Gina Johnson
Sleep problems are a common symptom of menopause, with many women experiencing poor sleep quality and sleep disturbances. The hormonal shifts, physical changes, and life circumstances that occur during menopause can all contribute to sleep problems.
During menopause, the body produces less oestrogen and progesterone, which can affect thermoregulation, mood, metabolism, and the circadian rhythm. This can lead to hot flashes, night sweats, snoring, sleep apnea, and restless leg syndrome, all of which can disrupt sleep.
Research suggests that menopausal hormone therapy (MHT) can help to reduce these symptoms and improve sleep quality. Other strategies for managing menopause-related sleep problems include optimising the sleep environment, managing stress, exercising regularly, and cognitive behavioural therapy for insomnia (CBT-I).
| Characteristics | Values |
|---|---|
| Sleep problems | Start during perimenopause and continue throughout menopause and postmenopause |
| Sleep problems causes | Hormone level changes, hot flashes, night sweats, weight gain, snoring, sleep apnea, restless leg syndrome, anxiety, depression, life circumstances |
| Sleep duration | 7-9 hours recommended by The National Sleep Foundation |
| Sleep duration (study) | 7 hours found to be optimal for mental health and wellbeing |
| Sleep solutions | Regular exercise, medication and therapies, lifestyle changes, melatonin, menopausal hormone therapy |
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What You'll Learn
Sleep disorders and menopause
Sleep disturbances are a common occurrence during menopause, with 40-60% of menopausal women reporting poor sleep quality. The hormonal shifts, physical changes, and life circumstances that occur during this time can all contribute to sleep problems. Here are some of the most common sleep disorders associated with menopause:
- Hot flashes and night sweats: Hot flashes are intense episodes of heat that spread from the chest up and usually last 2-4 minutes. They are often accompanied by sweating and feelings of anxiety. When someone wakes up during a hot flash, the discomfort can make it hard to fall back asleep.
- Insomnia: Insomnia is a sleep disorder characterized by difficulty falling and staying asleep. Research suggests that increased wakefulness during menopause may cause people to notice and be bothered by hot flashes that they might otherwise sleep through. The prevalence of insomnia during menopause may also be linked to anxiety and depression, which can be triggered by hormonal changes and life circumstances.
- Snoring and sleep apnea: Snoring becomes more common during menopause due to declining reproductive hormones, which can cause the soft tissues in the throat to become more collapsible. Snoring may also be a symptom of sleep apnea, a disorder that causes shallow breathing or temporary pauses in breathing during sleep. Sleep apnea affects about a quarter of people in the years leading up to menopause and more than a third in the years that follow.
- Restless legs syndrome (RLS): RLS causes uncomfortable sensations in the legs when lying down, which are temporarily relieved by movement. This can disrupt sleep and lead to insomnia. Fluctuating hormones and iron deficiency after menopause may trigger RLS.
Managing Menopause and Improving Sleep
The hormonal changes during menopause are the primary cause of its unpleasant side effects, so menopausal hormone therapy (MHT) is often used to alleviate symptoms. MHT typically involves boosting estrogen levels, and people with a uterus may also need to take synthetic progesterone. Research suggests that taking melatonin may also improve sleep and reduce hot flashes during menopause.
In addition to hormone therapy, there are several steps that can be taken to manage menopause symptoms and improve sleep:
- Optimize your sleep environment by keeping your bedroom cool, dark, and quiet.
- Manage stress with techniques like mindfulness meditation.
- Eat a healthy, plant-based diet that is low in fats and high in antioxidants, calcium, and vitamin D.
- Avoid alcohol, caffeine, and tobacco, which can interfere with sleep and intensify hot flashes.
- Exercise regularly to improve sleep and support heart health, prevent muscle and bone mass loss, and reduce stress.
- Try cognitive behavioral therapy for insomnia (CBT-I) to address menopause-related sleep problems and reduce irritation caused by hot flashes.
Some sleep disorders and mental health conditions associated with menopause may require treatment by a medical professional. If you experience symptoms of sleep apnea, RLS, depression, or anxiety, it is important to consult your doctor.
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Hot flashes and night sweats
Night sweats can disrupt sleep, as the discomfort and agitation they cause can make it difficult to fall back asleep. Research suggests that increased wakefulness during a hot flash may be what causes people to notice and be bothered by it. While night sweats were previously thought to lead to insomnia, it is now believed that insomnia may instead cause people to be more aware of hot flashes.
The prevalence of insomnia during menopause may be linked to anxiety and depression, which are more common during this time due to hormonal changes and life circumstances. Hormone therapy can help alleviate hot flashes and night sweats, and cognitive behavioural therapy for insomnia (CBT-I) is also recommended as a first-line treatment for insomnia.
