Dr. Paula Witt-Enderby Discusses Recent Research on Melatonin, Sleep and The Menopausal Transition
In the Q&A that follows Dr. Witt-Enterby explains how our natural melatonin rhythms work. That’s right, melatonin is not just a supplement taken to improve sleep; it’s also a hormone made by a gland in our brain. Dr. Witt-Enterby offers suggestions on how to support these natural rhythms for better sleep. Her suggestions will look the same as those you’ve seen before, so if you just scroll down quickly, you might think, I know this already!
But, we encourage you to take the time to understand what she is saying about how melatonin works in our bodies — our natural melatonin cycles. When we understood her suggestions in the context of supporting a natural rhythm, adopting these suggestions felt more compelling — and more doable!
WLB: Your training in both the Western science of pharmacology and toxicology — the effects of chemicals in the body — and the Eastern practice of Ayurveda gives you a unique perspective. What things would you recommend for women who are going through the menopausal transition and struggling with sleep disruption?
PWE: My studies in Eastern medicine were inspired by my melatonin research which demonstrated time and time again the importance of circadian rhythms/melatonin levels, diet (microbiome) and lifestyle in preventing bone loss, cancer, insulin resistance, and sleep disturbances. From both my Eastern/Ayurvedic and Western perspectives, here are some changes that can improve sleep and overall health.
Note: I recommend making these changes in “baby steps” because although these appear simple on paper, they are not easy to implement amid our busy lives.
1. PRE-SLEEP ACTIVITY
Think about a wind-down plan. Start minimizing your light exposure a few hours before bed by turning down the lights and turning off the TV. Use options on smartphones to block blue lights. Use blue light blocking glasses if you have to look at a device that doesn’t have this option before bed. Lying on the floor for 10 minutes can be grounding and bring down stress levels.
2. BEDTIME
Aim to be in bed by 10 pm to work with your natural melatonin rhythm.
3. SLEEP ENVIRONMENT
Aim to get “dark” sleep by minimizing light exposure while you sleep. Close blinds if there is an ambient street light. Cover alarm clocks. Don’t use night lights. Consider wearing an eye mask.
4. EATING HABITS
Try to eat your main meal in the middle of the day (if possible and if this is safe for you) because supper, which means “supplement”, should not be your main meal but enough to supplement you while sleeping. Try to finish eating by 8 pm.
5. ALCOHOL & MIND BODY PRACTICES
Minimize alcohol consumption. Incorporate a regular exercise routine into your life. I am a proponent of mind/body practices that include yoga especially restorative yoga for women going through the menopausal transition.
These changes, when put in place, will help you stay synchronized with the rhythms of the natural and seasonal 24-hour light/dark cycle. And, they can have an effect beyond improving your sleep as melatonin also synchronizes our rest/activity rhythms, bone rhythms, and metabolic rhythms.
WLB: There are recent studies on melatonin with respect to sleep and vasomotor symptoms — two things that women going through the menopausal transition struggle with — can you share your thoughts on this latest research and what you think women should know?
PWE: Much of the research on melatonin and menopause is still in the early stages so it is difficult to make strong conclusions about how melatonin levels affect FSH and LH — the hormones that govern our menstrual cycles — and the relationship between melatonin and vasomotor symptoms (night sweats and hot flashes) until larger, multi-center studies are conducted.
However, I’ll share two sets of studies and what I think we can conclude from them.
First, I have been involved in two pilot clinical trials, Melatonin Osteoporosis Prevention Study (MOPS) and Melatonin-micronutrients Osteopenia Treatment Study (MOTS). These studies (and others like it) have demonstrated three things:
1. Beneficial effects of melatonin supplementation on sleep/wake cycles and well-being, which may be attributed to melatonin’s ability to synchronize our sleep/wake cycles.
2. The fact that nighttime/nocturnal melatonin levels decline with age and with light exposure at night.
3. That low nighttime levels of melatonin are associated with sleep disruption.
Second, I am very excited by the recent work on sleep from the multi-center Study of Women’s Health Across the Nation (SWAN) which showed new findings with respect to the relationship between sleep and vasomotor symptoms.
Sleep and vasomotor symptoms: The study found that vasomotor symptoms (i.e. night sweats) disrupted women’s sleep and that sleep problems influenced the extent or how “bothered” a woman was by her vasomotor symptoms. In addition, the study found that a subgroup of perimenopausal women who did not suffer from vasomotor symptoms still had sleep disruption so we know not all sleep disruption can be explained by night sweats.
Desynchronization of natural rhythms: Other studies demonstrate that the desynchronization of these rhythms (e.g., working through the night, light exposure at night, eating late at night) can disturb our natural melatonin levels, which may contribute to anxiety, sleeplessness, racing mind, weight gain, bone loss, and insulin resistance.
For more on melatonin as a supplement, see Common Supplements.
Here are three videos from an interview with Dr. Witt-Enderby:
Video 1 – Understanding Melatonin for Better Sleep
Video 2 – Supporting Your Natural Melatonin Levels for Better Sleep
Video 3 – When to Supplement, Dosing, Side effects and Finding a Safe Product
Sources:
Lassila, H., Pratheepawanit-Johns, N., O’Neil, C.K., Johns, J.R., Balk, J.L. and Witt-Enderby, P.A. Alternative options to manage menopausal symptoms with a focus on melatonin and osteoporosis. Clinical Pharmacology and Biopharmaceutics-open access, Published February 12, 2014.
Health Consequences of Electric Lighting Practices in the Modern World: A Report on the National Toxicology Program’s Workshop on Shift Work at Night, Artificial Light at Night, and Circadian Disruption. Sci Total Environ. 2017 December 31; 607-608: 1073–1084.
Maria, S. and Witt-Enderby, P.A. Melatonin Effects on Bone: Potential Use for the Prevention and Treatment of Osteopenia, Osteoporosis, and Periodontal Disease and for Use in Bone Grafting Procedures. Journal of Pineal Research, 56(2): 115-125, 2014.
Maria S, Samsonraj, R.M., Munmun, F., Glas, J, Silvestros, M., Mary P. Kotlarczyk, M.P., Rylands, R., Dudakovic, A., van Wijnen, A.J., Enderby, L.T., Lassila, H., Dodda, B., Davis, V.L., Balk, J., Burow, M., Bunnell, B.A., and Witt-Enderby, P.A. Biological Effects of Melatonin on Osteoblast/Osteoclast Co-cultures, Bone and Quality of Life: implications of a role for MT2 melatonin receptors, MEK1/2 and MEK5 in melatonin-mediated osteoblastogenesis. Journal of Pineal Research, 2017.
