Going through menopause and can’t sleep? You’re not alone. Menopause is a time of major hormonal, physical, and psychological change for women — and all that change can wreak havoc on their sleep.
On average, around 12 percent of women experience sleep complaints. As women age into their late 40s to early 50s, that number increases dramatically to 40 percent. Sleep issues become more common and worsen during perimenopause to postmenopause, when women report the most sleep problems.
A woman reaches menopause one year after her menstrual periods have stopped, which happens around age 52. A woman’s ovaries gradually decrease production of the hormones estrogen and progesterone during perimenopause, a period of seven to ten years prior to menopause. These hormonal changes contribute to sleep issues that often continue into postmenopause, the period after menopause.
Menopausal symptoms can vary from woman to woman and throughout perimenopause into menopause. Sleep issues are common, with sleep disorders affecting 39 to 47 percent of perimenopausal women and 35 to 60 percent of postmenopausal women.
The most common sleep problems reported by women going through menopause include hot flashes, insomnia, sleep-disordered breathing, and other mood and sleep disorders.
Hot flashes are sudden and unexpected sensations of heat all over the body accompanied by sweating. Hot flashes begin in the face before spreading to the chest and the rest of the body. They can last as short as 30 seconds or as long as five minutes. Hot flashes affect 75 to 85 percent of women around menopause. Hot flashes typically occur for around seven years, but can continue for more than ten years.
Hot flashes that occur at night are also known as night sweats. Prior to the hot flash, a woman’s body temperature rises and blood flow increases to the face, creating a heating sensation that wakes them up. Hot flashes are extremely energizing due to the increase in heat and adrenaline, which can make it hard to fall back asleep. Even if a woman falls back asleep quickly, her sleep quality suffers due to the frequent awakenings and discomfort, causing fatigue the following day. Of women with severe hot flashes, nearly 44 percent meet the clinical criteria for chronic insomnia.
Insomnia describes a chronic difficulty falling or staying asleep that occurs more than three nights a week. Individuals with insomnia experience restless sleep, miss out on overall sleep, wake up early, and often feel sleepy and tired during the day. The sleep deprivation from insomnia can increase feelings of anxiousness and irritability, impair focus and memory, and increase headaches and inflammation.
One in seven adults suffers from chronic insomnia. For women, that number is nearly double, with one in four women experiencing some symptoms of insomnia. The risk of insomnia increases into menopause, with as many as 61 percent of postmenopausal women reporting insomnia symptoms.
Snoring and sleep apnea are more common and severe in postmeopausal women. Obstructive sleep apnea (OSA) is sleep disorder characterized by temporary pauses in breathing, which lead to gasping, snoring, and choking sounds, along with lowered sleep quality.
OSA occurs in 2 percent of women. Once perimenopause begins, a woman’s risk increases four percent with each year. Recent research suggests lower progesterone levels, like those observed in postmenopausal women, may contribute to the development of sleep apnea. It appears progesterone may prevent the relaxation of the upper airways which causes the lapses in breathing associated with OSA. Further, postmenopausal women on hormone replacement therapy are less likely to have OSA than those who are not.
Other sleep disorders may develop during menopause, including restless legs syndrome and periodic limb movements disorder. These disorders are associated with involuntary leg movements that cause uncomfortable sensations and disrupt sleep.
Estrogen plays a role in the metabolism of serotonin and other neurotransmitters that affect our sleep-wake cycle. Estrogen also helps keep our body temperature low at night, and therefore more conducive to restful sleep. Estrogen also has an antidepressant effect. With less estrogen, women may experience higher body temperatures, lower quality sleep, and poorer mood.
Our sleep-wake cycle also changes as we age, and loses its consistency. We begin to feel tired earlier, and wake up earlier in the morning, leading to less sleep overall. This may also explain why older adults, including menopausal women, are at increased risk for insomnia.
While the mood changes that occur with menopause could be linked to the hormonal changes, it’s also possible they’re brought on by other life stresses that happen to occur around menopause. Empty nesting, caring for aging parents, and concerns about their own aging may also increase stress for women.
Women may also begin taking medications, whether due to menopause or other symptoms of aging, which may interfere with their sleep. Joint pains, body aches, and bladder problems associated with age can also contribute to sleep problems.
Two common menopause treatments include Estrogen Replacement Therapy (ERT), which increases estrogen, and Hormone Replacement Therapy (HRT), which increases estrogen and progesterone. Both of these treatments have proven effective in relieving menopausal symptoms, including hot flashes, insomnia, and mood.
However, HRT poses serious risks for some women, particularly those who have had blood clots, strokes, heart attack, and certain types of cancer. As a result, doctors are recommended to prescribe HRT at the lowest effective dose and only to use it as a short-term treatment. It’s important to talk to your doctor about the risks and benefits of HRT, as there are many approaches for managing menopausal symptoms.
Lower doses of antidepressants and SSRIs, including fluoxetine, paroxetine, and venlafaxine, can relieve menopausal symptoms, including hot flashes. Some, like Bazedoxifene, may relieve hot flashes while also increasing sleep quality.
Soy products, including tofu, soybeans, and soymilk, contain phytoestrogen. This plant hormone is similar to estrogen, and some research indicates a diet rich in soy may help minimize hot flashes and improve sleep. Phytoestrogens like the ones found in soy are also available in over-the-counter supplements like ginseng, black cohosh, and red clover extract. However, natural supplements are not closely regulated by the FDA, so their efficacy in relieving menopausal symptoms, and their potential side effects, are not fully known. It’s always a good idea to speak to your doctor about any alternative treatments you are considering.
Melatonin, your body’s natural sleep hormone, can also be taken as an over-the-counter medication. Low doses of melatonin improved mood and sleep onset in postmenopausal women. Like estrogen and progesterone, melatonin also decreases as we age.
Cognitive behavioral therapy (CBT) is also effective in relieving insomnia, including symptoms associated with menopause. In CBT, you work with a trained therapist to recognize the thoughts and behaviors that are negatively impacting your sleep, and learn to replace them with healthier behaviors that promote good sleep.
If you are experiencing sleep issues related to menopause, consult your doctor. They know your personal medical history and can recommend appropriate treatment options, including medications and lifestyle changes that may improve your sleep. The following sleep tips may also help.
Sleep issues are a common experience of menopause, but there are many options for relieving them. If your sleep issues persist, seek out a therapist trained in CBT who has experience working with menopausal women.