It was an interesting discussion that I had whilst on holiday last year in Switzerland. I was reminded of it recently when a discussion came up in my private coaching community about alcohol and sleep.
The fondue pot was bubbling away in the middle of the table. How the Swiss got to have a national food that involved the shared ritual of dipping bread or small potatoes into a pot of hot melted cheese is beyond me. But here we were, sharing not only a fondue or two but sharing stories as well.
The inevitable “What do you do Wendy?” was asked by the middle-aged woman sitting beside me, who was endorsing the sentiment that if you are going to tolerate fondue, then you don’t drink water, only alcohol. Early on in the night, she was on her third glass of wine.
I’m always hesitant about discussing a topic that doesn’t get talked about in public much, especially when visiting foreign countries, but I casually told her, “I have a lifestyle coaching programme for midlife or older women who want to better understand how to change their lifestyle to suit their changing hormones in menopause or post-menopause.”
That’s when she told me she was on HRT, but it had stopped working for her in terms of her sleep.
We were having a nice conversation, even if there were some words lost in translation, so I asked her if she had had any lifestyle advice when she went on her menopause-HRT. Afterall, Switzerland is a very progressive country with its health system and has a strong focus on population wellbeing and lifestyle. The Swiss Peri-menopause study (Willi et al, 2020) has also contributed much knowledge about the menopause transition and symptoms in Swiss women, so I took my chance.
When she shook her head to indicate no, I was surprised.
It intrigued me that when she was prescribed HRT, she wasn’t told about the effect of alcohol on her menopause symptoms, especially on her sleep, now that she had moved into post-menopause. By the end of the night, the bottle was largely gone … most of it by my new middle-age dining partner.
Now don’t get me wrong – I’m not a teetotaler at all, and had a small glass of wine myself, but it was the amount she was drinking in one sitting which intrigued me and that she hadn’t connected this with her worsening insomnia.
The incident reminded me of the heading in the New York Times after the pandemic. Tucked in between an editorial on the crisis in Ukraine, the heading drew me in – ‘Too many women have a drinking problem.’ (New York Times, Thursday, April 7, 2022 p. 11).
Apparently, the pandemic has made excessive drinking (defined as four or more drinks in a few hours), worse. Especially in women, including midlife women. A new report from the National Institute on Alcohol Abuse said that mothers increased their drinking by more than 300 percent during the pandemic. I’m not surprised. Home schooling is a tough gig at any time.
It’s a similar story here in New Zealand. Data from the Ministry of Health reports that the prevalence of hazardous drinking increased from 2011/12 to 2015/16. These increases were substantial with more than 50% among those aged 45-54 years drinking hazardously and more than than 70% among those aged 55-64 years doing the same.
I find that with the thousands of women who have joined my coaching programmes over the past decade, very few of them are told to reduce their alcohol consumption, especially if they have chosen to go on Menopause HRT.
Many of them are also not connecting the consumption of alcohol with their menopause insomnia. I wonder if it’s the same for your clients too?
And yes, I was the same. Arriving home from a busy day working, one of the first actions I took whilst preparing dinner, was to have a glass of wine. As the menopause insomnia took over, I thought it might sedate me. How wrong I was.
Although alcohol generally is classified as a depressant drug, in fact it has both sedative and stimulatory effects. When we arrive in menopause and post-menopause, the ‘stimulatory effects’ might just take over from the sedative effects. And this is all to do with our ageing pituitary gland.
With our menopause transition arriving as the biological gateway to our ageing, there are numerous changes occurring to our pituitary gland which controls our circadian rhythm. As such, alcohol consumption leading up to bedtime, may result in messing up other hormones such as growth hormone, but also messing with our core temperature.
Initially, core temperature lowers, but then it rises (Roehrs & Roth, NIH). If your clients are experiencing insomnia and feeling hotter than usual after a few glasses of wine now that they are in menopause, this is why.
Sleep disturbance is one of the most common complaints of women as they enter menopause, but we have to remember that alcohol use disorder (AUD) is linked to this … whether women are on HRT or not.
A 2020 study exploring sleep and alcohol use in women (Inkelis et al, 2020), reminded readers that women are increasingly consuming alcohol at an earlier age and at higher rates.
This is a challenge for women going into peri-menopause, because if they have had a higher than normal rate of drinking for many years, then yes, the liver has had to work harder to manage all that alcohol.
As does the pancreas.
As Practitioners, it’s easy to forget about this precious organ with alcohol consumption, but alcohol is high in sugar and therefore, higher amounts of insulin are secreted from the pancreas in order to regulate blood sugar levels.
The pancreas is a gland that secretes digestive enzymes and releases insulin, which regulates sugar levels in the blood.
Therefore, the pancreatic acinar cells are thought to sustain damage from free radicals and other toxic byproducts of alcohol metabolism and this increases inflammation of the pancreas.
Hence, high alcohol intake means that the liver, pancreas and brain are having to do a lot more work than usual.
Add this to menopause hormonal changes and some of your clients may have the effects of the hangover and perhaps gut disturbances the next day. This may be a challenge for those of you taking them through exercise sessions.
Have your clients had a lifetime of alcohol consumption?
When your clients reflect back on the past few decades, I wonder if they have been consuming various forms of alcohol for decades?
This is an important question for women to consider, simply because acute alcohol consumption and chronic alcohol consumption have different effects on the body.
