Was this helpful?
How Does Menopause Affect Sleep?
Aug 19, 2024
Fact Checked
Hot flashes and insomnia are major sleep disruptors but we can help you find menopause-related relief.
Key Takeaways
- Menopause is the end of monthly menstrual periods.
- The age of onset of menopause is between your 40s and 50s, with the average age of 51.
- Approximately 75% of menopausal women experience hot flashes.
- As many as 40%–60% of menopausal women report sleep disturbances.
- The three main symptoms of menopause are hot flashes, difficulty sleeping, and mood fluctuations.
Menopause is not a single event, but rather a phase of life—and one that can leave you with sleepless nights. In fact, as many as 40%–60% of women experience sleep disruptions in the time leading up to and during menopause. Menopause can also affect your partner if you’re radiating heat from your body while you sleep, according to the firsthand experience of Jennifer Gunter, MD, an OB-GYN, podcast host, and the author of “The Menopause Manifesto.”
“The most common disturbance is waking up during the night, meaning women have trouble staying asleep,” Gunter said in her book. “Though some women may report trouble falling asleep and others wake up earlier than desired, these sleep disturbances are less common. Many women also report they feel unrested with the sleep they are getting. Sleep disturbances increase during the menopause transition and peak during the last few years before the final menstrual period.”
Hormonal changes can cause hot flashes, which are major sleep disruptors and can affect your overall mood. Lifestyle modifications and perhaps a cooling mattress can improve symptoms, but it may take some trial and error to find the right solution. Learn more about how menopause can cause sleep issues and what you can do to relieve them.
What is menopause?
Menopause occurs once the menstrual period stops for 12 consecutive months. The time leading up to menopause, called perimenopause, is when the ovaries slow down estrogen production until it stops completely. Perimenopause, the four to 10 years leading up to menopause, affect the majority of women during their 40s and some as early as their 30s, according to the North American Menopause Society (NAMS).
It’s important to understand the various phases of menopause throughout a woman’s reproductive life:
- Premenopause: This phase starts at puberty and lasts your entire reproductive life if you have regular periods.
- Perimenopause: When you start skipping your period for up to three months at a time, you’ve reached this phase. Your periods become erratic, but you can still get pregnant.
- Menopause: You’ve officially reached this phase at 12 consecutive months of having no periods.
- Postmenopause: This occurs when you are period-free for longer than one year but may have some lasting symptoms that will eventually dissipate.
Hot flashes are a key indicator you’re in the menopause transition. You may also experience some of these symptoms, as outlined by the National Institute on Aging:
- Hot flashes followed by cold sweats at night or during the day
- Changes in your menstrual period, skipping periods, and heavy periods
- A loss of bladder control, called incontinence
- Loss of libido
- Pain during sexual activity and vaginal dryness
- Mood swings
- Cognitive changes, sometimes referred to as brain fog
- Sleep disruptions
If you’re starting to have symptoms, your doctor may recommend tracking your monthly periods. In addition, they may do laboratory testing for the following:
- Estradiol level: This blood test measures the amount of estradiol, a form of estrogen. Low levels, below 30 pg/mL, indicate the ovaries are slowing down production and the woman is entering menopause.
- Follicle stimulating hormone level: This hormone stimulates the ovaries to produce estrogen. When the ovaries slow down estrogen production, levels of FSH increase as the body tries to boost estrogen levels. FSH levels higher than 40 UI/L typically mean women are in menopause.
Once you are in the menopause transition, estrogen levels naturally decrease until you are post-menopausal.
Gunter further explained in her book: “Estrogen and progesterone and possibly other reproductive hormones appear to influence circadian rhythms—our natural sleep-wake cycles—by influencing part of the brain called the suprachiasmatic nuclei, which is thought of as the sleep pacemaker. The hormone progesterone also has a mildly sedative effect.”
Although there may be great relief in no longer worrying about unintended pregnancy, the estrogen your body once created no longer offers protection to your bones, heart, and brain. That means you will want to take action to help all three stay strong.
