Menopause and Sleep


Written by Katherine Zheng

Reviewed by Dr. Michael Breus

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Medical Disclaimer: The following content should not be used as medical advice or as a recommendation for any specific supplement or medication. It is important to consult your health care provider prior to starting a new medication or altering your current treatment.

Women and people who menstruate experience menopause when their periods permanently stop, usually around age 50. Rather than occurring suddenly, menopause typically happens after a time of transition that lasts about four years. Nearly half of people going through this transition experience sleep disturbances, often alongside other symptoms, such as hot flashes.

The reasons why sleep disturbances occur in the years before and after menopause are complex, and the ways in which sleep is disturbed can be different from person to person. But treating the symptoms of menopause may help people get the sleep they need during this time of transition.

Why Does Menopause Impact Sleep?

Menopause brings about many physical and psychological changes that can disrupt sleep. During and after menopause, people may experience hot flashes, anxiety and depression, and sleep disorders such as sleep apnea and restless legs syndrome. All of these can make it difficult to get a good night’s sleep.

Many symptoms of menopause result from hormonal shifts. In the years leading up to menopause, the ovaries slow the production of estrogen and progesterone, hormones that help thicken the uterine lining during the menstrual cycle. As a result, periods occur less frequently and eventually stop.

Meanwhile, as the ovaries get closer to running out of eggs, the body starts producing more follicle stimulating hormone (FSH), a hormone involved in the release of eggs. The rising FSH levels combined with declining estrogen and progesterone levels can make it harder to fall asleep, sleep through the night, or get high-quality sleep.

Additionally, as the body ages, it produces less of the sleep hormone melatonin. This drop is especially pronounced in the lead-up to menopause, which may contribute to sleep disturbances.

What Sleep Issues Can Happen During Menopause?

The closer a person gets to menopause, the more likely they are to have difficulty sleeping. And sleep problems are even more common during and following menopause. It’s not always clear whether sleep difficulties result directly from menopause, occur as part of the aging process, or emerge as symptoms of other, coinciding medical conditions.

Hot Flashes

About three-quarters of menopausal people experience hot flashes: sudden and intense episodes of feeling hot, followed by sweating. Hot flashes that happen at night are often called night sweats. Evidence suggests these unpleasant episodes contribute significantly to nighttime wakefulness during and after menopause.

Sleep Apnea

The hormonal changes associated with menopause increase the likelihood that a person will develop obstructive sleep apnea (OSA). People with OSA have repeated breathing interruptions while they sleep, due to tissues collapsing in their airways. These pauses in breathing can disrupt sleep and lead to daytime sleepiness.

Mood Changes and Disorders

During menopause, fluctuating hormones can cause mood changes, as can changing life circumstances, such as caregiving for aging parents or becoming an “empty nester.” Anxiety, depression, and irritability are common during menopause and can make it harder to fall asleep or stay asleep.

Other Sleep Disorders and Parasomnias

Restless legs syndrome is a common sleep disorder in the years before and after menopause. People with this disorder have frequent uncomfortable sensations in their legs and a strong desire to move them, which can interfere with sleep.

Less frequently, people in or nearing menopause may experience other sleep disorders and parasomnias, which are unusual behaviors that occur while a person sleeps. These include teeth clenching or grinding, night terrors, and sleepwalking.

How Can Treating Menopause Improve Sleep?

Treating the symptoms of menopause, particularly those that result in sleep disturbances, can lead to better sleep. Some strategies involve lifestyle changes, while others involve therapies or medications overseen by a medical professional.

  • Yoga: Yoga is a mind-body practice that combines movement, controlled breathing, and meditation. Research indicates that it can help reduce hot flashes as well as anxiety and depression in people going through menopause.
  • Mindfulness Meditation: Mindfulness meditation is a contemplative practice that cultivates non-judgmental awareness of the present moment. Menopausal people who meditate have reported less-bothersome hot flashes, reduced anxiety and stress, and improvements in their sleep.
  • Acupuncture: Acupuncture is a type of traditional medicine that involves inserting thin needles through the skin at strategic locations. Research shows that this therapy may be effective in reducing menopausal hot flashes.
  • Cognitive Behavioral Therapy for Insomnia (CBT-I): CBT-I is a multi-part therapy, conducted by a mental health professional, that addresses thoughts and behaviors that may contribute to insomnia. Studies have shown that CBT-I can decrease the severity and symptoms of menopausal insomnia.
  • Hypnotherapy: This therapeutic approach employs hypnosis, which involves putting a person into a state of deep concentration and relaxation that makes them highly receptive to suggestions. When delivered by professionals, hypnotherapy can sometimes reduce hot flashes and improve sleep.
  • Hormone Replacement Therapy: Estrogen and progesterone pills, creams, or patches can help offset the symptoms of hormone changes. Your doctor can provide further guidance on whether this treatment is right for you.
  • Vitamin E: Limited studies suggest that vitamin E supplementation may, to a small degree, help reduce hot flashes and other menopausal symptoms. But be sure to consult with a doctor before using any new supplement.

Sleeping Better With Menopause

People nearing or in menopause may also benefit from adopting healthy sleep hygiene practices—that is, habits and routines known to help people fall asleep and stay asleep. Some sleep hygiene practices that can help everyone get a good night’s sleep include:

  • Maintaining a consistent bedtime and wake-up time
  • Developing a bedtime routine with relaxing activities, such as reading or taking a bath
  • Avoiding caffeine, alcohol, and big meals too close to bedtime
  • Exercising regularly
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Adapting your daily habits is one way to help you take control of your symptoms and improve your sleep. If you have sleep problems that you suspect are connected to menopause, you should also talk to your doctor about whether additional therapies or treatments might be right for you.

About The Author

Katherine Zheng

Staff Writer, Sleep Health

Katherine is a freelance writer based in Chicago. She has doctorate and bachelor’s degrees in nursing and is published in the journal Administration and Policy in Mental Health and Mental Health Services Research and the journal JMIR Mental Health. She has also worked as a policy fellow at Northwestern University Feinberg School of Medicine. With a background in academia, Katherine has always been interested in making healthcare research more accessible to the public. When not writing, Katherine is an actor and loves doing theater at night.

  • POSITION: Side Sleeper
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