How Does Menopause Affect Sleep?

As women approach their midlife stage, many experience problems getting high-quality sleep. This is attributed not only to menopause but also to perimenopause (transition to menopause) and postmenopause (after reaching menopause).

According to data from the National Health Survey Interview, 2015, women between ages 40 to 59 experience a wide range of sleep issues, including:

• Perimenopausal women were more likely than postmenopausal women and premenopausal to have less than 7 hours of sleep in a day
• Postmenopausal women were more likely than premenopausal women to have trouble falling and staying asleep
• Postmenopausal women were more likely to wake up feeling less rested than premenopausal women

Similarly, data from the Study of Women’s Health Across the Nation (SWAN) shows that women are more likely to experience sleep disorders as they enter and during menopause, with the prevalence of sleep disorders being:

• 16% to 42% in premenopausal women
• 39% to 47% in perimenopausal women
• 35% to 60% in postmenopausal women

If you’re at the menopausal stage of your life and the idea of getting consistent healthy sleep seems like a long-lost dream, know that this is far from the truth! You can still maintain healthy sleep by incorporating certain habits and, in some cases, getting additional support from a healthcare provider, if necessary.

How does menopause affect sleep? 

Menopause occurs when a woman’s ovaries no longer produce estrogen and progesterone, two main reproductive hormones in women. With these changes comes others—you may experience changes in your energy levels, mood, weight, sex drive, and sleep.

Most women experience menopause between ages 40 and 58, with the average age of onset being 51.

When it comes to changes in sleep, some of the contributing factors that may be at work include:

1. Hot flashes or flushes
2. Insomnia
3. Ovarian hormone changes
4. Obstructive sleep apnea
5. Periodic leg movement disorder
6. Restless leg syndrome
7. Mood disorders.

Vasomotor symptoms  

Vasomotor symptoms are more often referred to as hot flashes or flushes and are one of the most common symptoms women experience during menopause. Reports show that it happens to 75% to 85% of women during menopause. Vasomotor symptoms usually last for not more than 2 years after menopause, but some women may experience it for up to 10 years or more.

Hot flashes occur when a person experiences a sudden wave of heat, starting from the upper part of the body to the rest of the body, usually followed by sweating.

When hot flashes occur at night, they may disrupt sleep and cause multiple awakenings at night—impairing sleep continuity, one feature of healthy sleep. Hot flashes are also associated with the development of insomnia or may worsen insomnia symptoms in some cases.

Insomnia 

The Journal, Sleep Medicine Clinics, describes insomnia as the “most severe clinical manifestation of recurrent and chronic perceived poor sleep,” and one out of four women report experiencing at least one symptom of insomnia.

Insomnia is a sleep disorder that occurs when a person regularly finds it hard to fall and stay asleep, even without any external disturbance.

Insomnia rate in women during menopause is 28–63%, according to different studies, with data showing that menopausal women frequently get less than 6 hours of sleep in 24 hours.

Insomnia, in the short term, may cause tiredness, restlessness, poor mood, irritability, low energy levels, slow response time, and in the long term, it is associated with chronic disorders such as obesity and heart disease.

Ovarian hormone changes

Estrogen and progesterone levels begin to decline as a person enters menopause. And these drops have been linked with the likelihood of experiencing poor sleep.

An article published in the Journal of Menopausal Medicine explains the mechanisms that make estrogen and progesterone necessary for quality sleep:

• Estrogen has multiple positive effects on sleep architecture and may also reduce sleep onset latency (how long it takes a person to fall asleep), reduce nighttime awakenings, and increase sleep duration. Estrogen also lowers body temperature, vital for falling and staying asleep.
• On the other hand, progesterone has sedative and anxiolytic effects, which help the body relax and stay calm. It also triggers gamma-aminobutyric acid receptors, which promotes NREM sleep. Plus, it may help manage symptoms of obstructive sleep apnea because it supports respiratory center activity.

Obstructive sleep apnea 

Obstructive sleep apnea (OSA) is a common sleep-related breathing condition that occurs when the muscles in the airway drop intermittently during sleep, thereby inhibiting breathing.

Symptoms of OSA include excessive daytime sleepiness, fatigue, morning headache, loud snoring, irritability, and difficulty concentrating.

This disorder occurs in 17% and 34% of women and men in the US. However, studies suggest that obstructive sleep apnea is underdiagnosed in women.

Still, the prevalence of OSA in women increases as they enter menopause, with reports showing that it affects 47% to 67% of women during postmenopause. Weight gain and low estrogen and progesterone levels—occurring during menopause—may contribute to the development of this disorder.

Periodic limb movement disorder

Periodic limb movement disorder (PLMD) is a sleep disorder accompanied by repetitive and uncontrollable twitching and jerking of the legs during sleep and may impair sleep quality.

This disorder is common among women during menopause and may result from sleep apnea or anti-depressant medication use—also prevalent in women at menopause.

Restless leg syndrome

Restless leg syndrome is a sleep disorder characterized by an irresistible urge to move your legs during sleep.

This disorder occurs in 7 to 10 percent of people and happens more in women—especially those experiencing vasomotor symptoms—than men.

Mood disorders 

Women during menopause are at a higher risk of developing mood disorders such as anxiety and depression, and these disorders have been shown to affect sleep quality.

Ways to promote a better night’s rest during menopause 

If your sleep quality has dwindled with the start of menopause, consider consulting with your doctor, who may best prescribe treatment appropriate for your case.

If you’re looking to improve your sleep health, here are some tips that may help:

1. Consider adding yoga and tai-chi into your workout routine as evidence suggests that they may help manage hot flushes and other menopausal symptoms.
2. Try to include relaxation exercises such as meditation, deep breathing, soothing scents, and journaling into your daytime or nighttime routine to help improve your mood, ease your body and mind, and help you sleep better.
3. Wear loose or light clothing to reduce nighttime sweat that may come from hot flushes.
4. Maintain a regular sleep-wake schedule as this helps prime your body and mind for sleep and makes it easier to fall asleep during bedtime.
5. Make your room sleep-friendly by keeping it tidy, calm, cool (keeping the room temperature ideally between 60 and 68 degrees Fahrenheit), and quiet and using it strictly for sleep and intimacy.
6. Limit alcohol, caffeine intake, and spicy foods too close to bedtime as they may worsen menopausal symptoms and cause sleep disturbance at night
7. Exercise or physical activity during the day is an important part of maintaining sleep health. Try doing exercises or other activities that keep you moving regularly for at least four days a week.
8. Reduce exposure to blue light from screens at evening time as they may hinder melatonin release—the hormone that helps regulate your circadian rhythm and signal to your brain that it’s time for sleep
9. Consider creating a bedtime routine and include habits that help your body feel calm and ready for restorative sleep, such as having warm baths at night, and listening to white noise.