Menopause can cause bone loss and lead to osteopenia, a precursor to osteoporosis, which can increase the risk of a bone fracture. One in two postmenopausal women will be diagnosed with osteoporosis during their lifetime, according to the Endocrinology Society. Below, we’ll outline how to reduce your risk of bone breaks, heart issues, and cognitive decline through diet, exercise, hormonal therapy, and medications.
How does menopause affect sleep?
Menopause has its ups and downs when it comes to sleep. Hot flashes are one of the biggest sleep disruptors, but you may also experience things like restless leg syndrome, insomnia, or obstructive sleep apnea.
Hot flashes and night sweats
The media might try to make light of menopause, but it is no laughing matter for many. Hot flashes, sometimes called hot flushes, arrive with other symptoms that can come on suddenly.
“For many, hot flashes start like a mini panic attack before the heat and cold sweats come on,” says Alyssa Dweck, MD, chief medical officer of Bonafide Health.
Blood vessels near the surface of the skin begin to enlarge, increasing blood flow to the surface to dissipate body heat, which creates a redness that starts in the neck and climbs up the face, making you suddenly sweaty, and can rapidly increase your heartbeat. Imagine this not only disrupting your ability to sleep deeply, but also happening during the day, at work, at the grocery store, or while out to dinner with friends.
Hot flashes occur in 75% of women during perimenopause, which can arise a few times a day or hourly and can regularly occur during six month to 10 year stretches, according to NAMS. Once women have entered menopause, about 25% of women continue to experience hot flashes after five years, and one-third of women will experience hot flashes 10 years later. It varies greatly from person to person. Women undergoing breast cancer or uterine cancer treatment who may be forced into medical menopause due to surgery or hormone-blocking therapies can experience hot flashes.
Restless leg syndrome
Restless leg syndrome (RLS) is a condition where a person is at rest, either asleep or just watching TV on the couch, and gets the sudden, insatiable urge to move their legs. Research suggests the fluctuation of estrogen during perimenopause as one cause. RLS could also be caused by a dip in iron levels if monthly periods haven’t ceased. More research is needed to know how many women are affected, but in general, women tend to get RLS more than men. Medications may be prescribed for severe cases. For milder cases, you might try some of the following:
- Comfortable shoes
- Exercise
- Distraction through mental activities
- Reduced caffeine
- Massage
Insomnia
Sleep disruption is commonly reported during perimenopause and postmenopause, which is caused partly by the decrease in hormones, including melatonin, during this phase of life. A study breaks down the percentages into two phases. Insomnia, either having trouble falling asleep or staying asleep, increases from 16% to 47% during perimenopause and 35% to 60% at postmenopause.
You may experience different types of insomnia:
- Initial insomnia: You have trouble falling asleep.
- Middle insomnia: You wake up in the middle of the night, but fall back asleep.
- Late insomnia: You wake up too early in the morning and don’t fall back asleep.
If you fall into a pattern of disrupted sleep, this can lead to anxiety and depression. This is one reason why OB-GYNs prescribe antidepressants for hot flashes because the beginning of the hot flash may feel like a mini panic attack, as Dweck said. The medications may not stop the hot flashes completely, but you may be better equipped mentally to handle them.
Sleep apnea
Sleep apnea is a condition where you stop breathing while asleep. Obstructive sleep apnea (OSA) causes the nasal cavities, oral cavity, throat, and voice box to narrow and restrict your breathing for at least 10 seconds, resulting in reduced airflow and lower blood oxygen levels. Your risk of OSA increases as you age and if you put on extra pounds, which is common in mid-life. Approximately 8% of women between the ages of 50 and 70 have sleep apnea.
Symptoms include:
- Loud snoring
- Gasping for air when sleeping
- Daytime sleepiness
- Waking with a dry mouth
- Morning headaches
If you experience some of these symptoms, ask your doctor about sleep apnea.
