Midlife Sleep Disruptors (and How to Get Your Zzz’s Back)
By Dr. Bill Rawls Posted 08-27-2021

Is sleep a nightly battle for you? If so, you have plenty of bleary-eyed company, since at least 10-30% of adults suffer from sleep disorders, according to SleepFoundation.org.

Even folks who slept easily when they were younger are often perplexed in mid-life when the sleep fairy takes a hiatus. The amount of deep sleep—the good stuff—starts to wane as early as our thirties. It helps to understand why sleep can be so elusive. Why now, in mid-life?

Hormones

close-up stressed woman in bed at night

Most women notice a big sleep change at menopause as estrogen levels decline and hot flashes, night sweats and sleep become challenging. Part of that equation involves the hypothalamus, a walnut-sized part of the brain that regulates sleep, body temperature and more. Some women may choose hormone replacement therapy (HRT) to help alleviate symptoms. While HRT is not completely without potential risks, it does often resolve the sleep issue. Women who do not have that option (or decline it) may benefit from herbs such as ashwagandha, L-theanine, and ReloraTM. That last one is a combination of two Chinese tree barks, Magnolia officinalis and Phellodendron amurense; it helps to ease the symptoms of menopause, in general.

Though men do not have the equivalent of menopause, they are not immune to mid-life sleep disruption. Low testosterone levels can shake up the sleep cycle. According to a 2008 study reported in the Journal of Clinical Endocrinology and Metabolism, men 65 and older who had lower testosterone levels were more prone to reduced sleep efficiency, night awakenings, and less restorative sleep. There are some natural ways to help support testosterone production such as taking herbs like shilajit, rhodiola, rhaponticum, epimedium and ashwagandha. Pine pollen is another natural testosterone booster that can be added to smoothies.

Men are also more prone to develop sleep apnea, which may include excessive snoring. In sleep apnea, the airway can become temporarily blocked, and the body’s response is to awaken you. This can happen several times a night, leaving you drained in the morning. This condition sometimes requires medical intervention. For information on alternative therapies for sleep apnea, read Breathe by James Nestor.

Let’s spotlight the main hormones that keep us up at night: adrenaline and its sidekick, cortisol. Adrenaline is that hormone that gets your heart rate up when you have any kind of stress. It is quickly followed by a wave of cortisol, which keeps you alert and awake. And cortisol is produced in response to any kind of stress, real or perceived. Watching an action movie this evening? Your brain senses the stress, even if you are just lounging on the couch. Thanks to cortisol, you’ll likely be replaying that movie in your head until the wee hours.

frustrated woman at her work desk

Sleep and stress are intertwined, says Dr. Singar Jagadeesan, board certified physician in neurology and sleep medicine. Poor sleep leaves us a bit edgy in the morning, which makes us more sensitive to any bit of stress; in turn, that stress elevates our cortisol levels, making it harder to sleep. Dr. Jagadeesan says that stress particularly affects the amount of deep sleep as well as REM sleep. Deep sleep is when your cells carry out “housekeeping,” getting rid of the day’s accumulation of toxins and cellular debris. REM sleep, which occurs later in the sleep cycle, is when memories are stored and consolidated. So, it’s important to keep our cortisol levels as low as possible during the day so that we can get all the full benefits of sleep.

In addition to hormonal changes, other health issues can emerge in mid-life, too. Nagging pain, such as from arthritis, is often amplified at night, when there are no distractions; it aches more. In addition, older men may have prostate issues (and in women, urinary tract infections) that keep them trotting to the toilet at night.

Remove Sleep Roadblocks

Take heart: you have more control over your sleep than you might think! Have you tried these things?

#1 Limit alcohol consumption. Yes, alcohol is a sedative. But it causes a rebound effect: you will wake up during the night.

icon with wine glass and bottle#2 Limit caffeine. Caffeine works differently than you might think. The human body is designed to build sleep pressure all day long, thanks to a chemical called adenosine that naturally accumulates in our cells. Caffeine blocks adenosine receptors, which blocks sleep pressure. And it has a lasting effect: The half-life of caffeine is about six hours, which means that half of the caffeine in your afternoon pick-me-up is still with you at bedtime. So, if you want to be able to nod off at night, try limiting your coffee, tea and other caffeinated beverages to mornings only.

