Menopause insomnia can bring several changes to a woman's life, making it hard to get a good night's sleep. In fact, according to one report, up to 60% of women in perimenopause or menopause struggle with insomnia.
If menopause keeps you up at night, some lifestyle changes and sleep tips can help you get better rest.
This article will explain menopause insomnia, how to get a good night's sleep, and more.
Can Menopause Cause Insomnia?
Yes, perimenopausal and postmenopausal women often experience insomnia. While some menopausal women face mild or occasional sleep difficulties, others may have chronic insomnia.
According to one report, over 20% of women going through menopausal symptoms have different types of sleep disorders, including insomnia, that impact their everyday lives.
For females, insomnia becomes more common with age. The Study of Women's Health Across the Nation (SWAN) found that sleep problems occur in:
- 16-42% of premenopausal women
- 39-47% of women in perimenopause
- 35-60% of postmenopausal women
How Do Hormones Like Progesterone, Estrogen, and Testosterone Affect Sleep?
Hormones such as progesterone, estrogen, and testosterone play critical roles in regulating your sleep cycle. Changes in their levels—whether due to aging, menopause, or other factors—can significantly impact the quality and duration of your sleep.
1. Progesterone: The Calming Hormone
- Promotes Relaxation: Progesterone interacts with GABA receptors, the brain's calming neurotransmitters, helping reduce anxiety and encouraging restful sleep.
- Temperature Regulation: It helps stabilize body temperature during sleep, which is particularly important for avoiding night sweats or hot flashes.
- When Levels Decline: Low progesterone typically occurs during perimenopause (early 40s) and worsens in menopause (average age 51), often leading to insomnia or restless sleep.
2. Estrogen: The Sleep Protector
- Supports Sleep Stability: Estrogen contributes to maintaining deep, restorative sleep and regulates serotonin, a neurotransmitter that influences sleep cycles and mood.
- Hot Flashes and Night Sweats: A decrease in estrogen levels which is common during perimenopause and menopause can lead to vasomotor symptoms like hot flashes and night sweats, which disrupt sleep.
- Mood Regulation: Estrogen also helps stabilize mood by regulating neurotransmitters like serotonin and dopamine. Lower estrogen can increase anxiety and depression, which often worsen insomnia.
- When Levels Decline: Estrogen levels start fluctuating during perimenopause and drop significantly after menopause. Estrogen levels also decrease with age-related hormonal changes and certain medical conditions like polycystic ovary syndrome (PCOS).
Estrogen also supports the health of your heart, bones, and brain, and its decline during menopause can affect mood, libido, and overall well-being.
3. Testosterone: The Sleep Restorer
- Muscle Recovery and Energy: Testosterone contributes to physical restoration during sleep, aiding muscle repair and maintaining energy levels.
- Sleep Apnea Risk: Low testosterone, often associated with aging, is linked to increased risks of obstructive sleep apnea (OSA)—a condition that disrupts sleep by causing breathing pauses.
- Mood and Sleep Quality: Testosterone also affects mood and energy. Low levels may contribute to fatigue, irritability, and poor sleep quality.
- When Levels Decline: Testosterone gradually begins to decline in women as early as their late 20s, with more noticeable decreases in their 30s and 40s, which can affect sleep and energy levels.
How Do Estrogen Levels Affect Sleep Quality?
Hormonal changes in the menopause transition can lead to poor sleep quality and other sleep disturbances.
Reproductive hormones in women, such as estrogen, affect body systems. Not only does it help control your menstrual period, but it also supports the health of your heart, bones, and brain.
Moreover, it boosts your libido and depressed mood. As you reach menopause, your estrogen levels begin to decrease.
A decrease in estrogen levels can lead to hot flashes, including nocturnal hot flashes, which can disrupt sleep.
Hot Flashes or Night Sweats During Menopause
Hot flashes and night sweats are common vasomotor symptoms of menopause that can affect your sleep quality.
A hot flash is an episode of intense heat that spreads from the chest up. Night sweats are nocturnal episodes of hot flashes.
During the menopausal transition, a hot flash is a commonly reported symptom. It can range from mild to intense, with signs including:
- Flushed skin
- Sweating
- Flares of heat through the body
When you experience night sweats, you become too warm and wake up in damp attire and bedding. You pull back the covers to find some comfort. Afterward, you wake up feeling chilly and snuggle under the covers.
Recurrent hot flashes can start the frustrating, sweaty cycle all over again.
