When Sleep Changes After Surgery: Understanding Our New Normal

Surgical menopause and poor sleep quality? Those moments when sleep feels far away aren’t just in your head, they’re rooted in very real biological changes happening in your body. 

I was diagnosed a very long time ago with “psycho-physiological conditioned insomnia” and sent home with a bottle of Valium. Basically, I had insomnia from witnessing a lot of domestic violence during my childhood that would usually rear its ugly head after the bars closed and my dad would come home.  

So instead of becoming more relaxed as evening approached, I would become fearful and anxious, knowing what was going to happen.

I took benzodiazepine medication for many years and developed quite the addiction to them. It wasn’t easy to stop and I never thought I could live without them but four months ago, I set them down for good. I sleep better now than I ever have, thanks to really good sleep hygiene.

Let’s explore why surgical menopause and poor sleep quality go together when our ovaries are removed and what it means for our lives moving forward.

1. The Hidden Orchestra of Sleep: What Changed?

Your body before surgery was very finely tuned with every part in place for a reason and everything working together.  Estrogen and progesterone weren’t just about reproduction, they were in charge of numerous systems that affected our sleep:

The Temperature Control Center:  You might be thinking, now what does temperature have to do with whether I sleep or not??  The hypothalamus helps manage your body temperature plus a lot of very important processes including: hunger, thirst, mood, sex drive, blood pressure and “sleep.”  

Our hypothalamus, (a gland the size of an almond in our brain), relies heavily on estrogen to regulate body temperature.  Think of it as the “master control center” for hormones. 

So when our estrogen and progesterone gets cut off at the knees:

• Our internal thermostat becomes erratic.
• The temperature range that triggers sleep becomes narrower and isn’t as stable.
• Night sweats and hot flashes disrupt our rest. A “night sweat” is just a “hot flash” during the night.
• Our body struggles to maintain that cool temperature needed for deep sleep, which under normal circumstances is between 60` and 65`.

The Sleep-Wake Cycle

Progesterone was our natural sleep promoter:

• It helped stimulate the brain to produce a calming neurotransmitter called GABA (gamma-aminobutyric acid.)
• Progesterone supports regular sleep cycles as it has an anti-anxiety effect.
• It also helped maintain a healthy sleep architecture by helping restore normal sleep when it’s disturbed.

2. The HRT Decision: Understanding Your Options

For many women, (I’m not one of the lucky ones,) Hormone Replacement Therapy (HRT) can help restore the sleep-supporting benefits of estrogen and progesterone:

Benefits of HRT for Sleep:

• May help regulate body temperature, especially progesterone, which can counter estrogen because too much or fluctuations of estrogen can actually “cause” sleeping difficulties!! Think PMS!
• Can reduce night sweats and hot flashes, the things that are waking you up.
• May help restore normal sleep architecture which is the pattern of sleep stages or sleep cycles through the night for an individual person.

However, HRT isn’t an option for everyone. Some of us can’t use it due to: 

• Personal medical history: If you have a history of blood clots, HRT in tablet form is not recommended but taking HRT through the skin might be a possibility. Or if you have a history of heart disease or stroke, HRT could be a no-go.
• Cancer risk factors including: Breast cancer, ovarian cancer or womb (uterus) cancer. In my case, after a hysterectomy to remove fibroid tumors, they discovered LGESS, (low grade endometrial stromal sarcoma) which is an estrogen driven cancer. After having an oophorectomy 4 weeks later, I was told no HRT.
• Previous hormone-sensitive conditions: This could include liver disease, unexplained vaginal bleeding, elevated triglycerides or coronary heart disease, (CHD.)
• Individual choice: Women may have concerns about potential side effects, particularly an increased risk of breast cancer, they may fear putting synthetic hormones into their bodies.  Another reason may be that they think they should just “deal with it” as some women have actually been told.  

The Ripple Effect on Sleep Architecture

Sleep isn’t just one long period of unconsciousness, it’s a complex cycle of different stages. 

To begin with, anxiety and stress in and of itself can be worse for those of us in surgical MENOPAUSE and without HRT, just getting to sleep can be challenging.

1. Light Sleep (N1 and N2):

Compared with natural menopause, surgical menopause is associated with more insomnia symptoms, reduced total sleep time and a 27% higher risk of sleep apnea.  From Here

• We spend more time in lighter sleep stages where even the tiniest changes in body temperature or discomfort will wake us and we may not even be aware that it happened.
• We wake more easily from environmental changes.
• We have trouble transitioning to deeper sleep and staying there because estrogen affects the neurotransmitters that maintain a stable body temperature during sleep, which is crucial for achieving deep sleep.

2. Deep Sleep (N3):

• This restorative stage becomes more elusive because of the fluctuations in our body and the sensitivity we have to them, it’s hard to stay in deep sleep.

3. REM Sleep:

• Dreams may become more vivid or disturbing: TRUE! I’ve always had dramatic, in-color dreams, however, they have become a lot more frequent since having my ovaries removed. 
• Emotional processing is also affected because deep sleep is thought to play a vital role in that and memory consolidation as well. Who knew that there were so many things going on in our bodies while we slept? 

