Does Menopause Make It Hard to Sleep?

Menopause is a normal phase that every woman eventually goes through, occurring when your ovaries no longer produce as much of the female hormones estrogen and progesterone; this indicates the end of your menstrual cycle and child-bearing years. While every woman may experience these age-related changes in hormone levels a bit differently, for many, it can mean hot flashes, night sweats, mood swings, weight gain, declining cognitive function and can affect bone density. And, to add insult to injury, menopausal symptoms can also impact your sleep quality and even result in insomnia!

Male or female, younger or older, we all need good and restorative sleep that includes REM, the rapid eye movement that occurs while you dream. As anyone who’s had to face deadlines or toddlers on less than seven hours of sleep can attest, lack of sleep can negatively affect your life. For women in menopause, however, not being well-rested can be particularly problematic. Not only does a night of poor sleep make for an edgy and foggy day, but having sleep problems can affect your mental and heart health—all of which may already be negatively impacted by your changing hormones. Sleep disorders can also lead to depression and anxiety, affecting cognitive function, general well-being and work productivity.

Let’s learn more about menopause-related sleep problems—and also look at some solutions for getting the shut-eye your body needs to take this change of life in stride.

Does menopause cause insomnia?

Yes. All stages of the menopausal transition—perimenopause, menopause and post-menopause—are prevalent causes of sleep disorders. The prevalence of poor sleep quality increases with the normal aging process.

Many women experience sleep disturbances in different ways, but you may find that you:

• Have a hard time falling asleep at night
• Have a hard time staying asleep
• Wake up frequently and early in the morning before your alarm
• Feel that the overall quality of your sleep is poor

If you have a history of insomnia, you are more likely to continue to have insomnia symptoms as you go through menopause than someone who has never experienced sleep problems.

Is insomnia common in menopause?

Yes. If you’re menopausal (or in perimenopause) and have been experiencing sleep difficulties, rest assured, you’re not alone. More than 26 percent of women report significant insomnia while menopausal, so much so that it interferes with their daytime functioning. Not only are there the changes as we get older that affect good shuteye, but women going through menopause are also experiencing hormonal changes that lead to this undesirable side effect of entering middle age.

These symptoms may be common, but you can help your body find balance as you navigate your menopausal journey.

How do menopause symptoms affect the body?

Changes in your hormone levels directly cause menopause related symptoms. In addition to a decrease in estrogen production, progesterone levels drop, as do your estradiol levels. On top of this, your melatonin production, which is especially important at the start of the sleep cycle, also decreases as you enter menopause, which can cause sleep troubles. In other words, these hormonal changes that occur during menopause affect your circadian rhythm, or sleep-wake cycle, making a good night’s sleep difficult.

The most common complaint from women who have difficulty sleeping during perimenopause and menopause is waking up frequently at night, most often due to night sweats or hot flashes. These symptoms are the most common cause of menopausal insomnia. These vasomotor symptoms (hot flashes and sweating) account for 75 to 85 percent of all cases of insomnia during menopause. Studies have shown that some women may actually wake up just before the occurrence of a hot flash.

Other reasons why it’s hard to sleep in middle age

It is important to remember that while having menopausal symptoms, you might also be undergoing other significant life changes that may affect your mood and your ability to sleep. These non-hormonal things might include relationship problems, caring for aging parents, career stress, or assessing your future path. These things alone are enough to keep you up at night!

Then, in turn, not getting enough sleep causes you to feel more irritable, forgetful, or more prone to illness. Sometimes, you may have a sleep disturbance because you are depressed or anxious; both mood disorders can be caused by menopause. In addition to stress, other things that may aggravate insomnia during menopause include shift work and jet lag.

How to deal with insomnia during menopause?

The most important thing to remember is that your insomnia and other sleep disturbances will improve with time. They may not last forever!

Cognitive behavioral therapy (CBT) is the primary intervention for people with severe insomnia. In sleep-specialized centers, like at a university, a multi-disciplinary team carefully evaluates bodily and psychological symptoms to help manage a sleep disturbance, as every woman is different.

Some women use over-the-counter melatonin for insomnia. Others use prescription medications, such as anti-depressants (SSRIs) or other sleep aids such as Ambien, for their sleep problems. It is essential to remember that these medications should not be used for the long term and are only considered short-term relief.

Other women use hormone replacement therapy (HRT) for their menopausal symptoms, including insomnia. Hormone therapy treats vasomotor symptoms such as hot flashes and night sweats. Unfortunately, the risks of HRT may outweigh the benefits. The safer way to do this is with bioidentical hormone replacement therapy.

It is important to speak with your doctor to help determine the best treatment options for your individual experience.

One of the most promising treatments with the least amount of side effects for common menopausal symptoms may be using complementary and alternative medicine, such as acupuncture, massages and supplements, for symptom management without hormones.

10 lifestyle hacks to help you sleep better during menopause

While not sleeping well is a very common complaint of menopausal and perimenopausal women, it doesn’t have to be inevitable. There are specific lifestyle changes that you can make that may help to relieve your insomnia during menopause. Pro tip: Lifestyle changes aren’t a magic button; even if you follow every rule on this list, you might not see any initial results. Be kind and patient with yourself, as you’re building new daily habits that nurture sleep quality, and that takes time.

