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Sleep and Menopause

SCOFA-Sleep-and-Menopause-1

 
Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.

 

 
Perimenopause and Sleep | Postmenopause and Sleep |
Hot Flushes and Sleep Disruptions | Comorbid Sleep Disorders With Menopause |
Getting Better Sleep With Menopause

 

Overview

As women reach their late forties, how their body regulates sex hormones starts to go into free fall, resulting in a natural hormonal upheaval known as menopause. 

Menopause occurs one year after a woman experiences her last menstrual period. However, despite menopause being a natural and inevitable process, it brings with it a bunch of unwelcome symptoms, some of which can affect an individual’s sleep. 

In fact, according to the National Sleep Foundation, 61 percent of peri and postmenopausal women experience frequent insomnia, which, combined with other symptoms of menopause such as hot flushes and mood changes, can make the concept of a good night’s sleep but merely a dream.[1]

This article looks at the components of menopause that can, in some way, affect an individual’s sleep.

 

Perimenopause and Sleep

Perimenopause is the time before menopause when a woman’s ovaries produce less estrogen and progesterone, lasting from a few months to several years, depending on the individual.[2]

During perimenopause, a woman may notice changes in her menstrual cycle, such as irregular periods, heavier or lighter bleeding, or skipped periods.[3]

These symptoms, such as hot flashes, mood swings, irritability, overactive bladder, and headaches, can all interfere with sleep quality.[3]

A further consequence of hormonal disruption during menopause is the increased risk for obstructive sleep apnea (OSA).[4]

Before menopause, a woman’s risk of OSA is lower than a man’s.[4] However, it has been shown that the prevalence of OSA increases in women with age, which can predispose women to further health complications down the line.[5]

Lastly, to further add to the burden of sleepless nights faced by women undergoing menopause is attributed to restless legs syndrome (RLS). RLS has always been more common in women than in men.[6]

RLS is relatively difficult to diagnose given the lack of specific biomarkers available for recognition and the similarity of symptoms to other conditions, which doesn’t bode well for those who struggle to sleep at night. 

Paradoxically, menopause increases the likelihood for women to experience more frequent and more severe RLS symptoms, suggesting a role for reproductive hormones in the etiology of RLS.[6]

 

Postmenopause and Sleep

Postmenopause is the time after menopause when a woman has not had a menstrual period for 12 consecutive months. Postmenopause usually begins around 52 but can vary from person to person.

During postmenopause, a woman’s ovaries stop producing estrogen and progesterone completely, meaning she no longer experiences menstrual cycles or ovulation.

However, this does not mean that she no longer experiences menopausal symptoms or sleep problems: sleep disorders and problems such as insomnia, OSA, and RLS can occur in up to 60 percent of postmenopausal women.[7] These sleep disturbances are often multifactorial in origin, though they can be exaggerated by various lifestyle occurrences.

Moreover, postmenopause can increase the risk of developing certain health conditions affecting sleep quality and quantity. For example, post-menopause can increase the risk of certain illnesses, including:

  • Osteoporosis (bone loss) can cause pain, fractures, and reduced mobility.[8]
  • Cardiovascular disease (heart disease) can cause chest pain, shortness of breath, and irregular heartbeat.[9]
  • Diabetes (high blood sugar) can cause thirst, frequent urination, and fatigue.[10]
  • Dementia (cognitive decline) can cause confusion, memory loss, and behavioral changes.[11]

These conditions can interfere with sleep quality and quantity by causing physical discomfort, emotional distress, or cognitive impairment. 

 

SCOFA-Sleep-and-Menopause-2

 

Hot Flushes and Sleep Disruptions

One of the most prominent symptoms of menopause attributed to poor sleep is the occurrence of hot flashes. A hot flash is an unpleasant sensation of heat, often paired with excessive sweating, redness, or warmth in the skin, and if occurring at night, difficulty sleeping.[12]

While they’re naturally occurring, hot flashes are not a welcomed addition to aging life, bringing with them a host of discomfort.

While not all episodes of hot flashes contribute to poor sleep, studies have demonstrated the negative impact of hot flashes and other vasomotor menopausal symptoms on sleep. 

Results from one study showed that an exacerbation of a hot flash could result in early awakenings in nearly 70 percent of those who experience hot flashes.[12]

 

Comorbid Sleep Disorders With Menopause

Multiple sleep-related comorbidities are prevalent before, during, and after menopause, which can detrimentally impact an individual’s quality of life. 

In addition to RLS and OSA described above, women going through menopause are at a greater risk for developing mental health-related sleep disruptions.

