Sleep problems during menopause

Sleep problems are disproportionately prevalent among menopausal women. As much as half of the menopausal women will experience sleep complications, compared to just 15% of the general population.

This article will explore how menopause impacts sleep and the options for addressing sleep problems connected with or experienced alongside menopause.

What is menopause?

Menopause is the moment that a woman stops menstruating. It is diagnosed after 12 months have passed since a woman’s final menstrual period. However, hormonal changes can occur 7–10 years before women reach menopause. This is popularly referred to as the ‘perimenopause’, but it is more technically accurate to call it the ‘menopausal transition’. The period after the menopause is called the ‘postmenopause’.

During the menopausal transition, women’s oestrogen and progesterone levels decrease, causing their ovaries to stop producing eggs. These hormonal changes also cause other physical and psychological changes including mood swings, hot flushes, anxiety, depression and forgetfulness.

The hormonal changes, and the symptoms that they often cause, can both contribute to sleep problems.

What are the causes of sleep disorders in menopausal women?

The prevalence of sleep disorders appears to increase with age. 16–24% of premenopausal women experience sleep disorders, compared to 39–47% of women in the menopausal transition and 35–60% of postmenopausal women.

Menopausal women often report difficulties falling asleep or staying asleep, key symptoms of insomnia. Sleep-disordered breathing is more common and severe in postmenopausal women, often leading to a diagnosis of obstructive sleep apnea (OSA).

It is difficult for experts to ascertain whether these sleep problems are caused by aging or whether they are caused by menopause and its associated physiological and psychological symptoms.

We will consider some of the potential causes of sleep problems among menopausal women in turn. However, it’s important to recognize that much more research is required in this area and there may be many other menopause-related causes of sleep problems that experts are yet to identify.

Sex hormone changes

A decrease in progesterone may compromise non-rapid eye movement (NREM) sleep. NREM sleep, also known as ‘deep sleep’, is crucial to memory consolidation. Therefore, menopausal women will likely experience a lower quality of sleep and the long-term consequences of not getting enough deep sleep.

Oestrogen affects sleep in a number of different ways. Firstly, it plays a key role in metabolizing hormones and neurotransmitters that affect sleep patterns. With reductions in oestrogen levels, menopausal women will likely find it harder to fall and stay asleep.

Secondly, oestrogen contributes to the regulation of body temperature. With less oestrogen, many menopausal women experience vasomotor symptoms like sudden hot flushes. These hot flushes can make it difficult for women to fall asleep as the optimal temperature for sleep is cooler. They can also cause night wakings, which lead to less sleep continuity and a reduction in sleep quality.

Oestrogen also promotes norepinephrine activity — which regulates alertness — and the response and uptake of serotonin in the brain, thereby having an antidepressant effect. With less oestrogen, menopausal women are more likely to experience mood disorders like depression, which can prevent women from attaining the optimal emotional state for sleep.

Weight gain on sleep

Some women gain weight after menopause. This may lead to an increased neck circumference and changes to the upper airways. This can lead to sleep-disordered breathing or OSA, which results in interrupted sleep.

Decreased melatonin

Melatonin regulates the sleep-wake cycle. As melatonin levels decrease with age, the sleep-wake cycle is disrupted. Those with low levels of melatonin will struggle to fall and stay asleep. Menopausal women often have lower levels of melatonin by virtue of their age and no link has been found between menopause and reductions in melatonin.

Leg syndromes

Restless leg syndrome causes an uncomfortable urge to move the leg, which makes it difficult to get to sleep. Periodic leg movement syndrome causes repetitive cramping or jerking of the legs, causing interruptions of sleep. Both are age-related conditions, rather than menopause-related conditions.

Treatments

Hormone therapies, including oestrogen only replacement (ORT) and oestrogen and progesterone replacement (HRT), have been used to treat the symptoms of menopause. The effectiveness of these treatments varies depending on the form in which they are taken and the number of years that they have been taken. It is recommended that women are prescribed the lowest possible dose and for brief periods of time given that HRT has been linked to cancer, cardiovascular disease, and dementia. Hormone therapies have been found to improve sleep quality among women suffering from menopause-related sleep problems. Due to the complexities associated with hormone therapies, they can only be prescribed by a healthcare professional.

Alternatives to hormone therapies include nutritional products and medications, oestrogen creams and rings, and soy products that contain phytoestrogen. There is often limited research to support the effectiveness of these alternatives, so it’s wise to consult your doctor before adopting them.

It is important to identify the cause of the sleep problem, rather than simply assuming that it is caused by menopause or its symptoms. Recently, melatonin compounds have been developed that are more potent and slow-releasing. They have shown to be effective in increasing total sleep time and sleep efficiency, as well as helping those with insomnia to fall asleep. This treatment may be better suited to those suffering from age-related sleep problems.

Some women have found sleep-promoting drugs or hypnotics successful, while others have garnered results from lifestyle changes or other coping mechanisms.

Coping with menopause-related sleep problems

Other than improving your general sleep hygiene, you can make healthy changes to your diet, avoid large meals before bedtime and maintain a good weight. You could identify what triggers your hot flushes, for example, spicy or acidic food, and avoid it. You could also try food that is rich in soy or medications such as gabapentin and venlafaxine to minimize your hot flushes.

Opting for lightweight, loose-fitting, moisture-wicking clothing and bedding could improve your sleep continuity. A fan or air conditioning could help to cool the temperature of your bedroom and increase your circulation.

Relaxation techniques and aids, such as the Loóna app, can help you to reduce stress and worries to prepare you for a good night’s sleep. If your mental health is more concerning, it is recommended that you visit a healthcare professional who can help you work through your thoughts and feelings.