If you’re not sleeping well, you’re not alone—the major hormonal changes involved in menopause can indeed wreak havoc on sleep.
Sleep issues are frequently reported both in the years before and after menopause. While around 12 percent of women of all ages have sleep complaints on average, this number jumps to 40 percent for women in their late 40s and early 50s. So let’s examine what’s to blame—and what you can do about it.
Top sleep disturbances
Some of the most common problems reported by perimenopausal and postmenopausal women include:
- Hot flashes: Lasting from 30 seconds to five minutes, hot flashes affect 75% to 85% of women for around seven years on average, both before and after menopause.
- Why is it a sleep issue? At night, the increase in body temperature and blood flow to the face wakes you up, often in a full body sweat leaving you damp and sometimes cold as a result. And, because it also boosts your adrenaline, it can be hard to fall back asleep. When hot flashes occur at night, they’re also known as night sweats.
- Insomnia: This is when you have difficulty falling or staying asleep more than three nights a week. As many as 61 percent of postmenopausal women report symptoms of insomnia.
- Sleep-disordered breathing: Snoring can get worse during this time. In addition, your risk of obstructive sleep apnea, which causes your breathing to stop temporarily, increases.
- Mood disorders: Poor sleep is often associated with depression and anxiety, which can in turn worsen sleep issues.
- Other disorders: Restless legs syndrome and periodic limb movement disorder may also develop. Both feature involuntary nighttime movements that can disrupt sleep.
- Environmental factors: Such as too much light in the room, being too warm in general at night, a snoring partner, a child or pet waking you, or noise from outside your home.
Root causes and factors
The fluctuation of hormones during perimenopause is highly associated with mood disorder development in perimenopause in addition to hot flashes and night sweats. Depression and anxiety are common causes of insomnia. And night sweats are one of the most common causes of waking in the night. After menopause, your ovaries stop producing estrogen and progesterone. Sleep experts believe this may contribute to the increased risk of developing sleep apnea during this time of life., In general, our sleep-wake cycle also becomes less consistent as we age, leading to earlier wakeups and less sleep overall. Some women may experience low iron levels, also called anemia, which can negatively impact sleep.
Prescription treatments
Menopause hormone therapy (MHT) comes in the form of estrogen alone, or the combination of estrogen and progesterone (depending upon your personal circumstances). They can both effectively treat hot flashes, but are not recommended for the direct treatment of insomnia. Some studies show a potential benefit of higher doses of progesterone to help with falling asleep, but others show no significant benefit. Hormone therapy isn’t the right choice for everyone, so it is important to talk to your provider about the risks and benefits in your case. Other medications can be prescribed for the treatment of hot flashes, including a very low dose antidepressant medication, Veozah (a medication specifically for hot flashes), or gabapentin (a medication often used for nerve pain). These can all positively impact sleep by reducing the hot flashes, but some also cause drowsiness, so when taken at night, give you a little extra help falling asleep. If you’re anemic, iron supplements may also be suggested.
Other potential therapies
Both cognitive behavioral therapy (CBT) and clinical hypnosis could help with insomnia. They are both recommended for treatment of hot flashes and have been found to impact mood as well. Although this isn’t yet accessible for everyone, CBT and sleep restriction (SRT) have been very effective in multiple studies.
Tips for better Zzz’s
There are also some general strategies that can enhance your sleep quality, even during menopause.
- Lower your stress levels through exercise, yoga, massage, meditation, mindfulness, and breathing exercises
- Avoid large meals and spicy foods before bed
- Forgo nicotine, caffeine later in the day, and alcohol, as they can all disrupt sleep
- Develop a bedtime routine to wind down and relax (e.g. reading, a bath, meditation)
- Wear lightweight pajamas or moisture-wicking fabrics, or even sleep naked to stay cool
- Still hot? Lower your bedroom thermostat and/or get a fan (either ceiling or standing)
- Stick to a regular bedtime and wakeup time, and avoid napping during the day
- Keep a change of clothes and glass of water by your bed in case you wake up with night sweats
If you have further questions
Want to know more about sleep issues before and after menopause? Chat with an Ovia Health coach today.
Sources
- Joffe, H., Massler, A., & Sharkey, K. M. (2010). Evaluation and management of sleep disturbance during the menopause transition. Seminars in reproductive medicine, 28(5), 404–421. https://doi.org/10.1055/s-0030-1262900
- Drake CL, Kalmbach DA, Arnedt JT, Cheng P, Tonnu CV, Cuamatzi-Castelan A, Fellman-Couture C. Treating chronic insomnia in postmenopausal women: a randomized clinical trial comparing cognitive-behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education. Sleep. 2019 Feb 1;42(2):zsy217. doi: 10.1093/sleep/zsy217. PMID: 30481333; PMCID: PMC6369725.
