Symptom Guide: Sleep Issues

Jul 1, 2022
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What sleep issues occur during menopause?

Up to 60 percent of women going through the menopausal transition experience issues related to sleep. Some have trouble falling asleep; others have difficulty staying asleep. These sleep disturbances can take a toll on waking life, leading to mood and mental health changes such as increased fatigue, stress, irritability, and anxiety. Fortunately, maintaining healthy sleep habits and small lifestyle changes can go a long way in getting a good night’s rest.

What Causes Them?

Several factors can cause sleep issues during menopause, but the common thread between all of them is changing hormone levels. Decreasing levels of estrogen and progesterone can throw off your sleep cycle directly, but they can also cause other symptoms of menopause that make it difficult to sleep soundly—these can include hot flashes and night sweats, sleep apnea, restless leg syndrome, and mental health concerns like anxiety and depression.

What’s Happening Inside Your Body?

Several changes in the body during menopause can lead to difficulty sleeping:

Altered sleep cycle: Decreasing levels of estrogen, progesterone, and melatonin may have a direct impact on your ability to sleep. Research suggests that progesterone has sleep-inducing and anti-anxiety effects, so sleep may not come as easily when its levels start to decline. Though estrogen’s relationship to sleep is complex, estrogen helps reduce the number of awakenings during the night and promotes longer sleep time for women who are waking due to menopause symptoms like night sweats.

Hot flashes and night sweats: Some of the most common issues affecting menopausal women are hot flashes, which refer to the sensation of heat suddenly rising in the face then spreading throughout the body. Affecting up to 80% of women, they can be very uncomfortable—so much that they cause people to wake up at night, when they’re sometimes referred to as “night sweats.” They usually occur alongside a surge of adrenaline, the hormone that increases alertness during the “fight or flight” response to stress. As a result, it may be hard to fall back asleep even after the hot flash passes. 

Sleep apnea: Another factor that might cause difficulty staying asleep is obstructive sleep apnea (OSA), a condition where breathing intermittently stops during sleep because the throat muscles are too relaxed for normal breathing to occur. Sometimes people with OSA may snore or make gasping and choking sounds during sleep. It can lower sleep quality, leading to headaches, fatigue, irritability, and trouble focusing during the day. OSA becomes more common after menopause, affecting approximately 20% of women. Women concerned they might have sleep apnea should consult a physician.

Mental health conditions: Many menopausal women experience changes to their mental health, like the onset of depression or increased anxiety, and these can make it difficult to fall asleep or stay asleep. A range of factors, including changing hormone levels, increased personal and professional stress, and sleeplessness itself can increase risk of depression or anxiety. 

What Does the Research Say?

  • According to a 2019 paper in the journal Sleep Medicine Clinics, nighttime awakenings are the most common sleep-related complaint among menopausal women.
  • Research published in 2022 in the journal PLOS One showed evidence that women with higher levels of estrogen have significantly lower odds of sleep apnea and snoring.
  • A randomized controlled trial described in the journal JAMA Internal Medicine in 2016 found that cognitive behavioral therapy improved sleep in menopausal women suffering from insomnia.

How are sleep issues addressed?

Treatment for sleep problems depends on the factors driving sleeplessness. While some sleep problems can be addressed by creating a more restful sleep environment and maintaining healthy sleep habits, conditions such as sleep apnea, anxiety, or depression may be treated medically. 

What are some effective medical treatments?

  • Menopausal hormone therapy: This type of treatment consists of estrogen alone or estrogen combined with progesterone, supplied to the body in the form of a pill, patch, or cream. It can be effective in treating many symptoms of menopause, including insomnia and hot flashes, but it’s not suitable for everyone. Your doctor can help determine if MHT, is safe for you.
  • Antidepressants: Taking antidepressants prescribed by your doctor or mental health professional can help improve sleep, especially if your sleeplessness is caused by depression. But even in individuals who do not have depression, low doses of selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), paroxetine (Paxil), and venlafaxine (Effexor) can be helpful in easing insomnia.
  • Prescription sleep aids: Some prescription medications can help with insomnia in the short term. Because many of these medications can be addictive, they are not normally meant to be taken long term. 

What are some non-medical treatments?

  • Create a comfortable sleeping environment: Optimizing your bedroom can go a long way in helping you sleep through the night. If night sweats are an issue, turn the thermostat down as far as you can tolerate, invest in breathable linens, and wear light clothing to bed. Remove any devices that might make sudden noises or flash lights during the night, like TVs, clocks, cell phones, modems, and laptops. If bright lights outside are keeping you up, try blackout curtains or an eye mask. 
  • Improve sleep hygiene: While many of the drivers of sleeplessness during menopause can’t be cured directly, creating a healthy bedtime routine can help you feel more relaxed and comfortable, improving your chances at a better night’s sleep. Eating earlier in the evening can help prevent stomach issues that cause discomfort at night. Avoiding liquids near bedtime can reduce your chances of waking up to use the bathroom. Since alcoholic drinks can interfere with your ability to sleep through the night, it’s also best to avoid them in the evening. Putting away stimulating electronic devices before bed (and keeping them out of the bedroom) and opting for relaxation techniques such as yoga or gentle stretching can help you wind down in preparation for sleep.
  • Cognitive Behavioral Therapy for Insomnia Therapy: If your sleeplessness is being driven by mood or mental health changes, your healthcare provider may suggest cognitive-behavioral therapy, a type of talk therapy in which a counselor helps you become aware of and break the cycle of negative thoughts that are driving negative symptoms. Research suggests that cognitive behavioral therapy for insomnia (CBTI) can help postmenopausal women sleep for longer periods of time. 
  • Melatonin: Melatonin is a supplement that is very effective for helping people become sleepy at bedtime and research suggests it is reasonably safe to use. However, before using melatonin, it’s recommended to check in with a doctor about sleep concerns in order to ensure there’s nothing medical causing sleep disruption.

What to do next

  • Connect with a doctor: Speak with your doctor about the factors causing your sleeplessness and the impact that it’s having on your life. They can help determine the best treatment options for you and help you develop healthy habits that can improve your ability to sleep.
  • Monitor how you feel: Sleeplessness can have a wide range of effects on your waking life, such as mood changes, forgetfulness, and even susceptibility to slips and falls. If your symptoms intensify, let your doctor know so they can modify your treatment plan. 
  • Listen to your body: Sudden changes to your sleep cycle can be disorienting, but they can also be a good opportunity to check in with what your body needs. If you need to take more naps during the day, go for it; if you find that you need less sleep than you used to do, that’s okay too. Remember that your body is changing and so are its needs.

Learn more:

Are you experiencing other symptoms that you want to better understand and learn how to treat and manage them? Check out our following guides:

Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.