Perimenopause, Menopause and Sleep

Dr. Jessica Drummond (00:00:03) – Hi and welcome to the Integrative Women’s Health Podcast. I’m your host, Doctor Jessica Drummond, and I am so thrilled to have you here as we dive into today’s episode. As always, innovating and integrating in the world of women’s health. And just as a reminder, the content in this podcast episode is no substitute for medical advice, diagnosis, or treatment from your medical or licensed health care team. While myself and many of my guests are licensed healthcare professionals, we are not your licensed healthcare professionals, so you want to get advice on your unique circumstances. Diagnostic recommendations treatment recommendations from your home medical team. Enjoy the episode. Let’s innovate and integrate together. Hi, and welcome back to the Integrative Women’s Health Podcast. I’m your host, doctor Jessica Drummond. So today we are going to deep dive into exercise strategies and supplement strategies for optimal sleep in perimenopause and menopause. This is probably the number one complaint that myself and the health coaches that we train, and the students in our community, their clients, are all struggling with sleep.

Dr. Jessica Drummond (00:01:36) – So if you’re a women’s health or wellness practitioner, two things I hope you get out of this episode. First of all, I know you are also struggling with optimal sleep, so I really hope that you feel inspired to make some tweaks in your own self-care routine. Then utilize your really skillful coaching skills, your mindful listening, your reflections, your powerful questions, your storytelling metaphor, all of those tools to help see where your clients foundational strategies around sleep can be changed. Look, all of our clients are looking for just the golden pill that helps with sleep, but the reality is that that doesn’t, on its own, exist. We also have to put into place the health behavior foundations to optimize sleep. So I want to talk briefly about a study, a systematic review that came out in 2023, published in Frontiers in Medicine. And this systematic review and meta analysis reviewed 17 papers and then did a meta analysis on ten of those papers. And we’ll make sure we give you the link to the study in the show notes.

Dr. Jessica Drummond (00:02:55) – But there are a couple of key things I found most essential when thinking about exercise strategies for your clients in perimenopause and menopause, when they are struggling with sleep. So one of the things our clients will often intuitively do is just try to exercise more, just try to tire themselves out. But in these papers, they found that two very simple kinds of exercise. And there wasn’t, unfortunately, a lot of real specificity in the data that we have on exercise and sleep. You know, there’s not a lot of studies. There’s not tons and tons of research on whether strength training is better or yoga is better or whatever. Yoga was interestingly not found to have significant impact on sleep, but in these papers, they did find two kinds of exercise that did impact perimenopausal and menopausal sleep. And those were walking and mindful exercise, which is interesting because I think you could probably put yoga in that category as well. But specifically what they found was that this specific kind of exercise, mindful exercise and walking, decreased insomnia severity, alleviated sleep problems.

Dr. Jessica Drummond (00:04:14) – And especially for those women that were struggling with sleep disorders. So they had some kind of sleep diagnosis. Exercise was found to improve sleep quality, not so much found for people that were already sleeping okay. It didn’t really change that significantly. And so I think what’s most important about this data is that having our clients get outside and literally just getting their steps in is a key foundation for sleep quality in perimenopause and menopause. Now, the other thing I think we need to think about is this was not high intensity exercise. Most women in perimenopause and menopause will eventually benefit from some kind of higher intensity exercise for like optimal cardio training. And then we do want heavier strength training for muscle building, which is very protective both of quality and quantity of life in the later years and the midlife, you know, 40s and 50s and 60s and perimenopause and menopause transition is when your clients will need to be setting that muscle building foundation for those benefits. But if they’re struggling with sleep and day to day recovery, first we have to optimize that hypothalamic pituitary adrenal axis.

Dr. Jessica Drummond (00:05:40) – So before the heavy exercise begins to be slowly integrated in our job as women’s health and wellness professionals is to really assess their nervous system regulation, their hypothalamic pituitary adrenal function, how stress resilient. Are they? And then put the pillars in place to optimize that stress resilience before adding heavier exercise stress and then concurrently with that. But first, just to get those quick wins around sleep. Are your clients taking, you know, those 10,000 steps outside? It can be five short walks a day, could be a walk to and from work. It could be a walk to and from picking up kids from school or the grocery store, those functional day to day walking. It could be a long walk with a friend. It could be a long walk to listen to a podcast or music, or to just chill out in nature. That mindful movement activity, ideally outside for other benefits, not necessarily sleep benefits, but that certainly couldn’t hurt, as we add that in as this foundational movement. It’s really interesting when your clients start tracking on their wearable devices, which is what most of our students and client graduates have their clients do, is tracking that every day activity.

Dr. Jessica Drummond (00:07:06) – And that’s where we see these huge benefits, even to people who have sleep diagnoses. If you look at the blue zone cultures, what are people doing day in and day out? Walking to the store, walking up and down hills, walking to the farmer’s market, walking on the farm. Walking to cook. Walking to their neighbors. There’s a lot of day to day functional walking. And if we can start integrating that in our clients lives as a sort of foundational movement practice, that can make a huge difference for their sleep quality, because it also affects other menopausal symptoms, it can help reduce vasomotor symptoms. It can help with the metabolic changes of perimenopause and menopause. All right. And now let’s get into part two of this episode where I want to talk a bit more about the direct Golden pills. Right. Because your clients putting in those steps is foundational. And very specifically, we want to do it mindfully, consistently small bouts, longer bouts, you know, in a way that’s really feeling good and nourishing.

