The Ultimate Guide to Menopause and Sleep

Symptoms of menopause like hot flashes, questionable bladder control, and mood changes can sometimes make sleep feel unattainable. (1) Unsurprisingly, menopause and sleep don’t mix for most people, and up to half of women start sleeping worse right around the time menopause hits. (2)

In fact, the number of women with sleep disorders goes from as low as 16 percent as teenagers to 60 percent after menopause. (2) Although the cause of this spike in sleeplessness during menopause may seem obvious (hello, hot flashes), we’re going to explain how and why menopause affects your sleep so much and what you can do to get better shuteye.

Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t be taken as medical advice, and it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately. 

How Menopause Affects Your Sleep

So how do menopause and sleep interact? “Significantly and for the worse, due to hormonal changes — primarily a reduction in estrogen and progesterone levels,” says Dr. Chester Wu, MD, sleep medicine physician in Houston, TX. (2)

We’ll dig into how these hormones specifically sabotage your sleep, but for now, let’s look at all the other different ways menopause steals your slumber.

Hot Flashes and Night Sweats

When it gets close to bedtime, your body starts to cool down, and keeps cooling through the night. (3) We sleep better when we’re cool, so hot flashes and night sweats can wake you up throughout the night.(4) (5)

“It’s thought the reduction in estrogen levels is the primary driver [for hot flashes]. The reduction affects your body’s thermoregulation, which can lead to sudden vasodilation (widening blood vessels) and increased sweating as the body tries to cool down,” says Wu. 

Our bodies don’t like sleeping hot, so low-estrogen-fueled hot flashes often prevent good quality sleep. (4) (6) Luckily, there is some good news, most women only experience hot flashes for about two years before they fade away. (7)

Sleep Apnea and Snoring 

When you have sleep apnea, your breathing pathway (airway) blocks off periodically as you sleep, causing snoring and pauses in breathing. (8) After menopause, women have a much higher chance of developing sleep apnea. (9) But why?

We can blame hormones again here, says Wu, who adds that estrogen helps your throat muscles stay strong and progesterone supports breathing. So, when menopause trends these two hormones down, it’s harder to keep your throat open and your breathing regular.

In menopause, your metabolism also changes, which can lead to increased body weight. (10) (11) And with those extra pounds comes a higher risk of snoring and sleep apnea, adds Wu. (8)

Insomnia 

Insomnia doesn’t just describe a few awful nights of sleep — it means difficulty sleeping at least three nights a week for more than three months. (12) And (you guessed it) women going through menopause report more insomnia. (2) During the transition to menopause and after, women report trouble falling asleep and staying asleep, with hot flashes mostly to blame. (2)

Restless Leg Syndrome 

Restless leg syndrome (RLS) provides another common challenge for women going through menopause. (2) RLS often feels like an uncomfortable crawling sensation in the legs that only improves by moving your legs around. It usually hits later at night when you sit or lie down, but some say it even wakes them from sleep. (13) To banish those restless legs, you can talk to your healthcare provider about medications or other treatment options. (14)

Mood and Mental Health Conditions 

If all the above wasn’t enough, the change in hormone levels that come with menopause can also increase your risk for mental health disorders like anxiety and depression. (15) These two can make it harder to sleep, especially when you experience both. (16) Mental health conditions don’t have to steal your beauty rest, but more on that soon.

Changes to Natural Melatonin Levels 

We all make a hormone called melatonin that helps manage our circadian rhythm, or internal clock. (2) This clock changes as we age, especially in women, whose melatonin levels drop by a lot right around menopause. With less melatonin, your brain finds it harder to know when it’s time to get sleepy. (2) 

Let’s Talk About Hormones

We’re going to stay on the bad-news train a little longer, but keep reading — solutions are coming! As you start the transition to menopause, your estrogen and progesterone fluctuate more than usual for a while, and your menstrual cycle gets irregular. Then these hormones decrease steadily until they level off after the transition finishes up. (17) (18)

Progesterone and estrogen do important work throughout child-bearing years. Estrogen develops milk ducts, helps get your uterus ready for pregnancy, spurs vaginal moisture, and helps control cholesterol levels. (19) Progesterone gets your uterus ready for a baby, too, but also helps your thyroid work and keeps your mood steady. (20)

Estrogen also directly helps your sleep by increasing your rapid-eye movement (REM) stage, helping you fall asleep faster, stay asleep longer, and prevent nighttime wakings. (2) 

Though hormones play a significant role in the sleep changes you may experience, they aren’t the only reason why menopause affects sleep so much: in addition to the factors we’ve already called out above, a slowed metabolism, disrupted circadian rhythm, and mood changes can also contribute to higher risk of sleep disorders like sleep apnea. (2) (11) 

But you don’t have to sit back and take it — you can do plenty to improve your sleep through the transition to menopause and beyond. And in more good news, as your hormone levels stabilize to post menopausal levels, many women notice their menopause symptoms resolve. (6)

How to Improve Sleep During Menopause

So what’s a person to do? Your sleep needs don’t change — you still need seven to eight hours a night. (22) The good news is you don’t necessarily have to give up good sleep during this transition. Take a look below at our tips for better sleep during menopause.

