How Menopause Affects Sleep

You go through your nightly routine, already feeling exhausted and ready to get a good night’s sleep. You crawl into bed, feeling like you’ll be the mayor of Sleep Town in no time. The next thing you know, you’re tossing and turning as you do the bedtime version of the Hokey Pokey! 🎵 You put one leg in, you put one leg out, you put both legs out, and you shake them all about. 🎵Your mind starts racing as the clock keeps ticking and the sheep have jumped the fence so many times they’re passed out in the grass. Before you know it, hours have gone by and you’re just about to give up. And that’s the very moment you fall asleep, only to wake up a few ~~hours~~ minutes later. Sound familiar? Lucky for us (insert eyeroll), difficulty sleeping (insomnia) is one of the most common complaints during the menopause transition. Yes, getting those ZZZs can be tricky during midlife because *brace yourself* in addition to the other 50+ symptoms it may cause, menopause affects sleep.

Why Is It Hard to Catch Some ZZZs During Menopause?

What’s the one thing we always hear about our health? “It’s important to get your sleep.” Have the people who say this never had to fight night sweats, mood swings, anxiety, cramps, and headaches … all at the same time? I swear, at times, I feel like I could strip down to nothing and cover my body in ice packs to combat those darn night sweats, and still not wake up half as bright-eyed and bushy-tailed like those hundreds of sheep I keep counting. Who’s with me?!

So, why are you tossing and turning? Many of the sleep disturbances during menopause are caused by one or more of the following:

Night sweats and hot flashes
Emotional health changes (e.g., stress, mood changes, anxiety, depression)
Physical changes (e.g., weight fluctuations, cramping, headaches, restless leg syndrome, obstructive sleep apnea, periodic leg movement syndrome)
Hormonal changes

Grab your science cap because I’m about to get all technical on you. According to the National Institue of Health (NIH), “Insomnia and fatigue are the most common symptoms of postmenopausal women. The definition of menopause refers to the period after one year has elapsed since the last menstrual period. However, changes in hormones begin to occur 7 to 10 years before menopause, leading to a decrease in estradiol and inhibin and an increase in follicle-stimulating hormone and luteinizing hormone. Women undergo physical and psychological changes as a result of hormonal changes, e.g., mood swing, anxiety, stress, forgetfulness, and sexual dysfunction. Many women especially complain of sleep disorders at this time.” 🌈 The More You Know 🌈

How Common Are Sleep Disorders During Menopause?

The short answer? Menopause affects sleep and sleep disorders during menopause are extremely common. I’m handing it back over to the health experts at NIH for some interesting stats: “According to the Study of Women’s Health Across the Nation (SWAN), the prevalence of sleep disorders increases with age … ranging from 16 percent to 42 percent in premenopausal women, from 39 percent to 47 percent in perimenopausal women, and from 35 percent to 60 percent in postmenopausal women. Symptoms of sleep disorders that menopausal women complain about include falling asleep, frequent awakening and/or early morning awakening.”

In other words, people experience sleep issues before menopause, thanks to Aunt Flo’s famous brand of cramping and headache. And while there’s no menstruation during pregnancy, other bodily changes, shifting hormone levels, and uh, ever-protruding midsection can still cause sleepless nights. Why shouldn’t the last stage of our reproductive journey be left out of the sleeplessness soirée?

What Is Sleep Quality Like During Menopause?

In 2017, the Centers for Disease Control released new scientific findings about the sleep activity and quality of people experiencing the different stages of menopause, as well as the reasons menopause affects sleep.

For those in perimenopause, the study found:

More than half of perimenopausal women—56 percent—sleep less than 7 hours a night, on average. That’s a big jump from the third of pre-menopausal women who are sleeping less than 7 hours nightly.
Nearly one-quarter—24.8 percent—of perimenopausal women say they have trouble falling asleep four or more times in a week.
Even more common than trouble falling asleep? Difficulty staying asleep. Among women in perimenopause, 30.8 percent say they have trouble staying asleep at least four nights a week.
Half of perimenopausal women—49.9 percent—wake in the morning feeling tired four or more days in a week

For those in postmenopause, the study found:

Sleeping fewer than 7 hours a night on four or more nights a week occurs among 40.5 percent of post-menopausal women.
For post-menopausal women, symptoms of insomnia become somewhat more common than during perimenopause, with 27.1 percent having regular trouble falling asleep and 35.9 percent having routine difficulty staying asleep throughout the night.
More than half—55.1 percent—are sleeping poorly enough to wake feeling tired, not rested, four or more times a week.

I wasn’t lying when I said that menopause affects sleep and sleep during midlife is trickier than a magician with three decks of cards and a rabbit.

Why Are ZZZs Increasingly Harder to Catch As We Progress Through Menopause?

During the different stages of menopause, your hormones are like Barbie’s career choices, constantly changing. One minute your hormones have you feeling higher than a bird atop the empire state building, the next they are lower than that same bird trapped in a rudder of a submarine engine. All analogies aside, your estrogen levels decrease during menopause. As a result, menopause affects sleep.

