There are few things quite as irritating as waking up in the middle of the night and discovering that your brain has mistaken it for morning.
Eyes open.
Room dark.
House silent.
Everyone else asleep.
You glance at the clock.
3:17 a.m.
Of course it is.
For some reason, 3 a.m. seems to have become the official meeting time for menopausal women and their thoughts.
Nobody requested the meeting.
There is no agenda.
And yet attendance appears to be compulsory.
I’d wake up because I needed the loo.
Fair enough.
Go to the bathroom.
Come back.
Get into bed.
Pull up the duvet.
Close my eyes.
And…
Nothing.
Sleep had left the building.
My body was tired.
My brain, however, had apparently had an espresso.
What are we doing tomorrow?
Not now.
Did you remember to send that message?
Go to sleep.
You know that thing you’re slightly worried about?
Please don’t.
Shall we examine it in enormous detail?
Apparently so.
And then came the worst mistake.
Looking at the clock.
3:26.
Fine.
Plenty of time.
Close eyes.
Try again.
3:41.
WHY HAS IT ONLY BEEN FIFTEEN MINUTES?
Try another position.
Too hot.
Duvet off.
Too cold.
Duvet on.
Pillow wrong.
Turn pillow over.
3:58.
And somewhere around 4:30, sleep stops being something you’re allowing to happen and becomes something you’re desperately trying to achieve.
Which, as it turns out, is an excellent way not to sleep.
I used to be good at this
That’s what annoyed me.
Sleeping shouldn’t require a skill.
I’d been doing it successfully for decades.
Nobody had needed to teach me.
Lie down.
Close eyes.
See you tomorrow.
Then menopause arrived and apparently the terms and conditions changed.
Sleep problems are common during perimenopause and menopause.
Some women struggle to fall asleep.
Some wake repeatedly.
Some wake far too early.
Hot flushes and night sweats can make things worse.
And poor sleep doesn’t politely remain in the bedroom.
It follows you into the following day.
You’re tired.
Your concentration isn’t as good.
You’re more irritable.
Everything feels like slightly more effort.
Small annoyances become enormous annoyances.
Someone chewing too loudly can suddenly feel like a personal attack.
And then, just as you’re desperate to sit down quietly in the evening, your legs decide they would like to go for a walk.
Without you.
What on earth is wrong with my legs?
This was one of the strangest things.
I’d be sitting watching television in the evening and my legs would become…
uncomfortable.
It’s difficult to describe properly if you haven’t experienced it.
It wasn’t simply pain.
It felt like excess energy trapped inside them.
Like my legs were saying:
MOVE.
I’d change position.
No.
Stretch them out.
No.
Cross them.
Uncross them.
Rub them.
Still no.
Eventually I’d have to get up.
And walk.
So there I’d be, supposedly relaxing in front of the television, pacing around the room because sitting still had become unbearable.
Walk past the television.
Turn around.
Walk back.
Turn around.
Repeat.
This was not the relaxing evening I’d envisaged.
It was uncomfortable.
Frustrating.
And incredibly difficult to ignore.
Movement helped.
So I moved.
Which is all very well except that the entire point of sitting on the sofa watching television is generally the sitting part.
My legs hadn’t understood the assignment.
Restless legs is actually a thing
Eventually I discovered that what I was describing sounded very much like restless legs syndrome.
Another thing nobody had ever really talked to me about.
The NHS describes restless legs syndrome as a strong urge to move the legs, usually when resting at night, often accompanied by uncomfortable sensations.
Yes.
That.
Walking, stretching or massaging the legs can temporarily relieve the feeling, which also sounded very familiar.
But this is where I need to make an important distinction.
I was going through menopause.
I was experiencing restless legs.
That does not automatically mean menopause caused my restless legs.
Restless legs syndrome can occur for several reasons, and sometimes there is no obvious cause at all.
It can be associated with things including iron deficiency, kidney disease, pregnancy and certain medicines.
So this isn’t another:
Look! Menopause did that too!
story.
It’s:
This happened to me during this period of my life, so I investigated it.
There’s a difference.
And if restless legs are regularly disrupting sleep or affecting everyday life, they’re worth discussing with a GP rather than simply assuming they’re another hormonal nuisance.
Because sometimes there may be an underlying reason that can actually be treated.
Then magnesium entered the story
I’d already been experimenting with different things because of my sleep.
I’d tried bedtime drops, and I felt they helped me fall asleep.
But they hadn’t solved the main problem.
I could fall asleep.
I just couldn’t reliably stay asleep.
And once I woke up, that was often it.
Then I started taking magnesium.
I wasn’t expecting anything particularly dramatic.