OSA can lead to cardiovascular issues, high blood pressure, and stroke. The American Academy of Sleep Medicine (AASM) recommends using a CPAP machine to lessen your OSA symptoms and improve the quality of your sleep. You may also be interested in CPAP alternatives like physical therapy, mouthguards, or surgery.
A study suggests your risk of OSA is increased if you have medically induced menopause due to the removal of the ovaries rather than naturally occurring menopause. Researchers think medically induced menopause might cause an immediate decrease in estrogen levels rather than gradually over time.
Cognitive effects during menopause
Women’s brains go through phases; the brain does not age linearly, according to neuroscientist Lisa Mosconi, PhD, a recent guest on Sanjay Gupta’s podcast, “Chasing Life.” Mosconi discussed how women’s health has historically been overlooked and understudied. For context, she noted it wasn’t until 1996 that it became apparent to scientists that estrogen has an impact on the brain—27 years after the United States landed men on the moon.
In her research, she makes the connection between the estrogen decline during the transition and brain health, including the development of types of dementia, and is studying why women are being diagnosed with Alzheimer’s disease at a higher rate than men. The use of prescribed estrogen can offset some of the cognitive issues affecting women during this time. Sleep removes waste products, impurities, and toxins, including Alzheimer’s plaques from the brain, according to Mosconi.
If you’re having some memory issues, NAMS recommends the following:
- Maintain an extensive social network
- Remain physically and mentally active
- Eat a healthy diet
- Stop smoking
- Get cholesterol levels and blood pressure checked periodically
- Use moderation when drinking alcohol
Women who are concerned about brain health and performance should have a check-up with their doctors. Luckily, brain fog tends to lift during the postmenopausal phase, according to Mosconi.
Tips for improving sleep while in menopause
Creating a comfortable environment for sleep is vital to help set you up for a good night of rest. Here are some tools you can begin to implement:
Create a cool sleeping environment
Try to keep the bedroom for only two things: sleep and sex. While you’re getting ready for bed at night, turn off the electronics. Keep the room cool and dark. You might also have a cold glass of ice water by the bedside. Dress in loose, moisture-wicking layers, but keep a blanket nearby because a hot flash can turn into a cold sweat, and you want to be ready for a quick turnaround.
Maybe it’s time to rethink your bed if your sleeping style or position has changed over time. Do you need lighter sheets? Do you have back pain? Are you a side sleeper? Beds are made to accommodate different types of sleepers. Consider an adjustable bed to maximize your comfort and perhaps offset OSA for you or your partner.
Track your sleep and wake-up times with a journal, smartwatch, or fitness tracker to see if what you have tried has improved your sleep. If these at-home strategies aren’t effective, it may be important to consult with your physician for additional treatment options.
Research hormone therapy
Hormone therapy, sometimes called hormone replacement therapy (HRT), can be helpful for those who experience hot flashes and disrupted sleep, according to Dweck. Once the hot flashes are better controlled, women are able to sleep better, according to recent research.
“In general, initiation of hormone therapy is appropriate for those with bothersome symptoms who are younger than 60 and within 10 years of onset of menopause,” she said.
These are the two types of HRT, according to The American College of Obstetricians and Gynecologists (ACOG).
- Estrogen only: Estrogen is the main hormone used in hormone therapy.
- Estrogen plus progestin: If you have not had a hysterectomy and still have a uterus, you also will need a hormone called progestin. Taking progestin helps reduce the risk of uterine cancer that can occur when estrogen is used alone.
But it’s not for everyone, and you should take caution and talk with your doctor before trying a new therapy.
“Hormone therapy is best avoided in those with undiagnosed vaginal bleeding, those with a history of or active hormone-sensitive cancers, such as breast or uterine cancers, and those with a history of or genetic propensity for a blood clot. Individual medical history is taken into account for those with migraine headaches with aura, like flashes of light, active liver disease, and other medical issues.” — Alyssa Dweck, MD
Depending on your health history, your doctor can best tell you the safest types and dosages of hormone therapy, which are often a combination of estrogen and progesterone. No treatments are without risk, but you and your doctor can weigh the benefits versus risks to improve your quality of sleep.
