The Practical Guide to Getting Enough Sleep During Menopause
We talked to sleep expert and biologist Hasti Nazem about how to tame hot flashes -- and finally get some rest
Sponsored by Kindra
Hasti Nazem, Head of Product and Education at Kindra, is no stranger to reinvention. She grew up sure she’d become a doctor (there are 12 physicians in her family), but instead found herself on Wall Street at the precipice of the financial crisis. From there she pivoted into startups, and worked on a company whose main goal was to reinvent the way we approach sleep.
Nazem brought that expertise to Kindra. Here, she shares practical advice and tactics for all things sleep and menopause – how to fall asleep, stay asleep, and keep from waking up in a puddle of night sweats.
Lesley Jane Seymour: Let’s talk about sleep. I think people would probably say sleep is the most disruptive part of menopause. You know, you can live with the sweats. They’re uncomfortable, but you can’t live without sleep. So can you explain what is going on with menopause, and why your sleep is interrupted? With mine, I remember I had to get some sleep medication because I was sweating so much at night, it was waking me up. I was getting hot and cold and sweating and cold and hot. And so that definitely was a physical factor. But what else is going on with sleep?
Hasti Nazem: Sure. First I’ll do a really quick rundown of what’s happening on the cellular level, because I find that the more I can educate on what’s happening, the less anxious we feel. lf we can name what’s happening, then we can sort of address how it presents itself or manifests itself physically.
So a very simple, high-level understanding of menopause and sleep as far as the mechanics go is that when you approach menopause and go into post-menopause, over time there’s an overall marked decline in estrogen and progesterone. People tend to think that one day you wake up and you stop producing these two hormones. That’s not the case. It fluctuates over time.
And the decline overall is what is playing a factor in certain things that are impacting sleep. This can include a structure in the brain called the hypothalamus. We’ll just call this a switchboard. The switchboard is sending signals all over the body, tons of messages. And estrogen is one of the regulators for those messages. So when estrogen starts to decline over time, as we age, the switchboard gets dysregulated. It’s no longer clear how to systemize your sleep cycle the way that it used to.
Now, there’s a small gland in the hypothalamus/switchboard called the pineal gland. That helps systemize your circadian rhythm. When we’re younger, it pretty clearly understands what to do throughout the day. From the morning, you have higher cortisol, because cortisol helps you get through the day. And then as you approach evening, you have melatonin being produced in more amounts. But it all gets dysregulated as we age.
So that’s what’s happening from a more technical standpoint. But the way that it can present itself as it relates to menopause is that that same switchboard is not just impacting your sleep cycles, your circadian rhythm, but also your body temperature. So that’s why the hot flashes and night sweats come in.
Hot flashes and night sweats mechanically are pretty much the same. It’s just, does it happen during the day, or does it happen at night? And up to 85 percent of women in menopause experience these episodes, so it’s a very, very common symptom. It can last 30 seconds, it can last five minutes. And what’s even more interesting, some women can actually experience them for up to seven years. So they might not be the same level of occurrence in all women. And not every woman who experiences menopause has them.
But when you do, it can have a pretty adverse impact on sleep. Because you may wake up throughout the night. I mean, some women tell me they’ve soaked their pajamas.
Seymour: Oh, yes. Oh, I’ve been there. Yeah. You have to take it off. And I’m sleeping with the fan on. And then there’s the part about having anxiety about even falling asleep.
Nazem: Yes, you’re waiting for that night-sweat to kick in. So then, obviously, if you’re being woken up throughout the night, or just not sleeping as well, if you’re feeling a little bit more stressed than usual, that can also be because the melatonin secretions which would normally tell your body it’s time for bed aren’t kicking in as they should. And actually, the higher levels of stress for women over 50 can contribute to cortisol not tapering off throughout the day. It might still remain high, even at night. So that’s going to contribute to keeping you awake as well, because you may be feeling anxious, or experiencing a bout of depression, which is preventing you from calming down and falling asleep.
So it’s really, really interconnected. And it’s quite complex. But I really like talking about it on this high level, so that everyone can kind of take away from them what resonates with them, and kind of run with that into their research. Like do I feel like I can’t fall asleep? Or do I feel like I can’t stay asleep? These are two separate questions that we could, you know, talk about all day long.
Seymour: Let’s talk about falling asleep. What are the solutions that are OTC, and what are the solutions that we can change ourselves? I mean, there is a lot of research out there telling us to shut the damn computer off and get off the blue light, because the blue light is suppressing our melatonin, from what I understand. So what are the things that we can start with?
Nazem: Well, I’ll hop on the blue light comment quickly, because it’s becoming something that’s like in every article. But I think it’s kind of glossed over. And we don’t really fully understand. But I want to remind us, there’s scientific basis and all of that. There’s a cluster of cells in that hypothalamus that I was talking about, that actually registers light as a cue to signal the rest of the pathways that it’s time for bed. And so when we’re impacting that adversely, with all of the blue light exposure, there is direct impact.