Insomnia

There are mountains of evidence showing a clear increase in poor sleep quality in menopausal women. One of the most prominent and arguably most severe causes of poor sleep in menopause is insomnia.[12]

Insomnia is a severe clinical manifestation of recurrent poor sleep that makes falling and staying asleep more difficult.[12] The likelihood of a menopausal woman experiencing insomnia correlates directly with how often they experience hot flashes.[12]

Depression

A woman’s risk for depression increases during menopause, irrespective of other factors that may come into play.[12]

One study found that women were 2-4 times more likely to develop depression in menopause than pre-transition.[12] 

The reasons for this are multifactorial and are said to be caused as a result of a vicious circle of symptoms that trigger events that contribute to poor sleep: vasomotor symptoms prevent an individual from getting sufficient sleep, leading to mood swings and irritability, which over time lead to insomnia that develops into clinical depression.[12]

 

Getting Better Sleep With Menopause

Anybody experiencing menopause-related sleep disorders should contact their healthcare provider for proper examination, diagnosis, and treatment. Individuals who continue to seek sleep remedies to help through menopause can try some of the following tips:

  • Changing Lifestyle: Maintaining a healthy weight by eating better and exercising more can help reduce the risk of certain sleep disorders such as OSA and ease some vasomotor symptoms.[13]
  • Curbing Habits: Smoking and alcohol consumption can significantly affect sleep. Cutting down on these can help individuals take better control of their sleep habits, reducing the frequency of sleep fragmentation and improving overall sleep.[14]
  • Maintaining a Sleep Hygiene Routine: Assigning a bedtime, avoiding foods past a specific time, exercising, and reducing the use of blue-light emitting devices can all help individuals establish better sleep routines that encourage a good night’s rest.[15]

Unfortunately, sleep disorders and poor sleep are a rather prevalent side effect of menopause. However, there are specific ways these sleep problems can be treated.

If you are going through menopause and cannot sleep for one or more reasons outlined above, please don’t hesitate to contact your healthcare provider.

 

References:

  1. Pacheco, D., & Pacheco, D. (2022). Menopause and Sleep. Sleep Foundation. https://www.sleepfoundation.org/women-sleep/menopause-and-sleep
  2. Santoro, N. (2016). Perimenopause: From Research to Practice. Journal of Womens Health, 25(4), 332–339. https://doi.org/10.1089/jwh.2015.5556 
  3. Tandon, V. R., Sharma, S., Mahajan, A., Mahajan, A., & Tandon, A. (2022). Menopause and sleep disorders. Journal of Mid-life Health, 13(1), 26. https://doi.org/10.4103/jmh.jmh_18_22 
  4. Jehan, S. (2016). Obstructive Sleep Apnea: Women’s Perspective. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5323064/ 
  5. Perger, E., Mattaliano, P., & Lombardi, C. (2019). Menopause and Sleep Apnea. Maturitas, 124, 35–38. https://doi.org/10.1016/j.maturitas.2019.02.011 
  6. Seeman, M. V. (2020). Why Are Women Prone to Restless Legs Syndrome? International Journal of Environmental Research and Public Health, 17(1), 368. https://doi.org/10.3390/ijerph17010368 
  7. Jehan, S. (2015, August 1). Sleep Disorders in Postmenopausal Women. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4621258/ 
  8. Ji, M., & Yu, Q. (2015). Primary osteoporosis in postmenopausal women. Chronic Diseases and Translational Medicine, 1(1), 9–13. https://doi.org/10.1016/j.cdtm.2015.02.006 
  9. Rosano, G. M., Vitale, C., Marazzi, G., & Volterrani, M. (2007). Menopause and cardiovascular disease: the evidence. Climacteric, 10(sup1), 19–24. https://doi.org/10.1080/13697130601114917 
  10. Pérez, S. C. (2023). Menopause and diabetes. Climacteric, 26(3), 216–221. https://doi.org/10.1080/13697137.2023.2184252 
  11. Conde, D. M., Verdade, R. C., Valadares, A. L. R., Mella, L. F. B., Pedro, A. O., & Costa-Paiva, L. (2021). Menopause and cognitive impairment: A narrative review of current knowledge. World Journal of Psychiatry, 11(8), 412–428. https://doi.org/10.5498/wjp.v11.i8.412 
  12. Baker, F. C., Lampio, L., Saaresranta, T., & Polo-Kantola, P. (2018). Sleep and Sleep Disorders in the Menopausal Transition. Sleep Medicine Clinics, 13(3), 443–456. https://doi.org/10.1016/j.jsmc.2018.04.011 
  13. Noll, P. R. E. S., Campos, C. a. S., Leone, C., Zangirolami-Raimundo, J., Noll, M., Baracat, E. C., Júnior, J. a. a. C., & Sorpreso, I. C. E. (2020). Dietary intake and menopausal symptoms in postmenopausal women: a systematic review. Climacteric, 24(2), 128–138. https://doi.org/10.1080/13697137.2020.1828854 
  14. Spadola, C. E., Guo, N., Johnson, D. A., Sofer, T., Bertisch, S. M., Jackson, C. L., Rueschman, M., Mittleman, M. A., Wilson, J. F., & Redline, S. (2019). Evening intake of alcohol, caffeine, and nicotine: night-to-night associations with sleep duration and continuity among African Americans in the Jackson Heart Sleep Study. Sleep, 42(11). https://doi.org/10.1093/sleep/zsz136 
  15. Irish, L. A., Kline, C. E., Gunn, H. E., Buysse, D. J., & Hall, M. H. (2015). The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Medicine Reviews, 22, 23–36. https://doi.org/10.1016/j.smrv.2014.10.001 
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