The Ultimate Guide to Menopause and Sleep

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Whether your grandmother warned you about it or your mom’s experiencing it now, you’ve likely heard the term menopause. While the first occurrence of your menstrual cycle (or period) signifies what many refer to as “becoming a woman” at a young age, menopause shows that even without your period, women rarely get a break.

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Menopause can disrupt you physically and mentally, which stretches into your sleep quality too. Even if you’re decades away from experiencing it or you’re not even a member of the affected group, it’s important to know how this change can affect women. Aunt “Flow” has packed up and gone home for good, so let’s dive in.

The connection between menopause and sleep

According to the Mayo Clinic, symptoms leading up to menopause (perimenopause) can include irregular periods, sleep problems, vaginal dryness, hot flashes, chills, night sweats, mood changes, weight gain and slowed metabolism, thinning hair and dry skin, and/or loss of breast fullness. (1)

Dr. Stacy Sutton, board-certified Women’s Health Clinical Specialist, says “Sleep disturbance is one of the most common issues that women report during menopause. About 50 percent of all women of menopausal age (40-64) report sleep problems and about 70 percent report experiencing hot flashes.

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One 2017 study that looked at menopausal transitions of 60 women, with a follow-up six years later, found that a “significant deterioration in sleep continuity occurs when women age from 46 to 52 years, but the change from premenopausal to menopausal state restores some SWS.” (2) SWS, as mentioned in the quote, stands for slow-wave sleep, which the Harvard Medical School’s Division of Sleep Medicine defines as “​​The deepest stage of non-REM (NREM) sleep, characterized by a larger amount of synchronized slow-wave EEG (brainwave activity) than in other stages.” (3) In this stage, the brain is less responsive to external stimuli and it’s harder to be woken up.

Another study in the same journal, looked at 57 premenopausal women and followed up after 10 years, performing a polysomnography (PSG) both times. The results here showed that the “sleep of middle-aged women does not worsen over a 10-year time span due to the menopausal transition. The observed changes seem to be rather age- than menopause-dependent.” So it seems that menopause may not always worsen sleep quality in the longterm, but if it’s not that, then age can be a factor as well. (4)

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Johns Hopkins Medicine considers hot flashes to be a large culprit of sleeplessness during menopause. Though they can occur day or night, hot flashes can be associated with night sweats, and research shows that unexpected awakenings are common right before the occurrence of a hot flash, notes Grace Pien, M.D., M.S.C.E., an assistant professor of medicine at the Johns Hopkins Sleep Disorders Center. She also states that changes in the brain are also at play in waking you up in the night, and “Even women who don’t report sleep disturbances from hot flashes often say that they just have more trouble sleeping than they did before menopause.” (5)

Tip: If you’re looking for a cooling mattress that can support both you and your partner through perimenopause and menopause, take a look at our picks for best queen size mattresses.

Other risks for sleep disruptions that may arise during menopause include depression, anxiety, and sleep apnea, which can stem from the loss of reproductive hormones. (JH) Nancy Belcher, Phd, CEO and Co-Founder of Winona, a female-founded anti-aging wellness center that specializes in menopause treatments says that, “Because menopause equates to a dip in estrogen and progesterone levels, sleep can be greatly compromised during this stage of life. Progesterone, in particular, is known as a relaxing hormone that can help aid with sleep, so it’s not surprising that sleep quality fades when this hormone is decreased.”

Tips for better sleep during menopause

In need of some tips to improve your sleep quality and hygiene while going through menopause? We’ve got you covered. The National Institute on Aging within the U.S. Department of Health and Human Services has some suggestions:

Watch your intake.

This includes food and drinks. Avoid consuming large meals close to bedtime and avoid caffeine later in the day. Loop alcohol into the equation as well. Remember, even a small amount won’t help you sleep better.

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Jeanette Kimszal, Registered Dietitian, says that, “During menopause, nutrient needs change due to shifts in hormone function. Calcium, vitamins C, K, D, magnesium, selenium, and beta-carotene are needed for healthy bones. (6) Vitamin E may help with sleep. It has also been found to potentially reduce hot flashes. (7) (8)

Some research also shows during menopause there is less tryptophan delivered to the brain. Tryptophan is a nutrient needed for sleep. Low levels could prevent postmenopausal women from getting adequate sleep. Getting more foods rich in tryptophan may improve sleep. These include chicken, eggs, cheese, fish, peanuts, pumpkin seeds, sesame seeds, milk, turkey, and tofu. (9)

An increase in vegetables has been found to lower menopause symptoms. (10) The Mediterranean Diet offers a high intake of this type of food, nutrients needed for menopause, and may also improve sleep.” (11) (12)

Follow a routine.

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Practice waking up and going to bed at the same time each day. Maybe develop a nighttime ritual that works for you, like reading a book or taking a soothing bath. Exercise is also a great thing to bring into your routine, but avoid doing vigorous or intense exercise too close to bedtime.

Block out distractions.

Do your best to quit binging in the bedroom for good, as well as computer and phone use in bed. The blue light from each of these devices make it harder to fall asleep. You can also ward off added heat by keeping your room at a regulated temperature. Not too cold and not too hot.

Perform paced breathing.

When experiencing hot flashes, Dr. Sutton suggests performing paced breathing. “To perform paced breathing, get in a comfortable position.

  • As you take a breath in, try to breathe into your abdomen and relax your shoulders and chest.
  • Inhale for 4 seconds
  • Hold your breath at the top of your inhale for 2 seconds
  • Breathe out for 6 seconds
  • Hold your breath at the end of your exhale for 2 seconds
  • Repeat.

Perform this exercise for several minutes. If at any point you feel lightheaded or short of breath, resume normal breathing.” Please consult a physician before engaging in paced breathing.

