Good quality sleep is key to our health and well-being. It is arguably the most important of all the health pillars. Unfortunately for women, our sleep is vulnerable at times of hormonal fluctuations, and this includes menopause.
Why can menopause cause sleep issues?
A lack of sleep – for example, 4-5 hours a night instead of 7-8 hours – can have a negative impact on how your brain functions. It can cause brain fog and memory difficulties, and it can impact immunity, and metabolic health and increase your risk of developing conditions such as heart disease.
Poor sleep can also impact your mental health which is often vulnerable during the menopause transition anyway. In fact, women with poor sleep during menopause are two to three times more likely to experience depression.
40-60% of women experience sleep disruption during menopausal transition and often, poor sleep quality persists even after menopause. This is due to a variety of reasons including:
Hormones
During menopause, oestrogen and progesterone decline, and this can cause a myriad of physical and mental symptoms including hot flushes and night sweats, mood changes, needing to pass urine through the night and anxiety. All of these can result in sleep disruption during menopause and lead you to not feeling well rested in the morning, even if you have been in bed for many hours.
Decreased melatonin
The secretion of melatonin is partly influenced by oestrogen and progesterone, which decrease during perimenopause.
Melatonin plays a crucial role in the regulation of our circadian rhythm (sleep/wake cycle) and our mood. During perimenopause, menopause and beyond, many women find themselves struggling to fall asleep and/or waking early in the morning.
Age
Ageing impacts sleep quality so you may notice changes to your sleep that just so happen to coincide with the onset of menopause. Many people find that as they get older:
- They find it more difficult to fall and stay asleep
- They wake up earlier in the morning
- The transition between sleep and waking is more abrupt
- Less time is spent in deep REM sleep
- They have to get up in the night to urinate
- Symptoms of other health conditions or side effects of medications wake them
- They are lighter sleepers and are more easily disturbed by noise, movement or temperature changes
Lifestyle factors
A range of other lifestyle factors can influence how long and deep you sleep for. The hormonal changes that occur during menopause and resulting menopause symptoms can lead to or increase the impact of such factors. Lifestyle factors that influence sleep include:
- Alcohol consumption
- A highly processed food diet
- Screen time
- Caffeine
- Stress
- Nicotine
- Daytime napping
- Depression and anxiety
- Lack of exercise
- Geographical location (Reduced sleep quality occurs more frequently in urban areas, poorer neighbourhoods and those with higher crime rates)
Common sleep problems during menopause
Sleep disturbances, such as insomnia, night sweats and mood changes are extremely common and particularly affect women after menopause. According to data from the National Institutes of Health, 16% to 42% of women report sleep problems before menopause, increasing to 39% to 47% during perimenopause, and from 35% to 60% after menopause.
Night sweats and hot flushes
Hot flushes and night sweats in menopause impact around 80% of women. These sudden episodes of intense heat, often followed by sweating, can disrupt sleep by causing discomfort which leads you to wake up.
The hypothalamus, which regulates body temperature, becomes more sensitive as oestrogen levels drop, causing temperature regulation issues during menopause.
Insomnia
Insomnia during menopause is incredibly common and can manifest as difficulty falling asleep, staying asleep, or waking up too early and being unable to return to sleep. It often leads to daytime fatigue, mood disturbances, and poor concentration.
Hormonal fluctuations, particularly the decline in oestrogen and progesterone, contribute significantly to insomnia. Oestrogen helps regulate serotonin, while progesterone has a natural sedative effect. When these levels drop, sleep can be adversely affected.
Sleep apnoea
Research indicates that night sweats and hot flushes may be linked to an increased risk of sleep apnoea and that this is more likely in women who have gone through surgical menopause, as opposed to natural menopause.
It can also be induced by weight gain in menopause because of increased fatty deposits around the neck obstructing the airways.
Further, there is also evidence that suggests that progesterone influences muscle activity at the back of the throat as well as stimulus for breathing. As progesterone declines during menopause, this may result in partial obstruction of the upper airway and reduced breathing drive.
Sleep apnoea is not always characterised by heavy snoring and gasping. Many women won't snort loudly while asleep but will still suffer from headaches, insomnia, daytime fatigue and depression and/or anxiety.
Restless leg syndrome (RLS)
Those with restless leg syndrome deal with a tingly, creepy crawly sensation in their legs at night.
Women are twice as likely as men to experience restless leg syndrome and during menopause, it is thought it may be down to falling oestrogen and reduced dopamine levels although 69% of postmenopausal women reported their symptoms as worse than before menopause.
It is not known whether restless leg syndrome directly causes sleep during menopause or that poor sleep for other reasons means that individuals are awake and simply more aware of the undesirable sensation.
Mood changes
Around 4 in 10 menopausal women experience increased levels of anxiety, irritability, or depression, which can negatively impact sleep. Symptoms may include overthinking, heightened alertness at night, or waking up early.
Oestrogen and progesterone both play a role in mood regulation. With the hormonal fluctuations that occur during menopause, women are more prone to mood changes, which in turn impact their sleep quality. For instance, anxiety can make it harder to fall asleep, while depression can lead to difficulties getting out of bed in the morning or sleeping during the day.
Sleepiness and fatigue
Symptoms of menopause and sleeplessness don’t just disrupt your bedtime routine – the effects can also leak into your day-to-day activities and have a knock-on effect on your overall well-being too.
For example, daytime fatigue feels like an overwhelming sense of tiredness or lack of energy during the day, regardless of sleep duration. It often leads to reduced motivation, slower reaction times, and brain fog.
A lack of restorative sleep can also impact your emotions, further amplifying irritability and overwhelm and making it more difficult for you to handle the same tasks and situations that you did before menopause.
Reducing menopause sleep disturbances
Good sleep hygiene can be very helpful during this transition. Simple things you can do include:
- Keeping the bedroom cool, dark, comfortable, and quiet.
- Keeping a regular daily sleep/wake cycle, including on weekends
- Getting early morning light/ getting outdoors early.
- Limiting light before bed e.g. TV/screens/phones
- Dimming the lighting in the evening.
- Adopting a menopause diet rich in vitamins and minerals, and low in processed foods.
- Avoiding eating close to bedtime and keeping blood glucose levels steady.
- Limiting caffeine to mornings only.
- Avoiding alcohol.
- Taking supplements, and herbal remedies for menopause such as valerian root, magnesium, B vitamins, which may reduce menopause symptoms and promote better sleep quality.
- Exercising in the morning if possible, or doing gentle yin menopause yoga at night
- Systemic HRT has been found to improve sleep quality, making it easy to fall and stay asleep, as well as improve symptoms that can disrupt sleep. Body-identical progesterone acts as a sedative and has hypnotic effects.
- During menopause, cognitive behaviour therapy for insomnia (CBT-I) can be very effective. It can help to improve sleep, depressive symptoms and emotional health, daytime function, quality of life and work performance. This can be done online or in person, as well as 1:1 or in groups – whatever works for you.
Several of our menopause doctors specialise in sleep disruption. In addition, Dr Rebecca Smithson sees patients for Cognitive Behaviour Therapy and sleep deprivation therapy to treat sleep disorders. If you’d like tailored treatment from an experienced professional who understands what you're going through, book a consultation with a menopause doctor.
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