But after a while I noticed something.
My restless legs were happening less.
Then less again.
And eventually…
They stopped.
No pacing around the living room.
No feeling as though my legs contained three cans of Red Bull despite the rest of me wanting to sit down.
No constant need to move them to make the sensation ease.
They’d just…
settled.
That alone felt enormous.
But something else had changed too.
I was still waking up
This bit matters.
Magnesium did not magically make me sleep through the night.
I still woke up.
Usually because I needed a wee.
Midlife likes to keep you humble.
So I’d wake.
Realise I needed the loo.
Get up.
Go.
Come back.
But then something quite lovely started happening.
I’d go back to sleep.
Not always instantly.
Not dramatically.
I didn’t fall backwards onto the pillow like somebody had switched me off.
I just…
drifted.
No clock watching.
No:
It’s 3:42 and if I fall asleep NOW I’ll get three hours and forty-eight minutes.
No watching darkness slowly turn into dawn while becoming increasingly furious with the concept of time.
I’d wake.
Go to the loo.
Get back into bed.
And eventually realise the next thing I knew was morning.
For me, that felt transformative.
Not because I stopped waking.
Because waking stopped becoming the end of the night’s sleep.
And that’s when I realised that asking:
“Does something help with sleep?”
is actually a fairly useless question.
Which bit of sleep?
Falling asleep?
Staying asleep?
Waking less frequently?
Going back to sleep after waking?
Feeling rested in the morning?
They’re not necessarily the same problem.
In my case, magnesium seemed to make it easier to return to sleep.
And my restless legs reduced and eventually disappeared.
That’s what happened to me.
But—and by now you know me well enough to know there’s a but coming—
my experience isn’t proof that magnesium will do the same thing for somebody else.
Science would like me to calm down again
Naturally, once I noticed the difference, I became enthusiastic.
Magnesium!
Wonderful!
Problem solved!
And then I did what I’ve trained myself to do throughout this entire menopause adventure.
I checked.
And the evidence is considerably less enthusiastic than I was.
Research into magnesium supplements for insomnia has produced mixed results, and the quality of the evidence isn’t strong enough to say that magnesium is a reliable treatment for sleep problems.
There also isn’t good evidence that simply taking magnesium is a standard treatment for restless legs syndrome.
That matters.
Because there’s a very tempting story here:
I had restless legs.
I took magnesium.
They disappeared.
Therefore:
Magnesium cured my restless legs.
Except I can’t establish that.
I can tell you the sequence.
I can tell you the difference I noticed.
I can tell you that I still take my own experience seriously.
But I can’t turn one woman’s experience into a treatment recommendation.
This is exactly the lesson my knees taught me with collagen.
Personal experience can be valuable.
It’s just not the same thing as a clinical trial.
Iron was an interesting discovery
Something else caught my attention when I researched restless legs.
Iron.
Low iron can be associated with restless legs syndrome.
That doesn’t mean everybody with restless legs should immediately buy iron supplements.
In fact, that’s precisely the sort of thing I’m trying not to do anymore.
If there might be an iron problem, I’d rather know whether I actually have one.
That’s what blood tests and healthcare professionals are for.
This is particularly important because supplements aren’t sweets.
Taking something simply because it might help isn’t always harmless.
So if my restless legs returned and became persistent, I wouldn’t simply keep adding things to my supplement cupboard.
I’d speak to my GP.
Hercules has evolved.
She now occasionally asks for professional advice.
Character development.
The bladder would also like a word
Of course, there was still the reason I was waking in the first place.
I needed to pee.
Again.
Menopause can bring urinary changes too, including needing to urinate more often and needing to get up during the night.
This was another thing I hadn’t connected initially.
I’d assumed:
Well, I’m getting older.
Apparently that’s my default explanation for everything.
But changes to the tissues around the vagina, bladder and urethra after menopause can contribute to urinary symptoms.
And this is important because urinary and vaginal symptoms aren’t something women simply have to put up with.
There are treatments.
We’ll talk much more about that when we reach the chapter in which I promised we were going to talk properly about vaginas.
You were warned.
For now, though, the nightly loo trip remained.
I just became considerably better at what happened afterwards.
The night sweats deserve their own complaint
Sometimes the waking wasn’t caused by my bladder.
Sometimes I was simply…
hot.
Ridiculously hot.
Throw-off-the-duvet hot.
Why-am-I-sweating-when-it’s-February hot.
Then, naturally, five minutes later:
Cold.
Find duvet.
Pull duvet back.
Too hot.
One leg out.
Both legs out.
One leg back in.
There should be an Olympic event for menopausal duvet management.
I’d medal.