icon with coffee cup#3 Keep a sleep diary. (If you ever visit a sleep specialist, they will likely require this.) Write down the time you went to bed, how long it took you to fall asleep, whether you woke during the night, your estimated total sleep time and—importantly—how you felt the next morning. Also note your alcohol and/or caffeine consumption as well as any stress issues. See if you can identify any trends.

icon with medicine bottle and pill#4 Check your meds. Older adults are often on prescription medications, many of which have side effects that may include sleep disruption. If that’s the case for you, your healthcare provider may be able to adjust dosages or change medications to help solve the sleep issue.

icon of figure doing light exercise#5 Exercise. (But not at night.) Regular, moderate exercise does wonderful things for your body and, as a bonus, it promotes normal sleep. But exercise temporarily boosts your cortisol levels, so workout earlier in the day, if you can.

icon of snack foods and clock#6 Don’t eat after dinner. Many people suffer from acid reflux (heartburn), which gets much worse if you lie down to sleep right after a meal. Time your dinner to allow at least a couple of hours for your stomach to empty before you retire for the evening. (This idea, a type of intermittent fasting, is the default plan for us, anyway. Ancient humans probably did not eat at night. This allows the gastrointestinal system to rest overnight, which allows healing. Many people think that we should still follow that game plan, for optimal health as well as sleep.)

icon of comfortable couch#7 No couch-snoozing. Okay, admit it: How many evening movies have you slept through? But then, when you awaken (as the credits roll), it might be hard to go back to sleep again. This is because you’ve already burned through that adenosine (remember the sleep pressure chemical?), and it takes time to re-accumulate. So, try to stay up until your routine bedtime, but if you are watching TV and your eyelids start fluttering, it’s best to go ahead and hit the bed.

icon of sound machine making noise#8 Get a sound generator. This small device makes a huge difference for many sleep sufferers. You can adjust the volume as well as the background noise (ocean waves, rainfall, etc.).

icon of cell phone emitting blue light#9 Red light the blue light. In other words, turn off your lighted electronics (yes, even your cell phone) in the evening. They emit blue light, which signals our brains to wake up.

icon with turkey leg whole salmon and banana bunch#10 Eat salmon, turkey and bananas each week. (Not necessarily together and it doesn’t need to be at night!) These are three top sleep-inducing foods, according to the American Sleep Association thanks to their high tryptophan content which is an important precursor to melatonin, the sleep initiating hormone secreted in the evening.

icon of clock#11 Adjust your routine. Our circadian rhythm (biological clock) shifts a bit over the years. As we age, we tend to keep the same evening routine but awaken earlier, which means that we start the day sleep deprived. If this fits your scenario, pick a new, earlier bedtime and try to stick to it.

icon of thermostat temperature#12 Keep your cool. Most people sleep best when the room temperature is kept comfortably cool (75 F degrees or below).

icon of angry face#13 Don’t get angry when you can’t sleep. It will only make it worse, because anger will cause you to produce a cortisol surge, which will leave you wide awake. If you can’t sleep after 20 minutes, get up and go to another room (but keep the lights low). Do something else for a while and then try easing back to sleep.

icon of puzzle piece#14 Do a jigsaw puzzle. Or paint, draw, carve soap, knit, or strum a guitar. These are right-brained activities that move your brain activity out of the analytical “left-brained” mode, which is where more of the anxiety lies.

Recommended Herbs and Supplements

Tried all of those things and still counting sheep? Here are some herbs and other products that are of known benefit for sleep:

Herbal teas, including passionflower, chamomile, or valerian. All three are calming for most people, but sippers beware: chamomile and valerian increase agitation in about 25% of people.

passion flower growing in the wildPassionflower extract, taken as a supplement. Bring on the calm! Passionflower is thought to boost levels of GABA, a calming neurotransmitter that inhibits specific brain signals and decreases activity in the nervous system. This can promote relaxation and help with feelings of anxiety and stress. This helps calm an agitated nervous system in preparation for better sleep. Many people also report that it relaxes muscles. Take passionflower before bedtime and again if needed during middle-of-the-night awakenings.

lemon balm growing outsideLemon balm extract is also calming and can be combined with other herbs such as passionflower. In addition to mild sedative qualities, lemon balm has an array of antioxidant activity that helps defend the nervous system from sleep disturbance free radicals and antispasmodic properties that help relax the body. Of the many phytochemicals found in lemon balm, citronellal and rosmarinic acid are two that have been noted for their ability to help reduce stress and support the nervous system.

