Many women and people born female who previously slept well find themselves struggling with insomnia during perimenopause and menopause. Fluctuations in hormone levels, along with symptoms such as hot flashes, night sweats, mood changes, and increased stress, can all contribute to sleep difficulties.
Below, we’ll explain why and how menopause can affect sleep and what treatment options may help improve sleep quality.
Does Menopause Cause Insomnia?
Studies show that there’s a link between menopause and insomnia. Up to 60% of menopausal people experience sleep disturbances like nighttime wakings, insomnia, and unrefreshing sleep.
Sleep disturbances are one of the most commonly reported symptoms of menopause, alongside night sweats, hot flashes, and weight gain. These disturbances aren’t limited to people who have had them before, either. A review of menopause-related literature shows that sleep disturbances can occur during menopause, even in people who haven’t had any sleep-related problems before menopause.
And this can have serious health implications, regardless of the initial cause of insomnia. Sleeping fewer than seven hours a night can lead to increased risk for hypertension (high blood pressure), weight gain, diabetes, heart disease, stroke, and depression.
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Why Does Menopause Cause Insomnia?
Many of the sleep disturbances that stem from menopause, including insomnia, are due to hormonal changes. Menopause is a natural part of aging that everyone with female reproductive organs will experience. It typically happens between ages 45 and 55, and symptoms can last up to eight years.
Changes in Hormone Levels
Many menopause-related sleep problems stem from declining levels of estrogen and progesterone. These hormones play important roles beyond reproduction, helping regulate mood, brain function, and the sleep-wake cycle.
As estrogen levels fall, serotonin production may also decrease, contributing to mood changes and sleep disturbances. At the same time, lower progesterone levels can affect the activity of GABA, a brain chemical involved in relaxation and sleep, and reduce progesterone's natural sedative effects. Together, these hormonal changes can make it harder to fall asleep and stay asleep.
Hot Flashes and Night Sweats
About 75% of those in menopause experience hot flashes that give them sudden and intense feelings of heat. Often, people who get hot flashes wake up more and have poor sleep quality. Night sweats are another frequent menopause symptom. Like hot flashes, night sweats are ultimately caused by lower levels of circulating estrogen.
Feeling excessively hot and sweaty can disrupt a comfortable sleep. Because these symptoms can come on suddenly and without warning, it’s tough to set your bedroom temperature to accommodate night sweats or hot flashes.
Anxiety, Stress, and Mood Changes
As estrogen levels drop, so can serotonin levels, which may lead to mood swings, anxiety, and cognitive issues. Mood changes and stress are widely experienced menopause symptoms. And there’s a bi-directional relationship between sleep problems and stress: Lack of sleep can make stress levels worse and vice versa.
Other Menopause Symptoms That Affect Sleep
Some people experience bladder problems like incontinence, frequent urination, and urinary tract infections (UTIs). Each of these can cause people to wake up often throughout the night. Menopause can also cause weight gain, joint pain, and fatigue — all of which can affect sleep duration and quality.
What Are the Symptoms of Menopausal Insomnia?
There are several common symptoms of menopause-related insomnia and sleep disturbances.
- Frequent nighttime awakenings
- Trouble falling asleep
- Waking up from hot flashes
- Waking up from night sweats
- More time awake than usual
- Poor quality and non-restorative sleep
- Waking up too early, often around 2 to 3 a.m. with an inability to fall back asleep
Does Menopause Insomnia Go Away?
Menopausal symptoms can last between two and eight years, depending on the person’s age, race, and family history. Once hormone levels equalize, uncomfortable symptoms, including insomnia, usually go away. Evidence shows that as people age past menopause, their sleep often improves.
Menopause insomnia can also go away with treatment, whether that’s treatment for insomnia, menopause, or both.
How Long Does Menopause Insomnia Last?
Unfortunately, there’s no specific time frame for how long menopause sleep problems may last. However, if the insomnia is due to menopause-related hormone and body changes, symptoms could ease and disappear as menopause progresses. Most people go through menopause between ages 45 and 55, and the whole process can last years.