So this sounds really silly, but I’m a tactical person. And I always say, what are the tiniest, most tactical and practical things I can do first, to start addressing this? Number one, a very simple device I have is a blue light filter. Hop on Amazon, please, and get it on your laptop, get it on your cell phone, get it on your iPad, get it on every device that you have. It’s very simple, and it’s a very cheap way to reduce some of the exposure that you’re getting throughout the day and into the night.
The second thing we definitely say without question is we’re binging Netflix on our laptops, even if the TV’s not in the room. This is something I dealt with for six, seven years in sleep wellness. People say, I don’t have a TV in my room anymore. It’s like, oh, but aren’t you on Tik Tok? Watching dog videos until…let’s be honest about that.
Another thing I’ve talked to a lot of women about is creating an actual ritual that works for you. Meditation and mindfulness are incredibly impactful for reducing cortisol. The science is there. But maybe you’re just not there. Maybe it’s not what you want to do. Maybe you’re going through something really hard, and you don’t want to sit there and meditate on it. I understand. So I’m all about finding options that work for you.
One of the easiest rituals that we developed over a few years and that now I’ve brought it into Kindra, specific to menopause, is a bathtime ritual. We create bath products that are specifically made for the shifts that are happening in your body when you’re postmenopausal.
Seymour: So let’s get tactical. I will just tell you that I’m a bath junkie. That definitely unwinds me – you could find me in a bath every single night. And I know you guys have some bath products, because some people find that they get extremely dry. And it hurts the vaginal wall. Right?
Nazem: Yeah, that’s one of our new products. I was researching bath products last summer. And you know, I developed and sold a bath product seven or eight years ago that was sleep-focused, that had sleep-inducing extracts. And not once did vaginal pH come up in those eight years. But then when I’m studying menopause, I thought, ‘wait a minute, the vaginal pH is shifting and it’s actually becoming more alkaline. it’s higher on the pH scale, as a result of the estrogen decline.’
That’s resulting in very dry, sensitive, intimate skin that can be really, really uncomfortable. And then I thought, ‘well, bath products typically do have a high pH. So why are we soaking in something that’s only going to contribute to the discomfort?’ So we specifically formulated a product hand in hand with my chemist and our OB/GYN advisors. Because I didn’t want to just understand this from a perspective of the chemical structure of the formulation. I really want to also understand it from a clinical perspective. And we developed a product that did exceptionally well in consumer studies. And it was really exciting because it wasn’t just wow, finally, like vaginal dryness used to keep me up because I was so itchy and uncomfortable and inflamed. And now I have something that I can soak in to quell that discomfort, and calm me down a bit.
Seymour: What about journaling?
Nazem: So the journaling, we talk about this a lot. One of the recommendations we have is cognitive behavioral therapy. It helps us target those anxious thoughts you’re having at night, the ones that are preventing you from falling asleep. And it helps you negate each of them, one by one.
I brought in a personal friend, who is a psychotherapist and has worked directly with women experiencing chemotherapy due to breast cancer at UCLA. And I said, ‘Can you help us put together some cognitive behavioral therapy journal prompts for menopause? What does that look like?’
And what we came up with is very specific to menopause. For example, ‘These hot flashes are never going to end.’ ‘I’m going to have this the rest of my life.’ ‘This is going to ruin my life.’ ‘I’m never going to recover.’ Okay? That’s not 100% true. It’s frustrating. It’s not fun, but it is temporary. So how can you negate that thought?
So we thought, all right, we’re gonna put that on our site. Download this, go print it, read about it, create your own journal. And it’s not going to be, you know, 123, I’m grateful for XYZ. Do that if it works, but here’s what works for me, and what works for a lot of the women that I speak to in our Kindra community:
It’s called automatic negative thoughts. You put down the negative thought that is looping through your brain all day, all night when you’re going through this really uncomfortable transition. And next to each automatic negative thought, you write what may actually be based in reality or truth. And if there’s something that’s really, really bothering you and keeping you up or causing you anxiety, and it is true, maybe that’s the direction you can ask for some help, or find a solution.
The solutions can be as small as, ‘I’m going to buy a cooling mattress pad. Because my mattress pad is making me very hot.’ Or it can really be psychological.
Menopause, from what I’m understanding from the women who are always so open and candid with us, is making you feel like you’re out of control of your own body. A body that you spent decades becoming familiar with. And you feel overwhelmed. Where do you start?
And first of all, no one is alone in that. And second of all, the odds really are against you. It’s very frustrating. Every organ in your body has an estrogen receptor. Your estrogen is having an overall decline, and it was helping to regulate so many things. You’re not crazy, there’s nothing wrong with you. There’s just shifts that are happening to your body that of course women are experiencing 10x compared to what men go through – yet another thing.
