Journal / Menopause and Sleep

Menopause and Sleep : Learn How Menopause Affects Your Sleep

Nancy L. Belcher

Medically reviewed by Nancy L. Belcher Ph.D, MPA

Written by Winona Editorial Team

Last updated November 25, 2021

Menopause and Sleep : Learn How Menopause Affects Your Sleep

A good night’s sleep can be hard to find. Menopause and sleep problems often go hand-in-hand. 1If you are going through menopause and can’t sleep, or experiencing perimenopausal insomnia, you’re not alone. 

Peri- and menopause are times of major hormonal, physical, emotional, and psychological change. All of those changes together can create major sleep problems. For example, night sweats in women can wreak havoc on their sleep.  Treatment for night sweats and the causes for night sweats are some of the most common questions asked about menopause.

When women are in their 20s and early 30s only about 12% will report sleep problems, but with age,  insomnia becomes much more common. About 40% of women in their late 40s to early 50s will have serious sleep problems. During perimenopause and all the way through postmenopause (often 20 years), is when women report the most sleep problems.1

Perimenopause is defined as that period before menopause, and menopause is one year after menstrual periods have stopped, which happens around age 51.1 With perimenopause, women will decrease the production of estrogen, progesterone, and testosterone (called sex hormones). Women decrease the production of the sex hormones for 7-10 years before menopause. During this time they often experience significant symptoms, but may not really understand what the cause is.1,2 These hormonal decreases often contribute to sleep issues that can continue for decades.

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Five Specific Sleep Issues Associated With Menopause

Sleep issues are common during menopause, with sleep disorders affecting 39-47% of perimenopausal women and 35-60% of postmenopausal women. The most common sleep problems reported by women going through menopause include night sweats, hot flashes, insomnia, sleep-disordered breathing,  and sleep disorders.1,3

  • Hot Flashes & Night Sweats

Hot flashes (HF) are sudden, unexpected sensations of heat all over the body with sweating.  They can last 30 seconds to 10 minutes. HF’s affect 75-85% of women around menopause, and typically occur for around seven years but can continue for ten years or more.

Hot flashes that happen at night are known as night sweats. With an HF, a woman’s body temperature rises, creating a heating sensation that wakes them up. A hot flash can spike a woman’s adrenaline levels so they sweat and are waking up. It’s often hard to fall back to sleep. And even if they do fall back asleep, their sleep quality suffers due to the frequent awakenings and discomfort.  

Of the women with severe hot flashes, nearly half of them meet clinical criteria for chronic insomnia.4

  • Insomnia

Insomnia is defined as, “The chronic difficulty falling or staying asleep that occurs more than three nights a week”4 Insomnia includes restless sleep, waking up early, and often feeling sleepy and tired during the day. Sleep deprivation from insomnia can increase anxiety, create moodiness, impair focus and memory, and worsen headaches and overall inflammation.4

One in four women experiences some symptoms of insomnia before menopause. Insomnia increases in menopause, with as many as 61% of postmenopausal women reporting insomnia symptoms.

  • Sleep-Disordered Breathing

While there is more awareness about sleep disorders, most people associate sleep apnea with men which is inaccurate. Sleep apnea is a potentially serious sleep disorder that is characterized by temporary pauses in breathing, leading to gasping, snoring, and choking sounds during sleep. Of course, people with OSA experience lower sleep quality.

Obstructive sleep apnea (OSA), the most common form of apnea, occurs when throat muscles relax and are more common and severe in menopausal women.4 OSA occurs in 2% of women before menopause, but once perimenopause begins a woman’s risk of OSA increases 4% every year.4 If you’re in perimenopause for 10 years you have a 40% increased risk of OSA. Menopausal women on hormone replacement therapy have less OSA than those who are not.4,5,6

Lower progesterone levels may contribute to the development of sleep apnea. One of the problems with OSA is that the upper airway relaxes too much, closes, and causes lapses in breathing. Progesterone can prevent this relaxation of the upper airways.4 Not only does progesterone help you fall asleep it also helps you breathe while you sleep. A scientific study in Current Medical Chemistry noted that, 

“Progesterone exerts a sleep induction or hypnotic effect and is a potent respiratory stimulant that has been associated with a decrease in the number of central and obstructive sleep apnea episodes.”4 

  • Joint Pain and Restless Leg Syndrome

Other sleep disorders may develop during menopause, including restless legs syndrome and/or involuntary movement of arms or legs involuntarily which can disrupt sleep. Joint pain is a common complaint during menopause partially due to lowered hormones that can regularly disrupt sleep.