Other Menopausal Sleep Disorders
Research doesn't point to one clear cause for insomnia during menopausal transition. Numerous factors may contribute to it, such as:
Snoring and Sleep Apnea (Breathlessness During Sleep)
During menopause and postmenopause, snoring becomes more common.
This may happen because declining reproductive hormones make the throat's soft tissues more likely to collapse, and weight gain (common among menopausal women) can block the airway.
As a result, it causes snoring that disrupts your sleep cycle.
Snoring can also be a sign of sleep apnea - another sleep disorder.
Sleep apnea occurs when breathing becomes shallow or stops briefly during sleep. This troubled breathing can lower sleep quality, cause daytime sleepiness, and lead to long-term health issues and other risk factors.
According to one study, 25% of people experience sleep apnea before or during menopause, and over 33% experience it after menopause.
Restless Legs Syndrome
Over 50% of postmenopausal women face restless legs syndrome - a condition causing uncomfortable sensations in the legs when lying down.
This discomfort often goes away with movement but only temporarily, making it hard to sleep and potentially causing insomnia.
Many experts believe hormonal changes and iron deficiency may cause RLS after menopause.
Reduction In Melatonin
Melatonin is a hormone that helps people improve sleep quality and is increasingly beneficial for sleep onset. However, melatonin levels tend to decrease with age, which might cause sleep problems.
It's unclear if there's a direct link between menopause and lower melatonin levels, but some studies suggest that there is. Also, postmenopausal women have lower melatonin levels than premenopausal women.
Mental Health
For most women, menopause can signal a substantial change. It also signifies that the person is aging. This - along with menopausal symptoms - can affect a person's mental health.
Conditions such as anxiety and depression often impact sleep, and insomnia can also increase the risk of depression. The relationship between mood and sleep is bidirectional, and fluctuating hormone levels can also contribute.
Why Do Menopausal Symptoms Affect Sleep?
During menopause, the body produces less progesterone and estrogen. These hormonal changes can affect various body systems and processes, including sleep.
- Thermoregulation: As estrogen levels drop, the brain becomes more sensitive to temperature changes. This can cause it to start cooling the body, like sweating, at lower temperatures, leading to night sweats and hot flashes.
- Mood: Lower estrogen levels can affect neurotransmitters that control mood. This may explain why mood swings, depression, and anxiety are more common in menopausal women, along with sleep problems linked to these conditions.
- Metabolism: Menopause changes how the body turns food into energy. Lower estrogen can lead to weight gain, which may cause snoring or sleep apnea.
- Circadian Rhythm: Many menopausal women have weaker circadian rhythms, the body's natural 24-hour cycle that affects sleep and wakefulness.
How Long Does Insomnia Last?
Various factors determine the duration of insomnia during and after menopause. However, all menopausal women have a unique experience. Some may face symptoms for a longer duration than others.
Hormone levels in a person can begin to shift 7-10 years before menopause. Following this stage, women may experience symptoms like hot flashes for many years.
In addition, estradiol levels decrease slowly during the first 1-6 years of early postmenopause. This often leads to a continuation of symptoms, including sleep symptoms.
Numerous treatments and therapies are available to help alleviate sleep problems. It is also crucial to consider other factors that could impact sleep quality.
How Do We Treat Sleep Disturbances (Insomnia) During Menopausal Transitions?
There are various types of therapy available for sleep disturbances, including insomnia. These may include treatments, prescribed drugs, and natural remedies (discussed in the next heading).
Your treatment plan could be influenced by various factors, such as:
- whether you have temporary or chronic insomnia
- if you receive a diagnosis of additional mental health disorders
Cognitive Behavioral Therapy (CBT)
CBT is the primary treatment recommended for individuals experiencing chronic insomnia and is particularly beneficial for menopausal women.
Cognitive behavioral therapy helps you identify harmful patterns, actions, and thoughts that could impact your sleep quality.
When you realize it, contacting a doctor is recommended to identify coping mechanisms.
Hormone Replacement Therapy (HRT)
Hormone replacement therapy (or simply hormone therapy) helps you manage menopause symptoms such as night sweats, hot flashes, and insomnia. This treatment boosts your progesterone and estrogen levels as your natural levels decrease.
Consult a healthcare provider about menopausal hormone therapy if your symptoms lead to poor sleep quality or sleeplessness. There are various HRT options available, such as:
- Topical creams or gels
- Patches
- Oral tablets
Medication
A healthcare provider may recommend taking small amounts of specific prescription medications to improve sleep quality.