So we try to really break down the solutions. Is it a journal? Is it, like I said – I’ve been a hot sleeper since I was a kid, so a cooling mattress pad has been one of the best investments I have made. I am not sponsored by anybody. I don’t know anyone. I just ordered one online.
And then we pair them all. So back to the ritual that I was talking about earlier. In my last business, I had a sleep mist that had sleep-inducing botanicals in it. So I use that as my cue. When I take this mist out, it’s time for bed. And in reading about menopause, I thought, well, I know that misting has been a really helpful part of developing a bedtime ritual, because you don’t want your ritual to feel like a chore. You want it to feel like something that you enjoy.’ And so we developed one that’s a cooling agent, that’s clinically shown to cool the skin for at least two hours. And it’s developed with a peptide for sensitive skin. So we’re kind of creating these all-in-one tools that can be your go-to.
And what’s helpful is in consumer studies we filtered out the women who said that their night sweats, and especially their hot flashes, were very disruptive. I wanted to know, ‘does this work if you’re literally feeling terrible throughout the day and terrible throughout the night, because of this, this, you know, flashes of heat and discomfort?’ And 100% of women reported an improvement in the severity. And it’s because we actually explained to them, if it’s before bed, you can do your misting ritual 20 minutes before you go to sleep so that you can actually already feel cool before sleeping, and take away some of that anxiety. And two, if you can actually have it with you on the go, and you’re experiencing that hot flash, can you just take a couple minutes to breathe – all those amazing meditative rituals that we’re all starting to incorporate into our lives. Just add another product to it that will actually physically cool the skin. And you can kind of feel calmer and cooler throughout the day or throughout the night.
So I’m trying to target sleep very, very specifically. Because the other symptoms, like brain fog, mental clarity, mood, fatigue, all those things that are impacting women, are worse if you can’t sleep. You know, I don’t want half this planet to be walking around like zombies from lack of sleep. And if something as simple as cooling the skin can help, let’s do that. It’s very tactical, it’s very practical, super easy.
Seymour: Let’s talk about staying asleep. Because that’s the other half of the problem, right?
Nazem: Sure. So what’s happening there is that a night-sweat can actually trigger adrenaline. If you are woken up, I suggest disconnecting from what woke you up. Keep some type of cooling agent or water or something in your nightstand. Even if it’s like a bit of lavender or something like that. Can you go to the bathroom for just a minute and rinse your face? You don’t want to stay in that exact mode that you were in, because that’s sometimes how the anxiety gets impacted. And remember that to stay asleep, the more that you do in your bedtime ritual, the more likely you can reduce the chance of actually waking up throughout the night.
Seymour: Interesting. So an investment earlier on, that 15-minute routine, what a difference it can make. Okay, and where does meditation fit in? For those of us who like meditation? I mean, I use meditation to go back to sleep. It definitely helps me.
Nazem: Well, I definitely found for those years in sleep wellness, I ran sleep wellness workshops across the country. And we’d have hundreds of women who told us they couldn’t sleep. And we would set up a yoga mat, we would set up all these sleep-inducing products around them, and we would teach them these nighttime stretches. But what was key turned out to be that meditative part.
Sometimes I think we define meditation as ‘put on a very specific kind of music and hold your hand to your heart.’ And yes, that’s all great. But not everyone can reach that state so easily, especially those of us who are very wound up. Or maybe feeling like you’re going from 100 to zero at night is not feasible for everyone, depending on your job, depending on if you have kids, depending on your schedule. But that meditative state may also be reached with some movement.
What helped me was to redefine that meditation. It doesn’t have to be sitting in the spot and shutting down all your thoughts and not moving. Maybe it’s meditating through those breathing rituals, through those stretches, through those relaxing activities. Maybe it’s in the bath before bed. So I invite women who are looking to incorporate meditation into a better sleep habit to define what that means for them. It doesn’t have to be the quintessential definition of meditation that we think about. Make it easier for you to try a new habit so that you’re not going to consistently feel like you’re failing at it.
Seymour: Wow. Incredible, Hasti. A lot of those things I have not heard. So thank you – those are really different. And I love the fact you’re so practical about it. Because as we know, it doesn’t do anybody any good if we can’t implement it.
Nazem: And when women are sleep deprived, or feeling fatigue, what are we going to do? Throw out a 10-step program by which tool we know, let’s recognize that we’re tired when we take on so much at a time. So just shift the behavior one little step at a time, be really gentle with yourself, and you know, eventually you can get there.
And always remember that if the sleeplessness does not go away with some of the easier tactical things or lifestyle habits or changes, it’s always helpful to talk to your physician. Because women post-menopause are two to three times more likely to experience sleep apnea, which is an important condition to treat. So I’ll leave that nugget right there.
As a reminder, you can earn 20% off Kindra products to build a better sleep routine using promo code COVEY20.