Eat healthy and get moving
Try incorporating more of the following foods that are a source of melatonin, a naturally occurring hormone that can aid your sleep:
- Eggs
- Fish (codfish)
- Shellfish
- Nuts
- Cherries
- Strawberries
- Soy
- Sesame seeds
- Sunflower seeds
- Pumpkin seeds
If you’ve tried some of these recommendations and you’re not feeling better, you might be ready to throw in the towel and take a nap, but you’d be better served to exercise, especially early in the day. You don’t have to pump heavy weights; it’s best to take it easy and go slow if you’re reintroducing exercise into your routine. Walking, low-resistance exercise, yoga, and swimming can be beneficial for improving strength, bone density, hormonal levels, and, best of all, reducing hot flash symptoms, which should help improve your sleep. Exercise also protects your heart and reduces the risk of cardiovascular issues, like heart attacks and stroke, as well as improving your mood.
Try medication
Antidepressants are sometimes prescribed for hot flashes and night sweats since reducing these common menopause symptoms can improve your sleep quality by helping you wake up fewer times during the night. Selective serotonin-reuptake inhibitors (SSRIs) are a type of antidepressant effective in treating hot flashes, according to NAMS. Recent research shows paroxetine (Paxil) can reduce hot flashes and night sweats, resulting in longer sleep time for participants.
Your doctor may recommend other antidepressants, sleep medication, or gabapentin, a drug prescribed for RLS and migraines. Last year, the U.S. Food and Drug Administration (FDA) approved fezolinetant (Veozah) to treat hot flashes. It works by binding to and blocking the activities of a brain receptor, which plays a role in regulating body temperature.
If you’re wondering whether FDA-regulated medical marijuana, also called cannabis, might help with relaxation and sleep, it’s something you can bring up to your doctor—but be aware medical marijuana prescription laws vary from state to state.
In a recent survey of more than 250 women in perimenopause and postmenopause, 67.4% said using medical marijuana, either smoking it or eating edibles, helped reduce sleep disturbances like hot flashes. More studies are needed to better understand the risks and benefits of this treatment to ease menopause symptoms. Also, it’s important to note that medical marijuana and CBD products are not the same. You might find cannabidiol (CBD) products in stores or online, but not all companies follow FDA regulations, and there is almost no scientific evidence (beyond some individual accounts) to actually demonstrate effectiveness.
As always, be sure to consult with a physician to discuss whether specific medications and supplements may be right for you.
Bottom line
Menopause is a phase in life that can occur years before your final menstrual period. You may experience symptoms like hot flashes and insomnia, which can put a damper on your sleep quality and mood. Not every woman will have hot flashes, but they are common.
Sleep apnea is another potential menopause-related sleep disruptor that tends to occur mid-life, and you will want a doctor’s diagnosis so you can find the best method for treatment. Eating nutritious and healthy foods, exercising regularly, and taking medication like HRT and antidepressants can help. It’s best to visit your doctor to discuss how your physical and mental health concerns can improve overall.
Have questions about this review? Email us at reviewsteam@ncoa.org.
