Herbie Murray
Sleep disruption is a common issue for people going through menopause. Symptoms such as hot flashes, night sweats, and mood changes can all contribute to poor sleep. In addition, hormonal changes and shifts in sleep patterns can also impact sleep quality. As many as 46% of individuals experience sleep difficulties in the years leading up to menopause, and about half of people continue to have sleep disorders following menopause. While seven to nine hours of sleep per night is generally recommended, a study of almost half a million adults found that seven hours may be optimal for menopausal women in terms of cognitive performance and mental health.
| Characteristics | Values |
|---|---|
| Sleep problems | Start during perimenopause and may continue throughout menopause and beyond |
| Sleep duration | 7-9 hours recommended by The National Sleep Foundation |
| Sleep quality | Poor sleep quality is common during menopause |
| Sleep disruption | Night sweats, hot flashes, and anxiety can disrupt sleep |
| Sleep aids | Over-the-counter sleep aids and prescription medications can help in the short term |
| Sleep improvement | Regular exercise, hormone replacement therapy, and lifestyle changes can improve sleep |
| Sleep routine | A consistent sleep schedule, limited caffeine and screen time, and a relaxing bedtime routine are recommended |
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What You'll Learn
Hormonal changes and sleep
During menopause, the body experiences a decrease in estrogen and progesterone, the hormones involved in the reproductive cycle. These hormonal changes affect many bodily systems and processes, including sleep.
Thermoregulation
Estrogen withdrawal during menopause causes the brain to become more reactive to temperature shifts. This triggers cooling processes such as sweating at lower core body temperatures, leading to hot flashes and night sweats. These symptoms can disrupt sleep, as the discomfort and agitation make it harder to fall back asleep.
Mood
Fluctuating estrogen levels may interfere with neurotransmitters involved in mood regulation. This can lead to mood swings, anxiety, and depression, which are more prevalent during menopause and contribute to sleep difficulties.
Metabolism
Menopause affects how the body converts food into energy, with low estrogen levels contributing to weight gain. This weight gain can then lead to snoring or sleep apnea, causing further sleep disruption.
Circadian Rhythm
Many people experience a weakening of their circadian rhythms following menopause. This includes the sleep-wake cycle, with night sweats causing a narrower range of comfortable temperatures, making it harder to fall asleep and maintain a deep sleep.
Hormonal changes during menopause can significantly impact sleep through their effects on thermoregulation, mood, metabolism, and circadian rhythms. These changes can lead to hot flashes, night sweats, mood disturbances, and weight gain, all of which contribute to sleep difficulties.
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Hot flashes and night sweats
To manage hot flashes and night sweats, lifestyle changes are often recommended as a first line of treatment. This includes lowering the temperature in the bedroom, drinking cold water before bed, using layered bedding, and turning on a fan. Avoiding triggers such as alcohol, spicy foods, caffeine, and cigarettes is also advised. Maintaining a healthy weight, exercising regularly, and practising relaxation techniques can further help manage symptoms.
If lifestyle changes are insufficient, non-hormonal medications may be considered. The U.S. Food and Drug Administration (FDA) has approved the use of certain antidepressants, such as paroxetine (Brisdelle), and fezolinetant (Veozah), to treat moderate to severe hot flashes. Hormone therapy, also known as menopausal hormone therapy (MHT) or hormone replacement therapy (HRT), is another effective treatment option. However, it carries risks, including increased chances of heart attack, stroke, blood clots, breast cancer, gallbladder disease, and dementia.
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Insomnia
During the menopausal transition, people have an increased risk of developing insomnia, a sleep disorder characterised by difficulty falling and staying asleep. Research suggests that increased wakefulness causes people to notice and be bothered by hot flashes that they might otherwise sleep through.
The prevalence of insomnia during the menopausal transition may be linked to anxiety and depression. Hormonal changes and life circumstances, such as divorce or caring for ageing parents, can contribute to declining mental health in the years before and after menopause. Most people with depression or anxiety experience chronic insomnia.
If you are experiencing insomnia, you may want to consider cognitive behavioural therapy (CBT). This problem-solving approach to therapy has been shown to help improve sleep in women with menopausal symptoms. CBT can be found through a class or in one-on-one sessions. Be sure that your therapy is guided by a trained professional with experience working with women during their menopausal transition. Your doctor may be able to recommend a therapist in your area.
In addition to CBT, there are several steps you can take to manage the symptoms of menopause and support healthy, restorative sleep:
- Optimise your sleep environment: Make sure your bedroom is cool, dark, and quiet. Run a fan, if you have one, and keep a glass of ice water nearby.
