A Conversation with Jess White, BRIA’s Sleep Support Therapist 

Jessica White has a wealth of experience when it comes to getting a good night’s sleep. In this article, she helps us understand how sleep changes during pregnancy and perimenopause and how to deal with sleep anxiety.

BRIA: How do you help with sleep challenges in pregnancy?

Jess: During pregnancy, many women experience disrupted sleep due to physical discomfort or feeling overwhelmed or anxious about the changes that are going to occur in their lives.  I try to normalise this difficulty. Many moms feel pressure to get lots of sleep when they are pregnant, but it’s important to understand that they may have difficulty sleeping for many reasons. My goal is to figure out manageable ways for women to get as much sleep as possible. This could look like “chunked sleep,” where instead of sleeping in one large chunk of time during the night, sleep takes place in two or more sessions. Or, it may mean getting help from a caregiver or other parent if there are other children in the family, so that the pregnant person is able to prioritise their sleep. It’s important to take the pressure and stress off of sleep, because this can exacerbate sleep anxiety. Whatever needs to be done to take a more realistic and softer approach to sleep is often very effective. 

BRIA: How do you help with sleep changes in perimenopause?

Jess: Not surprisingly, sleep issues are among the most common and bothersome symptoms for perimenopausal women. It has been reported that women experiencing perimenopause have four times more difficulty falling asleep and are twice as likely to be dissatisfied with sleep than premenopausal women. 

During perimenopause women can experience symptoms such as hot flashes that lead to prolonged wakefulness during the night. The common assumption is that the hot flash is causing the arousal and this may be true for many people. However research has shown that there is brain wave activity or an arousal in the central nervous system that may precede the hot flash. Consequently, addressing stress management and understanding the factors or behaviours that inadvertently perpetuate sleep issues are important for treatment for this population.  Understanding an individual’s sleep timing, routines, responses to not sleeping, beliefs about sleep and current coping strategies through a biopsychosocial framework is achieved through an initial interview, and tracking specific sleep markers in a journal for a week.

Furthermore, not all sleep challenges are related to hormonal changes. Women in midlife often have multiple roles and responsibilities, such as looking after ageing parents, managing families and households, career transitions and fostering meaningful relationships. All of these demands make it challenging for women to prioritise self care, which can worsen perimenopausal symptoms such as irregular periods, hot flushes, mood changes, vaginal and bladder problems, and changing cholesterol levels. Along with those physical symptoms, the elevated levels of stress and burnout often experienced during this time, can lead to disrupted or unsatisfying sleep and waking feeling unrested. 

When working with women experiencing perimenopause, it is important to meet clients where they are as making changes can feel like another task on an exceedingly long list. My approach is trauma-informed, collaborative and strengths based, incorporating evidence-based theory from Cognitive Behavioural Therapy for Insomnia (CBT-I), Solutions Focused Therapy and Mindfulness. 

BRIA: What is “sleep anxiety” and what are some tips to deal with it?

Jess: Sleep anxiety is a feeling of distress or worry about not being able to fall asleep or back to sleep. It can begin early in the evening when thinking ahead to bedtime, the moment one gets into bed, or when lying in bed awake in the middle of the night or early mornings. Thoughts about not being able to fall asleep or concern about not being able to function or manage the next day without sleep, cause physical sensations in the body such as increased heart rate, shallow breathing, and tense muscles. These physical reactions make it difficult for the body and mind to relax enough for the sleep process to occur. Although sleep anxiety is commonly associated with sleep disorders such as insomnia, restless leg syndrome, and sleep apnea, it can also occur for those experiencing grief, anxiety or depression.

To manage sleep anxiety I recommend following these strategies:

1. Only go to bed when you are sleepy.
2. Get out of bed if you notice you are worrying or feeling distress.  Do a quiet activity in low level lighting and return to your bed after 20-30 minutes.
3. Change the goal at bedtime from falling asleep to resting.
4. Remind yourself that it is normal to have a few nights of imperfect sleep. Use positive self talk to tell yourself that you are okay, that you are safe and that your body will take care of you.  
5. Practise resting for 10 minutes during the day. Yoga Nidra (*I like guided practices from Jennifer Piercy on Insight Timer–see link below) is an excellent practice for deep relaxation. Alternatively, try guided meditations or deep breathing; release muscle tension and slow down the breath to an inhale and exhale of 5-6 counts. Repeat for 10 minutes.  A daily rest practice will help your body return to this state at night when you get into bed.

Guided Yoga Nidra Practices:

Ally Boothrood – link

Tracee Stanley – link

Jennifer Piercy – link

References:

de Zambotti, M., Sugarbaker, D., Trinder, J., Colrain, I. M., & Baker, F. C. (2016). Acute stress alters autonomic modulation during sleep in women approaching menopause. Psychoneuroendocrinology, 66, 1–10. https://doi.org/10.1016/j.psyneuen.2015.12.017

Lee, J., Han, Y., Cho, H. H., & Kim, M. R. (2019). Sleep Disorders and Menopause. Journal of menopausal medicine, 25(2), 83–87. https://doi.org/10.6118/jmm.19192

Meers, J. M, Dawson, D. B. & Nowakowski, S. (2022). Chapter 16 – CBT-I for perimenopause and postmenopause. In Adapting Cognitive Behavioural Therapy for Insomnia. Academic Press, 333-346. https://doi.org/10.1016/B978-0-12-822872-2.00011-6.

Zhou, Q., Wang, B., Hua, Q., Jin, Q., Xie, J., Ma, J., & Jin, F. (2021). Investigation of the relationship between hot flashes, sweating and sleep quality in perimenopausal and postmenopausal women: the mediating effect of anxiety and depression. BMC women’s health, 21(1), 293. https://doi.org/10.1186/s12905-021-01433-y