Dr. Jessica Drummond (00:08:13) – And then we want to look at the biochemistry of sleep and how we can help our clients directly support their brains using evidence based nutrient supplements. We have a deep dive blog post on this. Go to the website at Integrative Women’s Health institute.com. Go see the blog and you’ll read even more on some of the herbal supplements. But let’s deep dive into a few of the nutrient supplements today. So first is L-theanine. That is a component of green tea. One of the reasons why green tea is so good for people. And this molecule helps to modulate three of the very important neurotransmitters for sleep serotonin, dopamine and Gaba. So we can add l-theanine as a precursor to these neurotransmitters that settle the nervous system and support sleep. So specifically, in perimenopausal women, the intervention of adding l-theanine helped with all three falling asleep, staying asleep, and sleeping longer. And I really like to think about. So not only can we use L-theanine to modulate these particular neurotransmitters, we can directly use the neurotransmitters in some cases. So we could also directly add Gaba.

Dr. Jessica Drummond (00:09:39) – We could also use CBD oils to modulate the endocannabinoid system which impacts Gaba and Gaba receptors. So Gaba is this like calming, sleepy brain neurotransmitter that I think is one of the tools that is not used enough because perimenopausal and menopausal women who have sleep problems also have commonly this sort of, I like to call it body anxiety. So if your clients are feeling like they’re tense, generally their bodies kind of holding their anxiety, their pelvic floor, their your their neck, their shoulders are holding their anxiety and they’re having trouble sleeping. In that case, it’s going to be really valuable to support Gaba. So you can do it directly or you can use l-theanine. The next nutrient supplement I want to talk about is magnesium. We have data in general for absolutely everyone. So you can, you know, start with giving teenagers this men, women who are not perimenopausal or menopausal. We do have some specifics in menopausal women, but for everyone, optimal levels of magnesium and there are many different kinds of. Museum.

Dr. Jessica Drummond (00:10:59) – Magnesium glycine eight is the best absorbed. Magnesium citrate is valuable. If someone is having trouble with constipation, it can help with bowel function or magnesium L3 and eight, which can actually be absorbed more easily inside of the brain. So think about the quality and chelate of magnesium you’re helping your clients choose depending on their challenges in general. For everyone. Optimize magnesium levels, help to decrease daytime sleepiness, decrease snoring which many people appreciate it, maybe slip it in their partners nutrient stack for the evening and increase sleep duration at night. And then specifically for perimenopausal women, magnesium is found to decrease mood swings, decrease myofascial pain. So imagine if you’ve got someone with a low magnesium and low Gaba. They’re just walking around so tense, so tight. Their body is physically telling their brain that there’s something to be concerned about. And so it’s going to be very hard to fully relax the system, to fall and stay asleep. There’s going to be a level of hypervigilance if the whole body is tense and in myofascial pain decreases, anxiety decreases perimenopausal menstrual migraines decreases period pain in general decreases hot flashes and increases bone mineral density, decreasing fracture risk in this high risk population.

Dr. Jessica Drummond (00:12:32) – All right. So we’ve got l-theanine modulating Gaba also serotonin and dopamine. And really thinking about the brain neurotransmitters as a way to settle the whole nervous system. And don’t forget the nervous system is not just the brain. The nervous system is all the peripheral nerves, the spinal cord, the fascia where the nerves live, the lymph and the circulatory system where the nerves are fed and where wastes are brought away. So this whole sensation of the whole animal, the whole body, the whole mind, the jaw, the neck, the pelvic floor, the lower abdomen, the shoulders being able to deeply relax is related to optimized quantities of these brain neurotransmitters, particularly Gaba. I see this physical body anxiety so, so often in this population. And then magnesium is a next layer of support for that physical body anxiety. All right. And then finally I love this little oral peptide. It’s a small casein peptide. So even if your clients are sensitive to dairy they can often tolerate this. It’s called lactam. And this is a little casein peptide that is found in breast milk.

Dr. Jessica Drummond (00:13:49) – So if you think about those little babies who drink their breast milk and then they fall right to sleep, it’s because of this little sleepy peptide. And there was a randomized controlled trial published in the journal nutrients in 2019 that looked at doses of 300mg of lactam each day in a population of subjects, which was about 65% perimenopausal and menopausal women in this population with 300mg daily of lactam. Increased total sleep time, increased sleep efficiency, both subjectively but also objectively when measured on active safety and decreased sleep latency, so they fell asleep more quickly, also measured better objectively, and decrease number of times waking up in the night and plus, when this was given or dairy products in general were given with l-theanine. So circling back to the first nutrient we talked about, the benefits were even better. So what’s your action step here? Okay, it’s time for you to go back to your practice and start surveying the perimenopause and menopausal women that you’re working with. Ask them directly. Are they having trouble with their sleep? What is their sleep hygiene looking like? What exactly are their sleep challenges? Is it falling asleep? Staying asleep? Amount of time of sleep? Deep restorative sleep, sleep quality.

Dr. Jessica Drummond (00:15:17) – What’s going on there? Have they set that foundation of daily mindful movement? And getting those steps in is so, so valuable. And then layering on top of that, really nourishing the neurotransmitters throughout the nervous system with l-theanine or other Gaba support strategies. Magnesium and lactam. All right. You’ve got your marching orders. I hope that was super valuable for you and your clients. And I’ll see you next time. Thank you so much for joining me today for this episode of the Integrative Women’s Health Podcast. Please share this episode with a colleague and if you loved it, hit that subscribe or follow button on your favorite podcast streaming service so that we can do even more to make this podcast better for you and your clients. Let’s innovate and integrate in the world of women’s health.