1. Get regular movement

—Exercise is vital for overall health, especially for a good night’s sleep. Just try not to exercise three to four hours before bed, or your metabolism may be boosted too much for restful sleep.

2. Watch what—and when—you eat

—Try not to eat at least two to three hours before bed. You don’t want to be too full, but you don’t want to be hungry, either! Spicy foods cause stomach problems that may prevent you from sleeping well.

Studies have also shown that a diet that triggers high blood sugar levels, meaning it’s rich in sugars and carbohydrates, can cause poor sleep—many people on low carb diets have experienced improved sleep. It is best to eat a healthy, well-balanced diet full of fruits, vegetables, whole grains, lean meats, and dairy for restorative sleep.

Pro tip: Try not to consume too much liquid in the hours before bed, or you might have to get up to pee!

3. Consider Integrative medicine

—Treatments such as acupuncture, homeopathy, biofeedback, or Traditional Chinese Medicine (TCM) may help your insomnia. Studies have shown that nutrients such as black cohosh, Dong Quai, Maca, Siberian rhubarb, and evening primrose are helpful for insomnia during menopause. Also, a phytoestrogen found in foods such as soybeans and tofu, acts as a weak estrogen in the body and may reduce hot flashes.

Additionally, in one study, women who used a lavender diffuser during bedtime reported a 50 percent reduction in insomnia during menopause.

4. Make the environment of your bedroom perfect

—It has been proven that even a small amount of light, including your alarm clock, interrupts your sleep cycle. You’ll also want to make your room as noise-free as possible. Try using an eye mask and earplugs. They work wonders if you have a loud or restless bed partner or if you sleep on different schedules.

It might also help to create a comfy environment in your bedroom with cozy sheets and pajamas. And lastly, the temperature of your room is also very important for good sleep—the cooler, the better to help prevent hot flashes.

5. Adopt a regular sleep schedule

—Studies have shown that going to bed at the same time every night and waking up at the same time every morning improves sleep-related health. Also, try to avoid napping. If you need a daytime snooze, limit it to a 30-minute power nap.

6. Have a pre-bedtime relaxation routine

—Many women find it helpful to sit in front of the fireplace, read a light book, and drink a cup of your favorite calming tea (remember not to drink tea or other liquids too close to bedtime). It is beneficial to take a warm bath or shower or practice mindfulness techniques such as meditation or yoga before bed.

7. Minimize screen time before bed

—Your bedroom should only be used for sleep (and sex). Numerous studies have shown that television, phones, computers, and tablets can get in the way of good, restorative sleep.

8. Drink alcohol in moderation

—You might feel initially sleepy after drinking, but remember that even a tiny amount of alcohol has been shown to increase sleep problems.

9. Avoid caffeine and nicotine, especially before bed

—Stimulants, or substances that get your brain going, such as caffeine and nicotine, will make sleeping more difficult at night. This includes chocolate, which is full of caffeine and sugar!

10. Cultivate healthy relationships

—Healthy relationships with yourself, your friends, and your family that maintain intellectual and cognitive stimulation can help with insomnia symptoms and other sleep disorders, especially during menopause.

What if I still can’t sleep?

If you’re still restless and unable to sleep 20 minutes after getting into bed, get up and do something peaceful in another room. Read a book (not your tablet or phone), journal or play soothing music (skip the true crime podcasts), and then try and go back to bed when you’re feeling sleepy.

References

• Baker, Fiona et al. “Sleep and sleep disorders in the menopausal transition.” Sleep Med Clin. September 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092036/
• Baker, Fiona et al. “Sleep problems during the menopausal transition: prevalence, impact, and management challenges.” Nat Sci Sleep. February 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810528/
• Johnson, Alisa et al. “Complementary and alternative medicine for menopause. Journal of Evidence-Based Integrative Medicine. March 2019. https://journals.sagepub.com/doi/full/10.1177/2515690X19829380
• Lee, Jinju et al. “Sleep disorders and menopause.” J Menopausal Med. August 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718648/
• Proserpio, P et al. “Insomnia and menopause: a narrative review on mechanisms and treatments.” Climacteric. December 2020. https://pubmed.ncbi.nlm.nih.gov/32880197/
• Schaedel, Zoe et al. “Management of sleep disorders in the menopausal transition.” Post Reprod Health. December 2021. https://pubmed.ncbi.nlm.nih.gov/34748453/
• Suni, E. “Sleep Hygiene.” Sleep Foundation. February 2023. https://www.sleepfoundation.org/sleep-hygiene
• “Cognitive Behavioral Therapy for Insomnia.” Stanford Medicine. https://stanfordhealthcare.org/medical-treatments/c/cognitive-behavioral-therapy-insomnia/procedures.html
• “Sleep problems and menopause: What can I do?” National Institute on Aging. September 2021. https://www.nia.nih.gov/health/sleep-problems-and-menopause-what-can-i-do