Menopause and Sleep Problems: Causes and Solutions

The menopausal transition is a natural progression in the life of women and individuals assigned female at birth (AFABs). But this time may not be without its challenges. Sleep disorders are a common issue faced during menopause, affecting anywhere between 16% and 60% of individuals from peri- through post-menopause. With sleep being essential to your overall health, well-being, and quality of life, it’s important to understand the role that menopause plays with sleep and how to most effectively get a good night’s rest during this transitional period.

Understanding menopause

All individuals who menstruate will eventually go through menopause. Menopause refers to the period 12 months after your last period and is associated with significant changes in the production of sex-specific female hormones.

ADVERTISEMENT

This menopause timepoint is actually part of a multi-stage menopausal transition process that also includes the times before and after menopause. The time frame before menopause is referred to as perimenopause, which starts for most individuals between the ages of 45 and 55. During perimenopause, the estrogen and progesterone levels in the body will vary widely as your body transitions to menopause. During this time, most symptoms referred to as menopause symptoms begin.

Once your body has achieved menopause, the postmenopausal period begins, and you will remain in this stage for the rest of your life. During postmenopause, you no longer experience periods and are unable to become pregnant. However, some symptoms of menopause may be ongoing.

Common symptoms of menopause

During the menopausal transition, the resulting hormonal fluctuations may lead to various symptoms. Symptoms experienced during perimenopause include the following:

  • Hot flashes
  • Night sweats
  • Menstrual cycle changes
  • Poor sleep quality
  • Mood swings
  • Memory complaints
  • Vaginal dryness

However, each person will experience the menopausal transition differently. While these are common symptoms, it is not possible to predict the types or severity of symptoms each person will experience. In addition, other physical changes are possible, such as muscle aches and pains, fat gain, muscle loss, thinning skin, incontinence, and more. Some people after menopause are at higher risk of snoring and gasping/choking during sleep, which could be a sign of obstructive sleep apnea.

How menopause affects sleep

Estrogen and progesterone receptors are found throughout the central nervous system in areas that are also involved in sleep regulation, and the decrease in the levels of these specific reproductive hormones is associated with sleep disruption.

ADVERTISEMENT

Estrogen is believed to affect the sleep- and wake-promoting areas of the central nervous system, and both estrogen and progesterone hormones may also impact the circadian rhythm. As a result, changes in estrogen and progesterone hormone levels can affect sleep patterns.

However, while the decline in progesterone is linear, estrogen levels decrease in an erratic and irregular manner, correlating to a range in the type, severity, timing, and duration of symptoms during menopause.

The possible interactions between sex hormones and sleep are outlined in the table below:

Menstrual factorGeneral effect on sleep
Estrogen hormoneIncreased levels = fewer arousals during nighttime sleep = better nighttime sleep
Progesterone hormoneToo low = poorer nighttime sleep
Follicle stimulating hormoneIncreased levels = difficulty falling and staying asleep
Luteinizing hormoneIncreased levels = higher number of awakenings and lower sleep efficiency

In addition, according to Dr. Kathleen Jordan, Chief Medical Officer at a national virtual menopause care clinic, “The lack of estrogen and progesterone triggers changes in serotonin activity, changes in iron stores from frequent or heavy periods in perimenopause, and/or common life stressors of middle age — all of these contribute to disrupted sleep for women.”

Sleep problems during menopause

Sleep is essential for your overall well-being, including helping you feel rested and energetic, protecting your cardiovascular and mental wellness, and improving your immune system and cognition. However, women and AFAB people are more likely to experience sleep disorders than their male counterparts. During perimenopause, sleep quality may be negatively impacted by common menopausal symptoms, including insomnia, hot flashes and night sweats, snoring, as well as the increased severity of restless legs syndrome.

Insomnia

Insomnia is the most common sleep disorder, and research has shown that women and AFABs are typically more likely to experience insomnia. The disorder is characterized by difficulty falling and remaining asleep and the inability to return to sleep upon awakening. Decreasing progesterone levels and the erratic decline in estrogen levels can cause symptoms that disturb sleep.

For example, symptoms such as hot flashes and night sweats can make falling and staying asleep difficult. Mood swings, which may also be experienced during menopause, may be accompanied by anxiety (which can make it difficult to fall asleep), as well as feelings of depression that are further exacerbated by the lack of sleep. Additionally, for individuals experiencing restless legs syndrome, symptoms like constant leg itching and pulling can interfere with getting a good night's rest.

ADVERTISEMENT

Hot flashes and night sweats

Hot flashes and night sweats are very common symptoms that can last from peri- through post-menopause. These symptoms are linked to the fluctuations in estrogen, the sex hormone that also helps regulate body temperature. A hot flash is a sudden feeling in your body, which can be followed by profuse sweating and cold shivering. Hot flashes that are strong enough to wake you from your sleep are referred to as night sweats.

Hot flashes can vary in length and frequency due to the erratic changes in estrogen levels. For example, they can last just a few seconds or as long as 10 minutes. Additionally, hot flashes can occur anywhere from a few times an hour to just a few times over the course of a week.

Sleep apnea and snoring

Menopause has also been associated with an increased risk of obstructive sleep apnea, a chronic disorder in adults that is characterized by recurring closure and re-opening of the upper airway during sleep. Reproductive hormones have been shown to have a protective effect against sleep apnea in women, which explains why their decrease throughout the menopausal transition may be linked to increased rates of sleep apnea.

New or increased levels of snoring (even gasping) during sleep could be a sign of having sleep apnea.

