality of life and overall health will suffer, perhaps dramatically. Your health is your top priority. Integrate self-care tips into your daily life, seek professional medical help if the need arises, and you will find better, quality sleep and a richer lifestyle in perimenopause and menopause.