A couple of weeks ago, I wrote a post about the supplement DIM. I wasn't enthusiatic about its use for menopause symptoms. This week, I'm going to talk about a supplement that shows some promise to help with the sleep disturbances of menopause - L-theanine (Be aware that L-threonine is a completely different molecule - don't confuse them!)
I'll caveat that many sleep problems in menopause can be attributed to nights sweats, which are hot flashes during sleep. The preferred treatment for those sleep issues is to manage the night sweats using menopause hormone therapy (MHT) or non-hormonal options. In instances where night sweats aren't (completely) to blame, other treatments need to be considered. For example, menopausal women (particularly during peri-menopause) experience higher levels of anxiety and other mood disorders. There are many examples in the scientific literature showing that anxiety disrupts the ability to get to sleep and stay asleep. Unfortunately, many anxiolytic drugs, like barbiturates and benzodiazapines, are habit-forming and have significant side effects. Drugs designed specifically to treat insomnia like Ambien and Lunesta can only be used short term, tend to cause drowiness the day after treatment, and can be habit-forming. Some people have reported hallucinations and memory gaps during use. All of those drugs are listed as "controlled" by DEA due to their potential for being drugs of abuse.
I talked in a previous post about some things you can try at home before seeking help from your doctor or therapist. In addition to those options, there is some evidence that L-theanine can help with sleep disturbances. L-theanine is an amino acid found in green tea. When consumed, it is not used by the body like other amino acids to build proteins, but instead impacts neurotransmission (how cells talk to one another) in the brain. Neurotransmitters are proteins that communicate between cells in the brain. L-theanine is structurally similar to glutamate, which is the primary excitatory neurotransmitter and appears to act as a low-affinity glutamate antagonist (competes with glutamate) and upregulates GABA receptors (causes more of them to be made). The neurotransmitter GABA is the primary inhibitory neurotransmitter in the brain. Basically, this could lead to a decrease in excitation in the brain.
Animal studies suggest that L-theanine also increases brain serotonin and dopamine, which are also neurotransmitters (that sometimes act like hormones) with roles in learning, memory, body temperature, sleep, sexual behavior, and hunger. The combined chemical changes in the brain caused by L-theanine may slow brain activity and reduce anxiety, which may help women stay asleep longer. GABA also has been shown to increase brain waves associated with a relaxed state (alpha waves) and decrease those associated with stress and anxiety (beta waves), which may also help women fall asleep faster.
Data of the effect of L-theanine on human sleep and anxiety are limited. In 2019, a small clinical study demonstrated that L-theanine reduced anxiety and improved sleep. A separate clinical study found a decrease in anxiety in people who were treated with L-theanine. On the other hand, a different study found no effect of L-theanine on anxiety but did see notable improvement in sleep. A review article from 2020 noted that current research supports that L-theanine supplementation of 200-400 mg/day may help reduce stress and anxiety in people with acute stress. Those researchers noted that clinical studies with more subjects studied over a longer period of time are needed to verify the their preliminary results.
The effective dose for improving sleep in humans has not been definitively determined, but 200 mg appears to be the dose used in most studies. Few side effects have been reported except at very high doses. Side effects from drinking green tea are likely caused by the caffeine in the tea. Limit your green tea (and all caffeine) drinking to mornings so that the relaxing effect of L-threanine is not counteracted by the stimulating effect of caffeine. But like other drugs and supplements, you should talk with your doctor before taking L-theanine supplements since they interact with some drugs, namely high blood pressure medication, sedatives, and some chemotherapy agents. The safety of L-theanine has not been evaluated in pregnant or nursing women.
My standard warning about supplements still applies - like all supplements, the FDA doesn’t regulate L-theanine products so there is no guarantee that it's safe or effective. Make sure that you use supplements from companies that prioritize quality and that appear not to contain other ingredients. When possible, choose brands that are USP or NSF certified (that is, the supplement company submits their product for independent analysis.) USP and NSF are nonprofit organizations that set the most widely accepted standards for supplements. Words like "verified" and "approved" on the label without the USP or NSF seal are meaningless, marketing terms. For more info about using dietary supplements, go here.
I'll remind you one last time - do not confuse L-theanine with L-threonine. We have been talking about L-theanine.
The inability to sleep impacts every aspect of life - women experience more irritability, more brain fog, higher levels of depression and anxiety, and fatigue that makes it difficult to get through the day. My recommendation to my menopausal patients with trouble sleeping is that they first take stock to make sure they have good sleep hygeine, are exercising regularly, and have taken steps to reduce their stress, particularly before bed time. Evidence suggests a magnesium supplement may improve sleep, in addition to many other health benefits. I also recommend trying melatonin before bed - use a dose of 0.5-3 mg to avoid a morning hangover. Based on the available data, I see no reason not to try L-theanine if nothing else seems to help. But just pick one of the supplements to try for a couple of weeks before switching or adding another - don't start with all three. If you don't solve your menopausal sleep disorder quandary on your own, talk to your doctor. She can treat vasomotor symptoms (hot flashes, night sweats) with MHT (sometimes progesterone alone can help) or non-hormone options. If she diagnosis a mood disorder that may be impacting sleep, there are medications and/or therapy that can help. Notably, cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia. CBT-I tries to determine the underlying causes for the sleep problem. CBT-I therapists work to improve sleep hygeine, teach relaxation techniques, and set sleep timing limits, among other techniques. I'd also suggest an appointment with a sleep specialist to identify other potential causes.
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