According to the Mayo Clinic, “hot flashes occur when decreased estrogen levels cause your body’s thermostat (hypothalamus) to become more sensitive to slight changes in body temperature. When the hypothalamus thinks your body is too warm, it starts a chain of events— a hot flash—to cool you down. Rarely, hot flashes and night sweats are caused by something other than menopause.”

Let’s face it, between hot flashes and night sweats, menopause affects sleep. You may start to think that a good night’s sleep is nothing but a dream. Then again, you’ve forgotten how to dream, because YOU’RE NOT SLEEPING.

How Can You Sleep Better?

You know the problem, that’s why you’re here! So, what’s the solution to getting more shut-eye?

According to WebMD, “The traditional treatment for the symptoms related to menopause—like hot flashes and insomnia—has been hormone replacement therapy (HRT). HRT consists of estrogen given as a pill, patch, or vaginal cream, either alone or combined with progesterone (for women who still have their uterus). If you are not a candidate for HRT, if your symptoms are not severe, or if you simply decide not to use HRT, medications originally used as antidepressants may help relieve hot flashes. These include low doses of fluoxetine (Prozac), paroxetine (Brisdelle, Paxil), venlafaxine (Effexor)), and many other SSRIs. In addition, the Bazedoxifene (Duavee) has been shown to increase sleep quality. And two other drugs—the anti-seizure drug gabapentin and the blood pressure medication clonidine—also may be effective for menopausal symptoms.”

Other practices that might get your sleep in ship-shape include:

Avoid alcohol, caffeine, stress, spicy food, and smoking. These all tend to make hot flashes worse.
Use fans to help keep you cool.
Practice deep breathing. Like, really deep. Deep enough that you forget you feel like you might spontaneously combust.
Exercise regularly. (Or at least try to; it’s obviously hard to work up a sweat on top of a sweat. And no, hot flashes themselves don’t count as exercise.)
Take certain supplements, but always speak to your healthcare provider(s) first.
Avoid the battle. It’s important to not battle it. If you can’t fall asleep, then don’t lie in bed wrestling with it all night long.
Exercise on a regular basis. If you’re not into exercise, then don’t worry. I’m not talking about crazy barre or spin classes. Simply put on your shoes and take a walk around your neighborhood. A bonus is that the fresh air and movement should help make you nice and sleepy at night. Maybe you’ll sleep for 22 minutes at a time instead of 12!
Create a healthy bedtime routine. You can help train your mind to calm down before you hit the sheets. There are even meditation apps you can try.
Get some face masks, eye masks, awesome nighttime cream, cute bamboo PJs, and special menopause bed sheets (linen is all the rage right now) to combat night sweats. These items will make you excited to get ready for bed.
Talk to family and friends. The simple act of talking about your issues might help relieve stress related to sleep issues.
Explore the therapy option. If you are struggling with insomnia, talk to your doctor about Cognitive Behavioral Therapy (CBT).
Try eating more tofu and soybeans. According to WebMD, “Soy products contain a plant hormone called phytoestrogen that acts as a weak estrogen. In general, research has not shown significant hot flash reduction with soy products.”
Give supplements a go. According to WebMD, “Black cohosh, a perennial plant that is a member of the buttercup family, has also been used to treat hot flashes and sweating. Despite some positive results, studies that have investigated the role of black cohosh in reducing menopausal symptoms have been flawed. Keep in mind that dietary supplements are not regulated or controlled by the FDA like medications. Talk to your doctor before you take any of these products.” You can also try supplements like Vitamin D. There’s a whole slew of supplements to consider, talk to your doctor first.
Find ways to lessen your stress. Easier said than done, I know! Stress can shift an otherwise regular mood swing into high gear, so take a look at what’s on your plate/mind/mind plate and try to find ways to get rid of the stressful stuff. You may be thinking, “LOL, yeah, I’d love to eliminate ALL my stress, but this is real life, not a menopausal fairytale.” Fair! Eliminate the stressors that you CAN eliminate. Even baby steps will help you clear your mind and lessen mood swings.

If your lack-of-sleep issues interrupt your daily life to the point where you can’t function, then research sleep clinics and speak to a sleep specialist. Have hope: Many other treatment options exist. Be like a Beatles’ lyric, and seek “Help!”!

It’s a Wrap!

Yes, menopause affects sleep. Yes, that sucks. But just think, you and 25 million people around the world can say goodbye to “that time of the month.” At some point, we may all fall victim to menopausal sleep issues. Take heart in knowing that just as Sondheim wrote, 🎶No one is alone.🎶

Many sleep disturbances during the menopause transition are often related to hot flashes and night sweats. Let’s face it, with hot flashes and night sweats coming at you like a bat out of hell, how can anyone expect you to get sleep?

Thankfully, there are plenty of ways to try and combat sleepless nights. From exploring HRT to taking supplements, exercising regularly to avoiding spicy foods … try to find out what works for you (or least makes you feel a little better). We’re all, at some point, crawling out of bed in the middle of the night, trudging around the house, looking into the refrigerator for a slice of cake, sprawling out on the couch, and binging our sorrows bite after bite. Save a piece of that cake for me, because (cue High School Music soundtrack) 🎶We’re in this together. 🎶

Sources

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