  • Neurotransmitters and Sleep

Estrogen plays a role in regulating the levels of neurotransmitters in your body that affect your sleep-wake cycle. Estrogen also helps keep your body temperature low at night, which can help you sleep better. 

The Benefits of A Good Night’s Sleep

Getting a good night’s sleep isn’t always as simple as it seems. Getting the right amount of deep sleep helps produce and regulate hormones that have a wide variety of jobs, including those necessary for good hair, skin, and nails.7,8 Estrogen, Progesterone, DHEA, Testosterone, and Growth hormone help us feel younger and have improved energy. Some people refer to balanced hormone levels as, “the juice of youth.”  

The Benefits of good sleep are many and usually include improvements in:9

  • The balance of a wide variety of hormones that have many functions.

  • The health and appearance of your skin, hair, and nails.

  • Managing Stress and mood. Balancing hormones helps keep your emotions in check.

  • Reducing the risk of hypertension, stroke, heart attack, and death.  

  • Decreasing the risk of heart problems by easing stress.

  • The levels of specific hormones related to appetite are normalized with proper sleep, meaning you can take control of your metabolism and weight management. 

  • Reduction of diabetes. Because hormones improve with proper sleep, diabetes can be controlled.

  • Memory and Creativity. Getting a solid night's sleep can improve your ability to retain information by 20-40%.

  • Physical fitness; a good sleep helps you stay more physically fit.

  • Boosting your immune system to prevent disease. 

  • Risk reduction of dementia and Alzheimer’s by allowing the brain a ‘reset.

Estrogen and Progesterone Hormones and Sleep Disturbances

Your body naturally produces 50 hormones that we know of.  Each hormone has an important job in your body. When the levels of hormones aren’t controlled (too much or too little) you can start to feel really off - mentally, physically, and emotionally. Hormones are chemicals that act as messengers. These hormone messengers are made in one part of the body and then travel in your blood to other parts of the body where they help control how cells and organs do their job.

The two major hormones that women know quite well are estrogen and progesterone. They both have many jobs, but generally, estrogen helps control the monthly menstrual cycle, and progesterone is the hormone that helps maintain pregnancy. Known as the “relaxing hormone,” progesterone is also a mild sedative that can help you sleep.

These two female hormones will naturally shift up and down throughout a woman's life, and affect their sleep along the way. A woman’s sleep patterns change significantly throughout her life; the sleep-wake cycle also changes as we age, and loses its consistency. Specifically, the life phases and sleep include:

Sleep and Puberty

As a child, hormones don’t play as much of a role as they do during and after puberty. Women first really notice estrogen and progesterone during puberty when they begin menstruation - usually between the ages of 10- 15. After that, they are launched into life-long cycles of hormonal fluctuations that can affect their ability to sleep.

It’s interesting to note that it’s not until puberty that we see major sleep differences between boys and girls.3 As they age, due to the role female hormones play, women suffer from insomnia at nearly twice the rate of men.4 While hormones play a role, this can be caused by many reasons, including psychological, social, and physiological.

Sleep and Pregnancy

The next big change in the hormones progesterone and estrogen is during pregnancy. Did you know that a woman produces more estrogen during one pregnancy than throughout the entire rest of her life? This, and elevated progesterone, may be the reason women feel drowsy and take more naps in the first 12 weeks of pregnancy.3 

A multitude of factors leads to sleep problems and insomnia during pregnancy. Beginning in the first trimester, the fluctuating hormone levels, as well as generalized discomfort ( flu-like symptoms and the growing fetus) can make it difficult to fall asleep and stay asleep.

Sleep and Menopause

Once women hit the end of their reproductive years, during peri- and menopause, hormone levels drop dramatically. Lower levels of progesterone can make some women irritable and less able to relax. This drop can also cause night sweats and hot flashes, which can wake you up from a sound sleep. Women who have low estrogen experience less deep sleep and even if they get 8 hours of sleep, they can awake feeling tired.3

These hormone-related sleep issues often begin well before you are even aware that you are approaching menopause. That tossing and turning are likely perimenopause, and there is a solution. If untreated, these sleep disturbances can continue into postmenopause and worsen overall health.4

Age beautifully. Goodbye getting old.