two spoons filled with dried tea leavesL-theanine is relaxing and it can also help to mitigate the effects of too much caffeine. You can take L-theanine in the morning as well as at night to counteract stress. Interestingly, L-theanine is an amino acid found in tea. Green tea has more L-theanine (and less caffeine) which is why it isn’t as stimulating as black tea, and it’s a great option for people who are trying to wean off of caffeine. And green tea appears to have many health benefits.

turmeric root and powder in a bowlTurmeric is a wonderful spice that is commonly used in tasty Indian dishes that you recognize by the familiar yellow color. Turmeric is anti-inflammatory, which helps to reduce some forms of arthritis and other inflamed conditions that make it hard to sleep. If you choose to purchase turmeric as a supplement, select a full-spectrum extract; use 200-400 mg twice a day. (Note: It may be called curcumin, which is the main active compound in turmeric.)

white melatonin powder on surfaceMelatonin. But not too much. Your brain naturally starts to produce melatonin as soon as the sun goes down. Within hours, you should have enough melatonin to make you sleepy. Melatonin supplements are available, but don’t overdo it, or you’ll be too groggy the next day. I prefer 1.5 mg; stay under 5 mg.

CBD oil in dropperCBD Oil. Cannabadiol (CBD) is derived from the hemp plant. CBD is non-psychoactive and has a range of health benefits, including reducing anxiety (which helps us sleep), reducing inflammation (which reduces pain), and generally promoting healing in the body. It is available in different concentrations, such as 600 or 1200 mg/ml. Buy from a reputable supplier to ensure that you are actually getting what you are paying for. (If it’s cheap, there’s probably very little actual CBD in the product.)

light gray powder on surfaceMagnesium. This is an element that not only promotes restful sleep but also helps muscles to relax. It helps some people who have restless leg syndrome or muscle cramps at night. Food sources rich in magnesium include bananas, avocados, cashews, almonds and pumpkin seeds. (Chocolate also has a lot of magnesium, but we can’t recommend it here because of its caffeine content.) Magnesium can also be purchased in supplement form.

powdered substance on surfaceGABA. Gamma-aminobutyric acid (GABA) is a calming neurotransmitter involved in the natural sleep process. While there are no officially established dosing recommendations for GABA, clinical research and experience suggest that 100-300 mg 1-2 times per day is reasonable and effective.

lavender flowers and medicine bottle on tableEssential oils like lavender. Many folks swear by a drop of lavender on their pillows.

Make Sleep a Priority

Sleep is ultra-important to our health. A 2018 article published in the journal Pharmacy and Therapeutics suggests that sleep is related to disorders as varied as hypertension, obesity, mood disorders and dementia.

If you suffer from a chronic disease, you are more likely to have sleep issues because most chronic diseases involve inflammation—including inflammation in the brain, which can affect sleep onset, duration and quality.

Also, if you have been taking sleep medications for a long time, you will need to be patient with yourself while you gradually shift to the above strategies. Sleep medications temporarily alter cell receptors for the various molecules that naturally produce sleep. It can take weeks or months for your body to rebuild those normal receptors.

In any case, continue to explore lifestyle changes as well as herbal therapy to find a winning combination that will dependably ease you back into a regular sleep pattern that will leave you refreshed.

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References
1. Barrett-Connor E, Dam TT, Stone K, Harrison SL, Redline S, Orwoll E. The association of testosterone levels with overall sleep quality, sleep architecture, and sleep-disordered breathing. J Clin Endocrinol Metab. 2008 Jul; 93(7):2602-9. doi: 10.1210/jc.2007-2622. Epub 2008 Apr 15. PMID: 18413429; PMCID: PMC2453053.
2. Worley S. L. (2018). The Extraordinary Importance of Sleep: The Detrimental Effects of Inadequate Sleep on Health and Public Safety Drive an Explosion of Sleep Research. P & T : a peer-reviewed journal for formulary management, 43(12), 758–763.

About the Medical Director
Dr. Bill Rawls
Dr. Rawls is a licensed medical doctor in North Carolina and a leading expert in integrative health. He has extensive training in alternative therapies, and is the Medical Director of Vital Plan, a holistic health and herbal supplement company in Raleigh, NC.
  • Dr. Bill Rawls

    ABOUT BILL RAWLS, M.D.

    Dr. Rawls is a licensed medical doctor in North Carolina and a leading expert in integrative health. He has extensive training in alternative therapies, and is the Medical Director of Vital Plan, a holistic health and herbal supplement company in Raleigh, NC.

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