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    Three natural steps to improve your sleep

    By: Dr. Jordan Robertson ND.

    Difficulty sleeping or poor-quality sleep is a significant concern in patients of all ages, particularly around hormonal changes such as pregnancy and menopause. Although studies have not shown a difference between male and female sex hormones influencing sleep at adolescence1, fluctuating hormone levels (especially estrogen) throughout the rest of a patient’s life appears to have a great impact on the ability to fall asleep, stay asleep and other symptoms that influence sleep quality such as hot flashes2. By the time patients reach menopause there are significant influences of sex hormones on sleep quality2.

    When people are looking to improve their sleep, it’s important to rule out the possible causes of their sleep difficulties. Symptoms such as hot flashes, excessive urination, low mood, restless legs or even sleep apnea2 can stand in the way of a good night sleep, and must be treated at the same time as improving overall sleep quality for the best results possible.

    Patients often “get by” with as little sleep as possible, or they don’t realize how impactful consistent poor sleep is on the rest of their health – sometimes standing directly in the way of their other health goals such as weight management3 and reducing stress4. Poor sleep leads to daytime sleepiness and fatigue, which impacts appetite, eating and exercise3. Periods of insomnia and poor sleep quality impact mental health, resiliency and the ability to manage stress4.

    In addition to good sleep hygiene, which includes behaviours such as avoiding caffeine and alcohol, a dark quiet room, establishing regular bedtime and exercise routines and reducing stress5, you may benefit from lab testing to rule out anemia (a common cause of restless legs) and a sleep study to rule out sleep apnea. Hormone testing can confirm the hormonal stage of life6 (premenopause versus perimenopause versus menopause) but may not give enough insight given that hormone levels change day to day, and it’s the daily fluctuation in hormone levels that influences sleep, not the number found on lab work.

    Sleeping medication is often a last resort to support sleep, and many people consider alternative solutions to help them get a better night sleep. Melatonin is a hormone naturally produced by the pineal gland that regulates sleep and wakefulness. Melatonin has been shown to support mild insomnia and difficulty falling asleep, especially during perimenopause and menopause 7,8. Herbal remedies are gentle and safe and can offer a solution for mild sleep challenges. Ingredients such as valerian9-11, chamomile12, hops13, and passionflower9,14 have each been shown to reduce symptoms related to insomnia and improve sleep. Most herbal remedies such as valerian and passionflower work on relaxing the brain and working to initiate calmness before sleep9 and although they are safe, should not be combined with other sleeping medication that is prescribed to prevent being over-sedated.

    If you are struggling with your sleep, consider these steps:

    • List all the factors worsening your sleep, including your habits, symptoms such as hot flashes and your caffeine intake.
    • Talk to your doctor about testing for low iron or even sleep apnea, which can cause daytime fatigue and poor-quality sleep.
    • Consider using natural supplements with ingredients such as melatonin, passionflower, valerian, hops and chamomile to calm your mind and help support a good night’s sleep.


    1. Tobias, L., Thapa, S. & Won, C. H. J. Impact of Sex on Sleep Disorders Across the Lifespan. Clin. Chest Med. 42, 427–442 (2021).
    2. Caretto, M., Giannini, A. & Simoncini, T. An integrated approach to diagnosing and managing sleep disorders in menopausal women. Maturitas 128, 1–3 (2019).
    3. Rodrigues, G. D., Fiorelli, E. M., Furlan, L., Montano, N. & Tobaldini, E. Obesity and sleep disturbances: The ‘chicken or the egg’ question. Eur. J. Intern. Med. S0953-6205(21)00140–0 (2021) doi:10.1016/j.ejim.2021.04.017.
    4. Palagini, L. et al. Lack of Resilience Is Related to Stress-Related Sleep Reactivity, Hyperarousal, and Emotion Dysregulation in Insomnia Disorder. J. Clin. Sleep Med. JCSM Off. Publ. Am. Acad. Sleep Med. 14, 759–766 (2018).
    5. Irish, L. A., Kline, C. E., Gunn, H. E., Buysse, D. J. & Hall, M. H. The Role of Sleep Hygiene in Promoting Public Health: A Review of Empirical Evidence. Sleep Med. Rev. 22, 23–36 (2015).
    6. Peacock, K. & Ketvertis, K. M. Menopause. in StatPearls (StatPearls Publishing, 2021).
    7. Toffol, E. et al. Nighttime melatonin secretion and sleep architecture: different associations in perimenopausal and postmenopausal women. Sleep Med. 81, 52–61 (2021).
    8. Treister-Goltzman, Y. & Peleg, R. Melatonin and the health of menopausal women: A systematic review. J. Pineal Res. e12743 (2021) doi:10.1111/jpi.12743.
    9. Bruni, O., Ferini-Strambi, L., Giacomoni, E. & Pellegrino, P. Herbal Remedies and Their Possible Effect on the GABAergic System and Sleep. Nutrients 13, 530 (2021).
    10. Taavoni, S., Ekbatani, N., Kashaniyan, M. & Haghani, H. Effect of valerian on sleep quality in postmenopausal women: a randomized placebo-controlled clinical trial. Menopause N. Y. N 18, 951–955 (2011).
    11. Taavoni, S., Nazem Ekbatani, N. & Haghani, H. Valerian/lemon balm use for sleep disorders during menopause. Complement. Ther. Clin. Pract. 19, 193–196 (2013).
    12. Hieu, T. H. et al. Therapeutic efficacy and safety of chamomile for state anxiety, generalized anxiety disorder, insomnia, and sleep quality: A systematic review and meta-analysis of randomized trials and quasi-randomized trials. Phytother. Res. PTR 33, 1604–1615 (2019).
    13. Morin, C. M., Koetter, U., Bastien, C., Ware, J. C. & Wooten, V. Valerian-hops combination and diphenhydramine for treating insomnia: a randomized placebo-controlled clinical trial. Sleep 28, 1465–1471 (2005).
    14. Borrás, S., Martínez-Solís, I. & Ríos, J. L. Medicinal Plants for Insomnia Related to Anxiety: An Updated Review. Planta Med. (2021) doi:10.1055/a-1510-9826.
    15. Taibi, D. M., Landis, C. A., Petry, H. & Vitiello, M. V. A systematic review of valerian as a sleep aid: safe but not effective. Sleep Med. Rev. 11, 209–230 (2007).
    16. Abdi, F., Mobedi, H. & Roozbeh, N. Hops for Menopausal Vasomotor Symptoms: Mechanisms of Action. J. Menopausal Med. 22, 62–64 (2016).

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