Sleepy Secrets: Navigating Menopausal Sleep with Integrative Wisdom

Dr. Valerie Cacho is double board certified in sleep and integrative medicine.  She is passionate about inspiring her patients to obtain optimal sleep health and wellness through integrative, holistic and lifestyle medicine approaches. She is also an expert in the field of women's sleep health and is the founder of Sleephoria, an online educational company promoting sleep health and whole living for women. She also creates videos about sleep tips on YouTube. 

Leslie: Can you tell us about your background and how you became a sleep expert?

Valerie: I’m an integrative sleep medicine physician and women's sleep expert. I got into this field because I wanted a career where I could balance family life with meaningful work. I was inspired by a family friend who was a sleep doctor, and after hearing him speak about the importance of sleep, I fell in love with the field. Over the years, I noticed that many women, particularly those in midlife, struggle with sleep. I knew there had to be more we could do beyond just prescribing sleeping pills or conducting sleep apnea tests. So, I dove deep into understanding women’s sleep, especially during perimenopause and menopause.

Leslie: Why is sleep so important for women, especially those in perimenopause or menopause?

Valerie: Sleep impacts almost everything! It affects weight, metabolism, immune function, heart health, blood pressure, and even dementia risk. As we age, sleep becomes even more critical. Hormonal changes during perimenopause and menopause can make sleep more challenging. Poor sleep can make it harder to stay healthy, exercise, or even prepare nutritious meals, which is why sleep is foundational for overall well-being.

Leslie: What specific hormonal changes during menopause impact sleep?

Valerie: During perimenopause and menopause, levels of estrogen and progesterone fluctuate and then decrease significantly. Progesterone, for example, helps with relaxation by working on the neurotransmitter system in the brain, particularly the GABA system. When these hormone levels drop, women may find it harder to relax and sleep. Up to 60% of women experience sleep disturbances during this phase due to these hormonal changes.

Leslie: Are there other factors, beyond hormones, that disrupt sleep as we age?

Valerie: Absolutely. As we age, we naturally get less deep sleep and more light sleep, which can leave us feeling less rested. Additionally, health issues like diabetes, high blood pressure, or even the medications we take can affect sleep. It’s not uncommon for sleep disturbances to be brushed off as “just part of aging,” but it’s crucial to look deeper and address the root causes.

Leslie: How can women tell if they are experiencing sleep disturbances that need attention?

Valerie: Some clues are feeling tired during the day, needing more than two or three cups of coffee to function, or falling asleep in meetings. If you wake up frequently at night, especially around 2 or 3 AM, and find yourself staring at the ceiling, this could be another sign. Sometimes women attribute their fatigue to being busy, but it’s important to consider whether sleep quality or quantity is an underlying issue.

Leslie: What are some practical tips to improve sleep for women experiencing (peri)menopause?

Valerie: First, understand that sleep is a passive process. You can’t force it, but you can create conditions that support it. Start by recognizing your body's natural sleep cues—when your eyes get heavy or you start yawning, that’s your body telling you it’s time to sleep. Sticking to a consistent bedtime routine is key, just like we do with our kids. Adults benefit from a wind-down routine too, whether that’s reading, taking a bath, or listening to calming music. It’s also important to avoid over-stimulating activities before bed. Avoid screens, especially phones, as they not only emit blue light that disrupts melatonin production, but they’re also tied to work, entertainment, and social media, which can keep your mind too active.

Leslie: You mentioned that hormonal changes raise body temperature, leading to night sweats. How can women manage these symptoms?

Valerie: Yes, fluctuations in estrogen can cause your body temperature to rise during the night, leading to night sweats or hot flashes. To manage this, keep your bedroom cool and wear breathable fabrics to bed. Even subtle changes in temperature can trigger awakenings, so keeping your sleep environment as comfortable as possible can make a big difference.

Leslie: What should women do if they wake up in the middle of the night and can’t fall back asleep?

Valerie: One common issue during menopause is early morning awakenings, around 2 or 3 AM, where women wake up and can’t get back to sleep. If this happens, the best thing to do is avoid looking at the clock or reaching for your phone, as this can increase anxiety. Instead, focus on calming your mind with relaxation techniques like deep breathing, or even getting out of bed and reading something light.

Leslie: How can lifestyle changes during the day support better sleep at night?

Valerie: There’s a lot you can do during the day to support your sleep at night. Exercise is great—it helps tire you out physically, so you’re ready for rest. Also, pay attention to your diet. Foods high in fiber and magnesium, like leafy greens and nuts, can support better sleep by helping to relax muscles and calm the brain. Avoiding caffeine and alcohol close to bedtime is another crucial step.

Leslie: What about the relationship between sleep apnea and menopause? Should women be aware of this?

Valerie: Definitely. Obstructive sleep apnea becomes more common as women go through menopause, with the rates doubling or even tripling. It’s often underdiagnosed in women because we don’t always present with classic symptoms like snoring or gasping for breath. Instead, women might experience morning headaches, vivid dreams, fatigue, or irritability. If you’re consistently waking up tired, it’s worth getting tested for sleep apnea, even if you don’t think you fit the typical profile.

Leslie: Where can women find more resources or connect with you if they need help with their sleep?

Valerie: If you’re looking for resources on improving your sleep or want to connect with me, I run an online platform called Sleephoria where I offer sleep tips and advice specifically for women. You can visit my website or check out my YouTube channel where I share tips on sleep health and whole living. I believe that a well-rested woman has the energy, clarity, and drive to change the world, so I’m passionate about helping women improve their sleep.

Leslie: What’s your final advice for women struggling with sleep issues during menopause?

Valerie: My advice is to take your sleep seriously. If you’re feeling tired, it’s not something to brush off as normal or just a part of aging. Whether it’s improving your sleep environment, addressing hormonal changes, or talking to your doctor about potential sleep disorders like apnea, there are steps you can take to improve your sleep. And remember, good sleep is essential for everything else—when you’re well-rested, you have the energy, clarity, and focus to tackle whatever life throws at you.