For numerous women, entering menopause doesn't automatically lead to worsened sleep, particularly for those who previously had little trouble sleeping. However, studies show a significant fluctuation in sleep disruptions correlating with menopausal stages.
Sleep issues affect 16% to 42% of premenopausal women, escalate to 39% to 47% in perimenopausal women, and maintain a prevalence of 35% to 60% among postmenopausal women.1 These sleep disruptions are commonly linked to hormonal shifts during menopause.
Establishing solid sleep hygiene practices is a vital initial step. For those who find these practices insufficient, it’s crucial to consult a healthcare provider. Doing so can help address sleep disturbances and other menopause symptoms, as well as uncover and treat underlying health issues for improved quality of life.
What causes insomnia and sleep problems during menopause?
Insomnia is identified when someone struggles to fall asleep or stay asleep or doesn't feel rested after sleeping, even when they have enough time to sleep. According to a 2018 review, waking up frequently during the night is the most common sleep issue for those going through menopause.2
Here are some common changes occurring during the menopausal transition that can cause sleep problems:
Hot Flashes
Various studies suggest hot flashes may lead to frequent awakenings at night and even contribute to daytime irritability. A study reported that 42% of participants in postmenopause experienced hot flashes, with nearly half of them also showing symptoms of insomnia.3
The brain also undergoes changes during menopause that cause hot flashes, which may trigger awakenings.4
Sleep Apnea
The occurrence of obstructive sleep apnea (OSA) tends to rise markedly after women enter menopause. Studies indicate that 47% to 67% of postmenopausal women experience this condition. This increase can be attributed to a mix of physical and hormonal changes that accompany this stage of life.5
As women go through menopause, it's common to see an increase in body weight, which affects the body mass index (BMI), neck circumference, and waist-hip ratio. These changes can constrict the airways during sleep, making breathing more difficult.
The decrease in progesterone levels can weaken the muscles responsible for keeping the airway open. This hormonal reduction also lessens the stability of respiratory drive, leading to a more frequent collapse of the airway during sleep.5
Restless Legs Syndrome
Restless legs syndrome (RLS) is a neurological condition that is significantly more common in women than in men. This disorder is marked by uncomfortable sensations in the legs during periods of inactivity, particularly at night, prompting an overwhelming urge to move the legs to relieve the discomfort.
Interestingly, menopause appears to exacerbate both the frequency and severity of RLS symptoms. For instance, a study found that 69% of postmenopausal women reported an increase in their symptoms compared to before menopause.6 Researchers believe these changes in symptoms are linked to fluctuations in estrogen levels during menopause.
Anxiety, Stress, and Hypervigilance
Sleep disturbances in postmenopausal women are often associated with anxiety. This difficulty in falling asleep can precipitate anxiety and irritability, which may further degrade sleep quality.
This life phase often brings additional challenges that compound sleep problems, including heightened stress levels and an increase in insomnia cases. These issues are frequently aggravated by significant life events like career pressures, divorce, or the responsibilities of caring for a family.7
Another psychological phenomenon that disrupts sleep is hypervigilance, where the brain remains in a state of high alert, preventing sustained sleep throughout the night. This condition can be a consequence of post-traumatic stress or any past trauma. Furthermore, adverse childhood experiences (ACE) can exacerbate menopause symptoms and significantly disrupt sleep patterns.8
Hormone Changes
The reduction in estrogen levels can cause vaginal dryness, which might lead to sexual dysfunction. The link between vaginal dryness and sexual dysfunction may serve as a significant psychological factor contributing to depression, which, in turn, can precipitate sleep disturbances in menopausal and postmenopausal women.5
Decreased estrogen levels may also cause joint discomfort and urinary issues, such as the frequent need to urinate during the night, both of which can interrupt sleep. Additionally, the reduction in progesterone, known for its role in sleep induction through its effects on neural pathways, further complicates sleep patterns during menopause.
Additionally, melatonin, a hormone essential for regulating sleep, naturally diminishes with age. The production of melatonin is influenced by both estrogen and progesterone. As levels of these hormones drop during perimenopause, the concurrent decline in melatonin often intensifies sleep challenges.9
How is insomnia treated during menopause?
Addressing sleep issues starts with establishing good sleep habits. However, if these adjustments prove insufficient, it’s advisable to consult a healthcare provider to investigate potential underlying causes of sleep disturbances, such as depression, RLS, or sleep apnea.10
Sleep Hygiene
Here are some practices that may help maintain better sleep habits:
Establish and maintain fixed times for going to bed and waking up each day.
Refrain from napping in the late afternoon or evening to prevent disturbances in your nightly sleep.
Engage in tranquil activities like reading, listening to soothing music, or indulging in a warm bath to relax before bed.
Avoid the use of televisions, computers, and mobile devices in your sleeping area, as the emitted light can impede the onset of sleep.
Maintain a bedroom temperature that is neither too hot nor too cold and reduce noise levels to create a conducive sleep setting.
Engage in regular physical activity during the day, but avoid vigorous exercise close to bedtime.
Avoid large meals before sleeping to prevent discomfort and disruptions.
Avoid alcohol and limit intake of caffeine-laden products in the late hours.
Cognitive behavioral therapy (CBT)
CBT explores the relationship between thoughts, behaviors, and sleep. During therapy sessions, the therapist assesses the individual's beliefs and feelings about sleep to verify their accuracy and examines behaviors to see if they help or hinder sleep. The provider then helps to correct or modify any misconceptions and addresses challenges in a manner that enhances the possibility of restful sleep.11
Hormone replacement therapy (HRT)
HRT is considered the gold standard for treating menopausal symptoms, including hot flashes, night sweats, and sleep disturbances. This therapy works by restoring the balance of hormones, specifically estrogen and progesterone, as their natural levels diminish during menopause.
HRT is available in various forms, including oral tablets, topical creams or gels, and patches.12
Medication
During the menopausal transition, several medications can help address insomnia. However, these treatments might not be suitable for long-term use and can have adverse effects; so it’s essential to consult a physician:12
Antidepressants: These medications can treat underlying mental health conditions contributing to insomnia., Low doses of certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), duloxetine, and amitriptyline, may help improve sleep.
Benzodiazepines: Known for their sedative and muscle-relaxing properties, these drugs can assist with sleep but should be used with caution.
Melatonin: This hormone regulates sleep and wake cycles. Menopause may be linked to decreased melatonin levels, which can affect sleep quality. Melatonin supplements can help restore balance and improve sleep.
Can hormone replacement therapy help sleep problems during menopause?
Numerous studies have consistently demonstrated that HRT can significantly improve sleep in women, particularly when vasomotor symptoms are the cause of sleep disturbances. The primary component of HRT is estrogen, which addresses symptoms resulting from estrogen deficiency. For sleep disturbances, the addition of progesterone can offer further benefits, including an increase in non-REM sleep, which is considered the quiet or restful phase of the sleep cycle.
Experiencing menopausal sleep problems? Discover if HRT is right for you.
If you’ve entered the menopause transition and are struggling with sleep disruptions, you don’t have to suffer in silence. Take our brief menopause quiz to see if you’re an eligible candidate for HRT. Get started with Winona to take the first step toward feeling better.