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Insomnia and menopause
Insomnia is a sleep disorder characterised by difficulty falling and staying asleep. During and after the menopausal transition, people have an increased risk of developing insomnia. A study published in the journal 'Sleep' in April 2017 reported that an estimated 40% to 60% of menopausal women reported poor sleep quality and about 25% met the criteria for an insomnia disorder.
The hormonal changes that occur during menopause are thought to be the main cause of insomnia. Declining levels of the hormones oestrogen and progesterone affect many systems and processes in the body, including several that impact sleep. For example, during menopause, oestrogen withdrawal causes the brain to become more reactive to temperature shifts, triggering hot flashes and night sweats, which can make it harder to fall back asleep. In addition, changing oestrogen levels may interfere with neurotransmitters involved in mood regulation, leading to mood swings, depression, and anxiety, which are also associated with insomnia.
Other factors that can contribute to insomnia during menopause include weight gain, which can cause obstructions in the airway and result in snoring and sleep apnea, and restless legs syndrome (RLS), a sleep disorder that affects more than half of post-menopausal people.
To manage insomnia during menopause, some people may benefit from menopausal hormone therapy (MHT) or hormone replacement therapy (HRT), which can help to alleviate symptoms such as hot flashes and night sweats. Cognitive behavioural therapy for insomnia (CBT-I) is also a first-line treatment for insomnia and can help with menopause-related sleep problems. Other recommendations for improving sleep during menopause include optimising the sleep environment, managing stress, committing to a healthy diet, avoiding alcohol, caffeine, and tobacco, and exercising regularly.
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Hormone therapy and sleep
Sleep problems can start during perimenopause, the period before menopause when hormone levels and menstrual periods become irregular. These sleep issues can persist throughout menopause and beyond.
Hormone replacement therapy can improve sleep quality, especially if hot flashes and night sweats are the root cause of sleep disruption. However, a meta-analysis on hormone therapy and sleep quality found no sleep benefits for women without these vasomotor symptoms.
Ovarian hormones, specifically progesterone and estrogen, have been reported to affect sleep disorders. Progesterone has sedative and anxiolytic features and stimulates the production of the NREM-associated gamma-aminobutyric acid receptors. It also acts as a respiratory stimulant and has been used to treat mild obstructive sleep apnea.
The effect of estrogen on sleep structure is complex, as it has a wide range of effects that potentially affect sleep patterns. Estrogen has been proven to decrease sleep latency, the number of awakenings after sleep occurs, and cyclic spontaneous arousals; and increase total sleep time. It also has a regulating effect on body temperature, helping to keep the central body temperature low during the night. Additionally, estrogen has a direct effect on mood by influencing norepinephrine activity and serotonin response and uptake in the brain, resulting in an antidepressant effect.
Estrogen replacement therapy has been shown to improve sleep quality, facilitate falling asleep, and decrease nocturnal restlessness and awakenings. It is particularly effective in treating vasomotor symptoms, which are the most common menopausal symptoms, affecting 75-85% of postmenopausal women. However, the use of hormone therapy is controversial, as some studies suggest that the detrimental effects may outweigh the benefits.
For those who are starting hormone replacement therapy, the use of low-dose estradiol is more suitable than conjugated estrogen.
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Sleep apnea and menopause
Sleep apnea is a sleep disorder that can develop during the menopausal transition. Sleep apnea causes shallow breathing or temporary pauses in breathing during sleep. These breathing disruptions can reduce sleep quality, cause daytime sleepiness, and potentially lead to long-term health issues.
During menopause, the body's production of estrogen and progesterone decreases. These hormones are involved in the reproductive cycle, and their decline can affect many bodily systems and processes, including sleep. One of the consequences of hormonal changes during menopause is weight gain, which can cause obstructions in the airway and lead to snoring and sleep apnea. Additionally, the decrease in estrogen levels can make the soft tissues in the throat more collapsible, further contributing to snoring and sleep apnea.
Postmenopausal women are two to three times more likely to develop sleep apnea compared to premenopausal women. The protective effect of hormones is lost during menopause, increasing the risk of sleep apnea. Symptoms of sleep apnea include snoring, choking or gasping for air during sleep, and morning headaches. If you experience any of these symptoms, it is recommended to take a home sleep test for further evaluation.
While menopause can increase the risk of sleep apnea, it is important to note that other factors can also contribute to this sleep disorder. Age, weight, and lifestyle choices can influence the development of sleep apnea. Additionally, sleep apnea may be underdiagnosed in women, as the symptoms can sometimes be attributed to other conditions or menopause itself. Therefore, it is crucial to consult a healthcare professional if you experience any symptoms of sleep apnea to ensure proper evaluation and treatment.
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