Sources
- Baker FC, et al. Sleep and Sleep Disorders in the Menopausal Transition. Sleep Medicine Clinics. Sept. 13, 2018. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092036/
- North American Menopause Society. Menopause 101: A Primer For the Perimenopausal. Found on the internet at https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/menopause-101-a-primer-for-the-perimenopausal
- National Institute on Aging. What is Menopause? Found on the internet at https://www.nia.nih.gov/health/menopause/what-menopause
- National Menopause Foundation. Education. Found on the internet at https://nationalmenopausefoundation.org/education/
- Endocrine Society. Menopause and Bone Loss. Jan. 24, 2022. Found on the internet at https://www.endocrine.org/patient-engagement/endocrine-library/menopause-and-bone-loss
- Freeman EW, et al. Risk of Long-term Hot Flashes After Natural Menopause: Evidence from the Penn Ovarian Aging Study Cohort Menopause. 2014. Found on the internet at https://journals.lww.com/jomh/fulltext/2019/10010/menopausal_hot_flashes__a_concise_review.3.aspx
- North American Menopause Society. Menopause FAQs: Hot Flashes. Found on the internet at https://www.menopause.org/for-women/menopause-faqs-hot-flashes
- Cancer.Net. Breast Cancer: Follow-up Care and Monitoring. October 2022. Found on the internet at https://www.cancer.net/cancer-types/breast-cancer/follow-care-and-monitoring
- Cancer.Net. Ovarian, Fallopian Tube, and Peritoneal Cancer – Introduction. October 2022. Found on the internet at https://www.cancer.net/cancer-types/ovarian-cancer/view-all
- Seeman MV. Why Are Women Prone to Restless Legs Syndrome? International Journal of Environmental Research and Public Health. Jan. 6, 2020. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6981604/
- Tandon VR, et al. Menopause and Sleep Disorders. Journal of Midlife Health. Jan-March 2022. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9190958/
- Senaratna CV, et al. Prevalence of Obstructive Sleep Apnea in the General Population: A Systematic Review. Sleep Medicine Reviews. August 2017. Found on the internet at https://www.sciencedirect.com/science/article/abs/pii/S1087079216300648?via%3Dihub
- Bollu PC, et al. Sleep Medicine: Insomnia and Sleep. Missouri Medicine. Jan.-Feb. 2019. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390785/
- Patil SP, et al. Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of Clinical Sleep Medicine. Feb. 15, 2019. Found on the internet at https://jcsm.aasm.org/doi/10.5664/jcsm.7640
- Mishra A, et al. A Tale of Two Systems: Lessons Learned From Female Mid-life Aging with Implications for Alzheimer’s Prevention & Treatment. Ageing Research Reviews. February 2022. Found on the internet at https://pubmed.ncbi.nlm.nih.gov/34929348/
- North American Menopause Society. Menopause FAQs: Understanding the Symptoms. Found on the internet at https://www.menopause.org/for-women/expert-answers-to-frequently-asked-questions-about-menopause/menopause-faqs-understanding-the-symptoms
- The American College of Obstetricians and Gynecologists. Hormone Therapy for Menopause. February 2024. Found on the internet at https://www.acog.org/womens-health/faqs/hormone-therapy-for-menopause
- Faubion SS, et al. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022. Found on the internet at https://journals.lww.com/menopausejournal/fulltext/2022/07000/the_2022_hormone_therapy_position_statement_of_the.4.aspx
- Capel-Alcaraz AM, et al. The Efficacy of Strength Exercises for Reducing the Symptoms of Menopause: A Systematic Review. Journal of Clinical Medicine. Jan. 9, 2023. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9864448/
- Pinkerton JV, et al. Low-dose Paroxetine (7.5 mg) Improves Sleep in Women with Vasomotor Symptoms Associated with Menopause. Menopause. Jan. 22, 2015. Found on the internet at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274337/
- US Food and Drug Administration. FDA Approves Novel Drug to Treat Moderate to Severe Hot Flashes Caused by Menopause. May 12, 2023. Found on the internet at https://www.fda.gov/news-events/press-announcements/fda-approves-novel-drug-treat-moderate-severe-hot-flashes-caused-menopause
- Dahlgren, M. et al A Survey of Medical Cannabis use During Perimenopause and Postmenopause. Menopause. September 2022. Found on the internet at https://journals.lww.com/menopausejournal/fulltext/2022/09000/a_survey_of_medical_cannabis_use_during.6.aspx
- SAMHSA.gov. Cannabidiol (CBD) – Potential Harms, Side Effects, and Unknowns. February 2023. Found on the internet at https://store.samhsa.gov/sites/default/files/pep22-06-04-003.pdf