We often forget that whilst alcohol consumption has been going on for thousands of years, if your clients are between the ages of 45-60 years, (their midlife years), then I want you to reflect on the incredible increase in the marketing of alcohol to women over their lifetime.
Marketers have also realised that portraying alcohol as a reward for tired women at the end of the day is an effective strategy.
I wasn’t surprised to read in Erika Anderson’s New York Times article, that in America, new offerings such as ‘Mommy’s Time Out’ wine has reached the market, as has ‘Chick Beer‘. Low calorie drinks marketed as seltzers have also been heavily marketed to women with producers claiming over $4.5 billion in sales (NY Times, April 7, 2022). How many of these sales can be attributed to middle-aged women in menopause, I have no idea.
But let’s get back to the issue of menopause, sleep quality and chronic alcohol consumption.
Studies show that women who self-reported longer term alcohol dependence had increased sleep onset latency and a decreased time spent in Rapid Eye Movement (REM) sleep. (Inkelis, Hasler & Baker, 2020).
In sleep science, sleep onset latency is the length of time that it takes to accomplish the transition from full wakefulness to sleep.
When women don’t get into REM sleep, they can wake up more easily. Why this occurs with alcohol consumption is that heart rates remain elevated as does nervous activity. As such, the chronic stress hormone, cortisol stays elevated overnight too.
If your clients have been waking up anxious and have had alcohol prior to bedtime, then they are contributing to overnight feelings of restlessness, heightened anxiety and a higher resting heart rate.
Menopause is a challenging time for numerous women. I didn’t know about the effects of many of my lifestyle decisions until my symptoms began to get worse, despite taking menopause HRT and plenty of expensive supplements.
If I had my time again, I would have reduced or stopped alcohol earlier in my menopause transition. Many of my own clients find this too.
As your client’s enter peri-menopause, a time when they still have oestrogen and progesterone production, this phase is very different to menopause (when periods have stopped) and post-menopause (when periods have stopped for a year or more).
Women may better tolerate some alcohol consumption in peri-menopause, because they are still producing oestrogen, but this may change during menopause and post-menopause.
For some women on my programmes, this is what they find hardest – by this I mean, that it’s harder to change habits, the older they are, but it can be done with the right support. Some women may also require specific medical support and/or specific registered alcohol-cessation programmes.
Otherwise, sleep problems may tip them over into other health problems as they age.
Alcohol and sleep problems go hand-in-hand. Alcohol has a toxic effect on brain circuits, cardiovascular function and hormones that are important to sleep generation.
As such, the menopause transition is a vulnerable time for women who are regular drinkers of alcohol. Not only due to the inflammatory changes that arrive in the liver, pancreas and brain with alcohol, but also due to the contribution of alcohol to sleep disturbances.
Whilst MyMT™ is not an alcohol cessation programme for problem drinkers, I often dirext my own clients to other programmes if necessary and with their interest and permission.
But I do offer them specific suggestions to help them reduce alcohol and it’s detrimental effects on their changing and ageing, liver, brain and pancreas. Perhaps you can also share these ideas with your clients:
- Buy an organic wine that is lower in sugar and alcohol content. Take this to the party if your host doesn’t usually have organic wine available. You don’t want the chemicals and excess of sugar nor do you need the high ethanol content which is all just ‘overload’ for your liver to process.
- Have some protein if you are drinking, rather than high sugar treats or high salt carbohydrates. Protein will help to lower the effect of insulin production from your pancreas so your blood sugar doesn’t spike.
- Ask for sparkling water or bottled water as well. This way you have a balance of water and alcohol to slow down your drinking.
- Don’t eat a high fat meal before going out. Your liver will be too busy trying to process the fats and not the alcohol and excess glucose. It can’t do both.
I hope you might read Kimberley’s powerful story on my Success Stories pages. She too had numerous challenges which affected her mental health and alcohol was one of them.
I’m so proud of her recognising this and getting the right support at the time.
Dr Wendy Sweet, (PhD) Founder: MyMT™/ Member: Australasian Society of Lifestyle Medicine.
References:
Action Point from: www.actionpoint.org.nz/trends_in_old_people_drinking
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Inkelis, S. M., Hasler, B. P., & Baker, F. C. (2020). Sleep and Alcohol Use in Women. Alcohol research : current reviews, 40(2), 13. https://doi.org/10.35946/arcr.v40.2.13
Godos J, Giampieri F, Chisari E, Micek A, Paladino N, Forbes-Hernández TY, Quiles JL, Battino M, La Vignera S, Musumeci G, Grosso G. Alcohol Consumption, Bone Mineral Density, and Risk of Osteoporotic Fractures: A Dose-Response Meta-Analysis. Int J Environ Res Public Health. 2022 Jan 28;19(3):1515. doi: 10.3390/ijerph19031515.
Pietilä, J., Helander, E., Korhonen, I., Myllymäki, T., Kujala, U. M., & Lindholm, H. (2018). Acute Effect of Alcohol Intake on Cardiovascular Autonomic Regulation During the First Hours of Sleep in a Large Real-World Sample of Finnish Employees: Observational Study. JMIR mental health, 5(1), e23. https://doi.org/10.2196/mental.9519
Pohl K, Moodley P, Dhanda AD. Alcohol’s Impact on the Gut and Liver. Nutrients. 2021 Sep 11;13(9):3170.
Rohrs, T. & Roth, T. Sleep, Sleepiness, and Alcohol Use. Sourced from: https://pubs.niaaa.nih.gov/publications/arh25-2/101-109.htm