How to Treat Menopause Insomnia
Treating both insomnia and menopause symptoms may help you get back to better quality, more restful sleep.
Improve Sleep Hygiene
By improving your sleep hygiene, you can train your body to fall asleep more easily and stay asleep through the night. Go to bed at the same time each night and get up at the same time each morning, even on weekends. Avoid alcohol and other depressants, especially in the hours leading up to bedtime.
Shut off your phone and other screens and steer clear of blue light before bed. Some people find that meditating or reading before bed helps put their minds in a restful place, making it easier to fall asleep. Finally, make an inviting sleep environment with the right mattress, bedding you like, and a room temperature that’s conducive to sleep. Typically, the room temperature should be 2 to 5 degrees cooler than daytime temperatures.
Hormone Therapy
The first-line treatment for menopause symptoms is hormone therapy (HT) or menopause hormone therapy (MHT), previously known as hormone replacement therapy (HRT). People take estrogen, progestin (the synthetic version of progesterone), or both to boost hormone levels.
Replacing depleted hormones can ease many symptoms, including hot flashes, night sweats, brain fog, and sleep problems. A physician trained in administering these hormones should be consulted, as not all physicians are trained to prescribe them.
MHT isn’t right for everyone. People who’ve had certain types of cancers, liver disease, blood clots, strokes, heart attacks, and vaginal bleeding should avoid MHT. Pregnant individuals should also avoid it.
For those who can’t or don’t want to do MHT, there are non-hormonal methods. Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) have been studied as effective alternative treatments for hot flashes. Yoga, acupuncture, and relaxation training have also been studied as treatments for hot flashes, with varying degrees of success.
There are also many non-hormonal supplements available, but they should be taken with caution, as many have not been FDA-approved or studied adequately.
Cognitive Behavioral Therapy for Insomnia (CBT-I)
CBT-I is a multi-session treatment that uses multiple strategies to help people fall asleep and stay asleep. The main components are sleep restriction therapy (SRT), stimulus control therapy (SCT), sleep hygiene (SH), and cognitive therapy (CT).
Professionals use these four components to reshape a person’s relationship with sleep and to train them to practice healthy sleep habits. CBT-I isn’t a quick fix; it usually takes six to eight sessions. However, there’s evidence suggesting that it’s more effective at treating insomnia long-term than medications.
Medications for Insomnia
The Food and Drug Administration (FDA) has approved certain prescription drugs to treat insomnia, including Z-drugs. These medications slow brain activity enough to help you fall asleep and stay asleep. However, these drugs are only intended for short-term use, so a long-term solution still needs to be addressed, and relying heavily on these sleep aids is not advisable.
Melatonin is a popular over-the-counter supplement that many people take to help them fall asleep. However, it isn’t intended for long-term use. Some people may take antihistamines like Benadryl to fall asleep, but there are risks associated with it, and it isn’t intended to be used or recommended as a sleep aid.
Address Underlying Mental Health Concerns
Stress, anxiety, and mood swings are all common symptoms of menopause, and symptoms that can have a negative effect on your sleep. You may be able to help treat menopause insomnia by considering your mental health as a coexisting condition.
CBT-I is an effective treatment for insomnia, and CBT is an effective treatment for overall mental health. Speak with your physician or therapist to learn which option is right for you.
Consult With a Sleep Coach
For those looking for ongoing support, Sleep Doctor's Sleep Coaching provides personalized guidance, education, and accountability to help you build healthier sleep habits and address behaviors that may be interfering with sleep.
When to Talk to a Doctor
If your menopause-related insomnia is unmanageable and affecting your daily life, you should speak to your doctor. Consider making an appointment if you experience any of the following.
- Hot flashes and sweating
- Mood swings
- Frequent nighttime awakenings
- Daytime grogginess
- Trouble falling asleep and staying asleep
- Bladder problems
- Sleep that’s not restorative