- Hormonal Birth Control: Hormonal birth control may help balance your hormone levels. This could alleviate menopausal symptoms and improve sleep quality.
- Antidepressants: Antidepressants can help with any mental health issues that may cause insomnia. Some antidepressants, such as SSRIs, duloxetine, and amitriptyline, can improve sleep when taken in low dosages.
- Benzodiazepines: These medications can have soothing and muscle-relaxing effects that might help with sleep.
- Melatonin: Melatonin regulates sleep and wake patterns. Menopause may cause lower melatonin levels, which can affect sleep. Taking melatonin supplements can help restore balance and improve sleep.
Menopause Insomnia: Tips to Get a Good Night's Sleep
The good news is that menopause doesn't have to mean losing a good night's sleep. There are things you can do to improve your sleep.
Do exercise
Studies show that people who exercise regularly sleep better. If your heart rate is not up during the day, you'll have trouble sleeping at night.
One study analyzed 17 clinical trials and found exercise interventions like yoga, walking, and aerobics greatly reduce insomnia and sleep problems in menopausal women.
Another study showed that perimenopausal women who did an hour of aerobic exercise twice a week for eight weeks saw big improvements in anxiety, depression, and sleep issues.
However, it's important to exercise caution. Avoid working out two to three hours before bedtime, as this can interfere with your rest.
Sip Selectively
Caffeine - found in tea, colas, coffee, and chocolate - is a stimulant that can take up to 10 hours to leave the system.
It may keep you awake and cause hot flashes. If you're dealing with insomnia or night sweats, it's best to avoid caffeine or have it only early in the day.
Also, try to avoid alcohol before bed. Although it may help you relax at first, it can wake you up mid-night and trigger hot flashes.
Keep Cool
Keep your bedroom cool to prevent night sweats and hot flashes, ideally between 60 and 67 degrees Fahrenheit.
Wear breathable cotton pajamas or nightgowns, and use cotton sheets instead of synthetic ones. Take a cold shower before bed.
If you wake up because of hot flashes, don't just lie there awake. After about 20 minutes, get out of bed and do a fun, relaxing activity such as reading a book until you feel sleepy again.
Try Relaxation Techniques
If menopause-related anxiety is keeping you up, relaxation techniques like yoga, meditation, or deep breathing can help you calm down.
Many apps are available that make it easy to practice these techniques. One study analyzed the efficacy of these apps with 263 adults who had insomnia. Over 50% of participants used the app to meditate for at least 10 minutes daily for eight weeks. Those who meditated reported less daytime fatigue, sleepiness, and pre-sleep anxiety than those who didn't use the app.
Stick to a Schedule
It might be tempting to stay up late during the week and catch up on sleep over the weekend, but keeping the same schedule every night is better for quality sleep.
Try to go to bed and wake up at a similar time every day. Creating a bedtime routine, such as meditating, reading, or listening to soft music is also helpful.
We also suggest avoiding screens one to two hours before sleep.
Lights off
It's crucial to turn off all lights, including alarm clocks, lamps, TVs, and smartphones. Blinking or buzzing lights can wake up your brain and prevent you from sleeping.
According to one study, people who suffer from insomnia tend to glance at their clocks upon waking up in the middle of the night. This could activate your brain and heighten preexisting anxiety about insomnia.
To help improve sleep quality, it's better to reduce the brightness or adjust the position of your alarm clock.
Other Factors That Can Cause Insomnia
Many factors, besides menopause, can lead to insomnia, including:
- Stress
- A noisy or uncomfortable sleep environment
- Exposure to blue light from screens on phones, TVs, or tablets
- Night terrors or bad dreams
- A disrupted sleep schedule from irregular sleep patterns, shift work, or jet lag
- Sleep disorders
When to Consult a Doctor?
Menopausal women who experience insomnia should see a doctor if:
- They had trouble sleeping for weeks, probably months.
- Insomnia affects their everyday life.
- Changing bedtime routines and habits hasn't helped.
A doctor can determine what causes your insomnia and whether it's linked to menopause. They may also run tests to understand the problem better and recommend the best treatment.
Also, inform a doctor if you believe any medications might be causing your insomnia. Don't change the dosage or stop taking a medication without consulting a professional first.
Conclusion
Many people face frequent bouts of insomnia, but menopause insomnia can last for weeks or even months if left untreated.
Some natural remedies can help you fall asleep, such as keeping your room cool, avoiding phone use before bed, and meditating. If you think you have chronic insomnia, restless legs syndrome, sleep apnea, depression, or anxiety, consult your doctor.