Cut Out Hot Flash Triggers

We know hot flashes can steal your sleep fast. But did you know you can trigger a hot flash? Some of the most common hot flash triggers include: (23)

• Hot environment
• Smoking
• Caffeine
• Alcohol
• Spicy food
• Tight clothes
• Stress

You may not be able to avoid these every minute of the day, but once you know your triggers, you can try to steer clear of them before lights out for better sleep. 

Establish Good Exercise and Nutrition Habits

When menopause symptoms hit, exercising may sound like the last thing you want to do. But working out can relieve a lot of menopause symptoms and help you sleep through the night. (6) 

Since menopause often leads to extra weight gain, your nutrition becomes more important than ever. If you can establish a good diet balance, you may more easily maintain a healthy weight and avoid sleep disorders like sleep apnea. (8)

Try CBT for Insomnia 

Cognitive behavioral therapy uses professionally guided therapy to discover your thought patterns and behaviors that hurt your sleep. Once you know these, you can work to adjust your thoughts and habits to promote better slumber. (24)

CBT kicks insomnia symptoms to the curb for 70 to 80 percent of people who try it, and plenty of women going through sleep troubles during menopause have seen positive results from this therapy. (2) (25)

Create a Bedtime Routine 

You can combat your dip in melatonin a few different ways. Follow a regular sleep schedule: try to go to bed and wake up at the same time every day (yep, even on the weekends). (5)

The same bedtime routine every night can also give your body extra cues that it’s time to drift to sleep. This can look like reading a book, taking a chill walk, or relaxing in a warm bath. If you can, try to skip screen time before bed, though. (5)

Personalize Your Sleep Hygiene

A lot of the tips above follow good sleep hygiene practices (sleep-supporting habits), and while sleep hygiene doesn’t specifically target people going through menopause, it’s always a good idea. (2)

These additional sleep hygiene tips can get you sleeping better all throughout your transition to menopause: (2)

• If you don’t fall asleep within 20 minutes, get up and do something relaxing until you feel sleepy again.
• Avoid naps, especially in the late afternoon.
• Steer clear of caffeine and alcohol before bed.
• Stick to light snacks before bed — no heavy meals.
• Create a quiet, comfortable, and cool sleeping space.
• Invest in some comfy PJs.
• Don’t guzzle liquids right before you go to bed.
• Try meditation and relaxation exercises.

Medication 

If you’ve done all you can to improve your sleep during perimenopause and menopause and you still can’t get enough rest, you can talk to your healthcare provider about medications and supplements.

Hormone Replacement Therapy

If all these sleep woes arise from your falling hormone levels, can’t you add more hormones to the mix? The answer: yes, sometimes you can. (2)

Your provider may recommend one of a few types of hormone replacement therapy (HRT): estrogen, progesterone, or a combination of the two. (26) “HRT can alleviate symptoms like hot flashes and mood disturbances to improve sleep,” says Wu.

Melatonin Supplements for Menopause

As your natural melatonin levels drop, you can try a melatonin supplement under the direction of your provider. For some, this added melatonin can help make you feel sleepy when you’re looking to go to bed. Just remember that melatonin is typically reserved for short-term use. (2)

Prescription Sleep Medication

While you may see gobs of advertisements touting the benefit of prescription sleeping pills, it’s always best to keep this option temporary (no longer than three weeks). (27) Your provider can help you decide if these medications could help you get over a bad sleep hump.

FAQs

The Last Word From Sleepopolis 

Between mood swings and hot flashes, menopause is already a barrel of laughs before you add poor sleep to the party. But even though your falling hormones try to steal your sleep, you have plenty of options to defend your rest. Give our tips a try, but always reach out to your healthcare provider with questions or to make a plan for better sleep during menopause.

Sources

Abby McCoy

Abby McCoy is an RN of 16 years who has worked with adults and pediatric patients encompassing trauma, orthopedics, home care, transplant, and case management. She has practiced nursing all over the world from San Fransisco, CA to Tharaka, Kenya. Abby loves spending time with her husband, four kids, and their cat named Cat.