- Manage stress: Consider incorporating stress-reduction techniques, such as mindfulness meditation, into your bedtime routine.
- Commit to a healthy diet: Eat a plant-based diet that is low in fats, high in antioxidants, and rich in calcium and vitamin D.
- Avoid alcohol, caffeine, and tobacco: These substances can all interfere with sleep and intensify hot flashes.
- Exercise regularly: In addition to helping you sleep better, regular exercise supports heart health, prevents the loss of bone and muscle mass, and helps reduce stress.
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Snoring and sleep apnea
Sleep apnea is a sleep disorder that affects both men and women but is more common in men. However, women are at a higher risk of developing sleep apnea than men due to certain risk factors, particularly hormonal changes. During menopause, the body produces less estrogen and progesterone, which are involved in the reproductive cycle. These hormones also play a role in maintaining the airway's muscle tone and keeping it from collapsing. As the levels of these hormones decline during menopause, the prevalence of sleep apnea in women increases.
The symptoms of menopause and sleep apnea can overlap, making it difficult for women to identify sleep apnea as a potential issue. Some common symptoms of menopause that can also be signs of sleep apnea include irregular periods, joint or muscle pain, decreased sexual interest or discomfort, poor concentration or memory loss, vaginal and urinary problems, and mood swings or irritability. Additionally, the snoring associated with sleep apnea in women might not be as loud and disruptive as in men due to the shape and size of the female airway.
The risk of developing sleep apnea increases with age, and older women have the same risk of developing sleep apnea as men. Women who have undergone hysterectomies or similar surgeries that affect their hormones are also at a higher risk. Weight gain during menopause can further contribute to the development of sleep apnea by causing obstructions in the airway.
Sleep apnea can have serious health consequences if left untreated. It can lead to reduced sleep quality, daytime sleepiness, and long-term physical and mental health issues. Therefore, it is important for menopausal women to pay attention to any sleep-related symptoms and seek medical advice if necessary.
Treatments for sleep apnea in menopausal women include hormone replacement therapy, selective serotonin reuptake inhibitors (SSRIs), exercise, and oral appliance therapy (OAT). Lifestyle changes such as weight loss, avoiding alcohol and caffeine, and sleeping on the side can also help manage the condition.
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Restless legs syndrome
Causes
RLS is twice as common in women as in men, and perimenopause or menopause can increase the occurrence and severity of the symptoms. While the reasons for this imbalance are not fully understood, it is thought that changes in hormone levels, such as oestrogen, may be responsible for the onset of RLS. Fluctuating oestrogen levels during perimenopause may interfere with the functioning of dopamine, which is involved in controlling muscle movement.
Iron deficiency may also be a cause of RLS, and this is a common issue for women during perimenopause due to increased blood loss from heavy periods.
Risk Factors
You are more likely to experience RLS if:
- You are going through perimenopause or have reached menopause
- You had RLS when you were pregnant
- RLS runs in your family
- You get night sweats during menopause
- You have an iron deficiency
- You have kidney failure, diabetes, Parkinson's, rheumatoid arthritis, an underactive thyroid or fibromyalgia
Treatment
Depending on the cause of RLS, treatments may include:
- Iron supplements
- Dopamine antagonists
- Epilepsy drugs
- Pneumatic compression devices
- Regular exercise
For short-term relief, the NHS suggests:
- Massaging your legs or affected areas
- Stretching or walking
- Applying a hot compress to your leg muscles
- Mild opiate painkillers like codeine
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Frequently asked questions
Research suggests that seven hours of sleep per night is the optimal amount for cognitive performance and mental health. However, individuals will vary, and some may need more or less sleep. During menopause, it is common to experience sleep disturbances due to hormonal changes, hot flashes, night sweats, and mood changes.
Menopause can affect sleep in several ways. Hormonal fluctuations, particularly the decrease in estrogen and progesterone, can impact the sleep-wake cycle and increase the risk of insomnia. Hot flashes and night sweats, which are common during menopause, can disrupt sleep. Additionally, menopause-related weight gain can contribute to snoring and sleep apnea, further affecting sleep quality.
There are several strategies that can help improve sleep during menopause. These include maintaining a consistent sleep schedule, optimizing the sleep environment by keeping the room cool and dark, managing stress through relaxation techniques, regular exercise, and avoiding caffeine, alcohol, and heavy meals close to bedtime. Hormone replacement therapy and over-the-counter sleep aids may also be considered but should be discussed with a healthcare professional.