Hot flushes and night sweats are among the best-known menopause symptoms, and they can disrupt sleep considerably.
Keeping the bedroom cooler, using lighter bedding and reducing personal triggers can help some women.
But if night sweats are severe, regular or accompanied by other worrying symptoms, I wouldn’t automatically assume menopause is responsible.
There’s that rule again.
Menopause can explain a lot. It doesn’t explain everything.
Honestly, I should put it on a mug.
Sleep hygiene sounds annoyingly sensible
Eventually, I also had to look at the boring things.
You know the ones.
Regular sleep times.
A dark bedroom.
A comfortable temperature.
Not drinking enormous quantities of caffeine late in the day.
Not scrolling endlessly on your phone in bed.
Exercise.
Relaxation.
All extremely sensible.
None nearly as exciting as discovering a secret sleep supplement harvested from an ancient tree.
But the boring things matter.
I also learnt that sleep can become tangled up with worrying about sleep.
You wake.
You look at the clock.
You calculate how much sleep you have left.
You become anxious that you won’t sleep.
Now you’re trying desperately to sleep.
And sleep, apparently offended by being put under pressure, refuses to participate.
This made me look differently at that habit of checking the time.
The clock wasn’t helping me sleep.
It was simply giving me regular updates on how badly I thought I was doing.
So I stopped treating every awakening as a crisis.
Sometimes I wake.
That’s frustrating.
But I don’t need to conduct a performance review at 3:17 a.m.
There’s more than one way to tackle menopausal sleep problems
This was another area where I was pleased to discover that the official advice isn’t simply:
Try going to bed earlier.
Current NICE guidance includes menopause-specific cognitive behavioural therapy—CBT—as an option for sleep problems associated with menopause, particularly night-time waking associated with hot flushes and night sweats.
CBT doesn’t mean somebody telling you that your sleep problem is imaginary.
It looks at the thoughts, behaviours and responses around sleep and menopause symptoms and can help reduce how disruptive they become.
HRT can also be part of the conversation when menopausal symptoms such as hot flushes and night sweats are contributing to poor sleep.
That’s something I’ll explore properly later when we get to treatment options.
Because I don’t think women need another book that quietly tells them they should be able to lifestyle-hack their way out of every menopause symptom.
Sometimes lifestyle changes help.
Sometimes treatment helps.
Sometimes both.
The important thing is knowing we have options.
Sleep affects absolutely everything
The biggest revelation wasn’t really about magnesium.
It was about how much better life feels when you’ve slept.
After a bad night, everything becomes harder.
Exercise?
No, thank you.
Cook something nutritious?
Could I interest you in toast?
Patience?
Unavailable.
Brain fog?
Thick enough to affect air traffic.
Joint pain?
Feels worse.
Motivation?
Missing.
Then somebody asks:
“Did you sleep well?”
And you have to resist the urge to throw something.
Poor sleep doesn’t remain neatly contained within the hours of 11 p.m. to 7 a.m.
It leaks into everything.
And that’s why I stopped treating sleep as an indulgence.
Rest isn’t what happens after I’ve finished doing all the important things.
Rest is one of the important things.
That was surprisingly difficult to accept.
My nights aren’t perfect
I wish I could end this chapter by saying I now sleep eight uninterrupted hours every night.
I don’t.
I still wake.
I still need the loo.
Occasionally my brain decides that the middle of the night is an excellent time to remember something completely irrelevant.
Sometimes I’m too hot.
Sometimes there’s no obvious reason at all.
But things are much better.
The restless, uncomfortable energy in my legs that once had me pacing around the living room in the evening gradually reduced and eventually disappeared after I started taking magnesium.
And when I wake in the night now, I find it much easier to drift back to sleep.
No lying there watching the hours crawl past.
No clock watching until sunrise.
For me, that has made an enormous difference.
Would magnesium do exactly the same thing for you?
I don’t know.
And I won’t pretend I do.
But my experience did teach me something important.
Don’t simply accept feeling dreadful because you’re in menopause.
Investigate.
Ask questions.
Look at the evidence.
Talk to your GP when you need to.
And pay attention to your own body.
Because sometimes the answer isn’t:
How do I get through this?
It’s:
Is there something I can actually do about it?
That question was becoming increasingly useful.
Unfortunately, a better night’s sleep didn’t solve everything.
I could now wake up feeling considerably more human…
…and still walk upstairs for something, arrive on the landing and have absolutely no idea why I was there.
Or open my phone to do something and immediately forget what it was.
Or stop halfway through a sentence because the perfectly ordinary word I wanted had apparently left the country.
Sleep might have improved.
My brain, however, had some explaining to do.