If any of these tips don’t do the trick for you or symptoms are increasingly affecting your quality of life, Dr. Sutton also suggests hormone replacement therapy, which “has been shown to be helpful in decreasing symptoms of menopause, but there are potential associated risks that should be discussed in detail with your healthcare professional.”

You may want to consider cognitive behavioral therapy, which may be used to treat insomnia. We recommend consulting a doctor or therapist for treatment and any additional remedies. (13)

What happens during menopause?

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Menopause specifically affects women, signifying the end of their menstrual cycles. The average age for women experiencing it is 51 years old, most often in their 40s and 50s, but it can also occur at older or younger ages. A diagnosis occurs when a menstrual cycle hasn’t taken place for 12 months.

Bonafide, a women’s healthcare company, conducted the State of Menopause Study, which included 1,039 women in the United States, from 40 to 65 years of age. Results showed that “45% of women didn’t know the difference between perimenopause and menopause prior to experiencing symptoms.” Additionally, 16% reported having hot flashes, 15% reported weight gain, 14% had difficulties with sleep, and 14% experienced night sweats. (14)

Perimenouse refers to the period leading up to menopause, menopause signifies the actual end of a woman’s period, and postmenopause is essentially the stage of life after this milestone has happened.

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According to Mount Sinai, perimenopause can occur a few years before the end of a woman’s menstrual cycle. Its early stage can begin around age 40 to 44 and may include changes in menstrual flow, period length, and surges of estrogen. The later stage in a woman’s 40s or 50s includes missing periods until the eventual, final end of the menstrual cycle. In this stage, estrogen levels drop considerably and can contribute to vaginal dryness and hot flashes. These symptoms can last anywhere from 6 months to 5 years after menopause onset. (15)

Last word from Sleepopolis

As always, we want to remind everyone reading this article that we aren’t medical experts. Any menopausal related medical symptoms, questions, or concerns should be addressed by a medical professional.

Menopause is a life-changing event. If you can take away anything, let it be knowledge and support. If you’re a woman, you can be more aware of symptoms to be better prepared for when it happens for you. If you’re outside of this group, offer your support to those you know who are affected, and as always, stay educated.

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  1. Mayo Clinic Staff. Menopause. Mayo Clinic, Patient Care & Health Information, Diseases & Conditions. October 2020.
  2. Laura Lampio, MD, Päivi Polo-Kantola, MD, PhD, Sari-Leena Himanen, MD, PhD, Samu Kurki, PhD, Eero Huupponen, PhD, Janne Engblom, DSc, MSc, Olli J. Heinonen, MD, PhD, Olli Polo, MD, PhD, Tarja Saaresranta, MD, PhD. Sleep During Menopausal Transition: A 6-Year Follow-Up. SLEEP: Official Publication of the Sleep Research Society, Volume 40, Issue 7, July 2017.
  3. N3 sleep (Stage 3 or slow-wave sleep [SWS]). Harvard Medical School Division of Sleep Medicine, Healthy Sleep.
  4. Nea Kalleinen, Jenni Aittokallio, Laura Lampio, Matti Kaisti, Päivi Polo-Kantola, Olli Polo, Olli J Heinonen, Tarja Saaresranta. Sleep during menopausal transition: a 10-year follow-up. SLEEP: Official Publication of the Sleep Research Society, Volume 44, Issue 6, June 2021.
  5. How Does Menopause Affect My Sleep? Johns Hopkins Medicine, Health.
  6. Thais R. Silva,Karen Oppermann, Fernando M. Reis, Poli Mara Spritzer. Nutrition in Menopausal Women: A Narrative Review. Nutrients, June 2021.
  7. Kenneth L Lichstein, PhD, Kristen L Payne, MA, James P Soeffing, MA, H Heith Durrence, PhD, Daniel J Taylor, PhD, Brant W Riedel, PhD, and Andrew J Bush, PhD. Vitamins and Sleep: An Exploratory Study. Sleep Medicine, Volume 9, Issue 1, 2007.
  8. S Ziaei , A Kazemnejad, M Zareai. The effect of vitamin E on hot flashes in menopausal women. Gynecologic and Obstetric Investigation. July 2007
  9. N Carretti, P Florio, F M Reis, S Comai, F Petraglia, C V L Costa. Menopause alters the metabolism of serum serotonin precursors and their correlation with gonadotropins and estradiol. Climacteric, Volume 10, Issue 5, 2007.
  10. Mahshid Soleymani, Fereydoun Siassi, Mostafa Qorbani, Shahla Khosravi, Zahra Aslany, Maryam Abshirini, Ghazal Zolfaghari, Gity Sotoudeh, Dietary patterns and their association with menopausal symptoms: a cross-sectional study. Menopause: The Journal of the North American Menopause Society. Volume 26, Issue 4, April 2019.
  11. Thais R. Silva, Karen Oppermann, Fernando M. Reis, Poli Mara Spritzer, Nutrition in Menopausal Women: A Narrative Review. Nutrients, June 2021.
  12. Faris M. Zuraikat, Nour Makarem, Marie-Pierre St-Onge, Huaqing Xi,5 Alekha Akkapeddi,4 and Brooke Aggarwal, A Mediterranean Dietary Pattern Predicts Better Sleep Quality in US Women from the American Heart Association Go Red for Women Strategically Focused Research Network. Nutrients, September 2020.
  13. Sleep Problems and Menopause: What Can I Do? The National Institute on Aging, U.S. Department of Health and Human Services.
  14. State of Menopause Survey. Bonafide.
  15. Menopause. Mount Sinai Health System, July 2019.
Carley Prendergast

Carley Prendergast

Carley is a former Staff Writer at Sleepopolis. She is a Certified Sleep Science Coach who wrote news, sleep health content, and managed our newsletter.