3. Finding Your Path: HRT and Non-HRT Approaches

For Those Using HRT:

• Work with your healthcare provider for the best time to start: For women without health risks, they can start HRT immediately after surgery. Upon more research, a woman could even start HRT several years after surgery.

• Monitor your response to different formulations: If you decide to take HRT be aware that one size doesn’t fit all. Some women may only need one hormone in a pill form daily but some might need more than one type of hormone, different dosages, and in a different delivery mechanism like a patch or cream.

For Those Not Using HRT:

• Focus on natural temperature regulation: Which would include the basics like exercise, a balanced diet and developing a really good sleep hygiene schedule. Also, certain prescription medications can help with hot flashes. I take Effexor for hot flashes and depression and they seem to work better when I take them at the same time every day. I also take Clonidine for hot flashes and a side effect from it is drowsiness, so I take it at bedtime.  It’s a win-win!! 😁
• Explore sleep-supporting supplements (with medical guidance): There are many foods, vitamins and supplements out there that could be beneficial like, Black Cohosh, Red Clover and Primrose Oil but please always talk to your doctor first because the wrong amounts could be harmful. Let’s not forget: MELATONIN!! I tried this several years before my hysterectomy and it didn’t seem to work so I forgot about it. Recently, I tried again and SUCCESS!! Things that you’ve used before that didn’t work might just work with your system now. It doesn’t hurt to give things another try.
• Implement consistent sleep hygiene practices: I will be making a sleep hygiene guide very soon as sleep is so important to our well-being, especially in surgical menopause!
• Consider cognitive behavioral therapy for insomnia: This is a subject that I totally believe in because I know that our minds are so much more powerful than we think.  CBT works in a variety of ways from changing our belief systems that make us stress about sleep to sleep routines and relaxation techniques.

Why Traditional Sleep Advice May Not Work

Those standard sleep hygiene tips? They were designed for people with normal hormone levels. Our bodies are working with a completely different system now, which is why we need targeted approaches.

4. Creating New Sleep Patterns: Working With Your Changed Body

Understanding these changes helps us create more effective solutions:

Temperature Regulation Strategies

Because our temperature control is compromised:

• Keep your room cooler (around 65°F/18°C) even a couple of degrees cooler than you might be used to just might do the trick for night sweat awakenings.
• Use layered bedding for quick adjustments: this reminds me of a cartoon strip, “one leg out for temperature control!” It works!
• Consider cooling technologies for your bed: there are several different technologies like bedding, mattress toppers and cooling pillows.  
• Have overnight temperature management tools ready like a small hand fan that you can quickly grab or a glass of water or an extra night shirt!

Supporting New Brain Chemistry

To help your brain adjust:

• Time light exposure carefully to support your own natural melatonin production: dim you lights 2-3 hours before you want to sleep. If you absolutely cannot go without a little bit of cell phone or Kindle time, be sure to use your Blue Shade screen.
• Consider natural supplements that support GABA production. GABA functions to calm the nervous system and help your nerves process sensory input in an organized way.

The following foods are good for this:

• Yogurt
• Brown rice
• Lean proteins like halibut, shrimp, and soy
• Theanine
• Ashwagandha
• Berries

• Practice stress-reduction techniques that work with your new sensitivity: MBSR, (Mindfulness-Based Stress Reduction,) is something that we all should try. 

Managing the Emotional Impact

Remember that sleep disruption affects our emotional well-being:

• Practice self-compassion when sleep is challenging: You are your own worst critic and instead of being upset with yourself for not being able to get sleep right every time, try to realize that what you’re going through is tough and you are NOT the only one. Be your own cheer leader instead!
• Understand that your experience is valid and real: I don’t care what anybody says, this has been hands down, the hardest time in my life and I’m determined to make this experience worth something. 
• Know that adaptation is possible with time and support: it did take me a while to get used to all the symptoms but if you are informed, you can prepare and THAT makes ALL the difference!

5. Signs of Hope: How Your Body Adapts

There is some good news though!  From this study 👇🏻👇🏻👇🏻

“Our study suggests that the brain has the ability to find a new ‘normal’ after menopause, at least in most women. We hope our findings will help overcome the stigma around menopause and encourage all women to take care of their brains during this transition.” Source here.

When to Seek Additional Support

• If sleep disruption severely impacts daily function.
• When current approaches aren’t providing relief.
• If anxiety or depression develop, please do not hesitate!
• When you need support developing new sleep strategies.

In conclusion:  

It’s a lot to take in isn’t it?  For me personally, sleep is key. If I miss a night of sleep or run short for two or three nights, I’m just done.

I have way more hot flashes, am lethargic and can’t concentrate. These are also the times when my husband or I could have an argument start out of nowhere.  Sleep just makes EVERYTHING better!!

So, wherever you’re at in your journey, know that you can take your control back and help yourself. Know that the symptoms WILL get better as your body adjusts over time. Who knows, maybe this chapter in your life could be the healthiest and happiest version of yourself ever!!