Restless legs syndrome

Restless legs syndrome (RLS), also referred to as Willis-Ekbom disease, is a neurological disorder characterized by the continuous urge to move the legs. RLS is both a sleep and movement disorder as you are forced to move your body to relieve symptoms that are experienced when you are inactive for extended periods of time, like sitting at your computer or while you are trying to sleep.

Symptoms of RLS include unpleasant or uncomfortable sensations only relieved by moving your legs, and these sensations tend to worsen in the evenings or at night. While generally more prevalent in women, menopause has been shown to increase the prevalence and severity of restless syndrome symptoms even further, likely due to the changes in estrogen levels.

How to get better sleep during menopause

Sleep challenges will vary from person to person. However, implementing a few strategies can help you get better sleep while undergoing the menopausal transition.

ADVERTISEMENT

Lifestyle changes

Improving sleep quality starts with improved lifestyle habits. For example, wellness practices, such as meditation and journaling, can reduce anxiety and better support sleep efficiency.

Dr. Brynna Connor, Healthcare Ambassador, encourages the use of regular exercise to promote sleep quality. Just be sure to “give yourself at least 1 to 2 hours after exercise to let your body process the endorphins that come from exercise, and to let your brain unwind” before bedtime. Additionally, reducing caffeine and wearing sensible shoes can help decrease the symptoms of accompanying conditions, such as restless legs syndrome.

Overall, positive lifestyle changes — such as healthy eating, avoiding alcohol and smoking, improved physical activity, and social support — can all help contribute to improved sleep quality.

Improved sleep hygiene

Sleep hygiene refers to the practices everyone should follow, including individuals experiencing menopause, to ensure a good night’s sleep. This includes creating a comfortable, quiet environment in your bedroom to support better sleep; for example, establishing a regular bedtime and avoiding watching television or using mobile devices before bedtime may prove useful. Using the 'dead man' position can also support good sleep, as is avoiding too much water before bedtime to avoid frequent bathroom trips.

In addition, according to Dr. Chelsie Rohrscheib, sleep expert and neuroscientist, using bed cooling technology and wearing moisture-wicking sleepwear to manage night sweating can support better sleep.

Melatonin

Melatonin is a hormone that helps regulate our sleep-wake cycle and one that naturally declines with aging. The hormone is available as an over-the-counter supplement, which is marketed for shortening time to falling asleep. However, there is a lack of evidence supporting the safety or effectiveness of melatonin supplementation for threatening chronic insomnia.

It’s important to consult with your healthcare provider before starting any supplements to support sleep health.

Hormone replacement therapy (HRT)

In the case of individuals experiencing severe menopausal symptoms, hormone replacement therapy (HRT), may be prescribed to treat certain symptoms. For example, HRT may be helpful for individuals experiencing hot flashes and night sweats. If those symptoms are affecting your sleep, then the use of HRT could prove helpful in reducing them.

However, the use of HRT comes with the possibility of health risks, such as potentially increasing your chance of getting blood clots, heart attacks, strokes, and breast cancer (although some studies suggest preventative benefits of HRT). Therefore, it may not be suitable for all people, especially those with certain risk factors.

Additionally, some studies cite a lack of evidence supporting the use of HRT to specifically treat certain sleep disorders, such as sleep apnea or insomnia. Your healthcare provider will help determine if HRT is the right choice for you.

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) is a type of psychotherapy and standard intervention for treating insomnia. According to Dr. Daphne Lee, expert endocrinologist, cognitive behavioral therapy for insomnia (CBT-I), “focuses on restructuring the thoughts, feelings, and behaviors that are contributing to insomnia.” This therapy helps individuals understand and change their thoughts and behavioral patterns linked to insomnia to improve their mental health and overall well-being.

In fact, prior research indicates that CBT was superior to other treatments for chronic insomnia disorder in individuals experiencing menopause. CBT incorporates sleep hygiene practices and relaxation techniques to improve sleep quality. Additionally, using CBT in combination with positive lifestyle changes can help support better quality sleep.

Complementary and integrative medicine (CIM)

Complementary and integrative medicine (CIM) focuses on traditional and alternative health techniques that supplement conventional medicine. The use of CIM has been shown to potentially improve mental wellness, may support better sleep and overall quality of life, and could be helpful for individuals experiencing menopause.

Examples of CIM practices, which studies have indicated as helpful for insomnia, include yoga, tai chi, acupressure, and acupuncture.

When to seek professional help

“Poor sleep is not an inevitable fact of aging,” says Dr. Jordan, “and too many women think that it is.” Given how important sleep is to our health, individuals experiencing sleep challenges during menopause and the years leading up to it should consider contacting their healthcare providers. Resources and therapies are available to help improve your sleep wellness at any stage of menopause.

A good rule to remember, according to Dr. Rohrscheib, is to speak to a health professional “if your insomnia is chronic, meaning it lasts more than 3 months.” Dr. Lee recommends that “individuals experiencing severe or prolonged symptoms like hot flashes, mood changes, or sleep disturbances that interfere with daily activities or overall wellbeing” should reach out for support. Furthermore, Dr. Connor notes that your healthcare provider will help “rule out any other underlying health concerns and create a course of treatment that’s best for your specific needs.”

During menopause, you may experience a variety of symptoms. Sleep disturbances are a common symptom associated with the menopausal transition due to the decreasing levels of progesterone and estrogen. However, it is possible to find relief from sleep challenges through improved lifestyle changes, sleep hygiene, and therapies such as CBT. If getting a good night’s sleep is a challenge, it may be time to reach out to your healthcare provider to find out what solutions will work best for you.

FAQ

Key takeaways:
18 resources

ADVERTISEMENT

Leave a reply

Your email will not be published. All fields are required.