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Progesterone, Anti-Aging, and Fatigue

Once you have reached the point of fatigue, you’d think sleep would be easy. Unfortunately, fatigue can lead to a dangerous cycle of insomnia. Fatigue has a variety of causes and can lead to serious health issues. If you’re a woman over 35 years old, your low progesterone levels likely play a role in your fatigue and inability to get a good night's sleep.

Progesterone is a hormone that is critical to a woman’s health, specifically the mental and physical traits that are often associated with the youth and vitality we see in younger women. Progesterone impacts nearly all cells of a woman’s body.8 Some of the things progesterone impacts are:7 

  • Mood, feelings of well-being, and happiness,

  • Sleep, 

  • Eating, and digestion,

  • Memory, 

  • Bone strength, 

  • Conversion of stored fat to energy,

  • Improvement of brain functioning (memory and thought development processes),

  • Heart & cardiovascular health, 

  • Lower risk of endometrial cancer,

  • Feelings of fatigue.

Treatments and How to Solve Estrogen and Progesterone Sleep Disturbances

Hormone replacement therapy (HRT) can be used to help solve sleep disturbances when women are peri - and menopausal. Sleep issues become more common and worsen during peri- to postmenopause when women report the most sleep problems. As women age (40s to 50s), about 40% of women experience sleep problems.1-4

The symptoms of menopause, including hot flashes and night sweats, may underlie many of the sleep problems that peri- and early menopausal women commonly encounter. For women facing these challenges, estrogen and progesterone replacement therapy may help them to sleep more soundly.

While on HRT, there can be changes in deep sleep that mimic the deep sleep patterns seen in younger, healthy women. HRT also appears to play a role in the improvement of cognitive functioning possibly due to improved sleep.1,2 In one study the women without HRT rated their sleep as dissatisfying and reported three to five awakenings per night. That ratio changed dramatically after HRT was added and women rated the quality of their sleep as very or quite satisfying, with only one or two awakenings per night.

Peri- and menopausal women often experience much better sleep improvements when on estrogen and progesterone than going with strictly traditional sleep medications. Many scientists believe that if a patient's sleep disruption is due to [hot flashes], 95- 98% can be cured with HRT.1 HRT is the most proven method for decreasing Hot Flashes and Night Sweats.

Other Tips for Sleeping Better in Menopause

  • Balance is the keyword. Not just hormonal balance, which you can achieve with HRT, but also try to maintain a healthy weight and diet. Higher body weights are associated with OSA, and women tend to gain weight after menopause - about 15-20 lbs! 

  • Avoid large meals, and spicy or acidic foods before bed. They can trigger hot flashes.

  • Nicotine, caffeine, and alcohol, especially in the late afternoon and early evening can disrupt sleep and lower your sleep quality.

  • While hydration is important to good health, try to decrease liquids before bedtime.

  • Use the restroom before going to bed to avoid the potty breaks that might wake you.

  • Some think alcohol can help with sleep, and while it can make you drowsy, it also reduces REM sleep, reducing your quality of sleep.

  • Reduce stress as much as possible. Anxious and stressful thoughts can keep you up at night, making it harder to fall asleep. 

  • Regular exercise and yoga can help lower your stress levels and improve sleep. Try some relaxation techniques, such as meditation or deep breathing.

  • Develop a bedtime routine that is calming and lowers your stress. Reading, music, or a bath.

  • If you do find yourself awake, develop a routine for falling back asleep. Don’t stress about it… stay in bed, lights off,  and avoid doing things that will wake you up further, like watching TV. 

  • Dress in layers so you can remove as needed and think about keeping a change of clothes and a glass of water on your nightstand.

  • Dress in lightweight pajamas, like cotton or moisture-wicking exercise clothes. 

  • Swapping out your bedding for cooler fabrics with multiple layers can help.

  • Keep your bedroom temperature comfortably cool, say 65 degrees F.

  • Fans are great not only for coolness but also for the white noise they provide. 

  • Follow a regular sleep schedule, going to bed, and waking up at the same time every day.

  • Avoid napping during the day, especially for longer than 20 minutes.

Depression, Antidepressants, and Sleep

Perimenopause is a period of risk for all women - those who have and those who have not previously experienced depression. This suggests that this period of widely fluctuating estrogen and progesterone levels creates a vulnerability to depression for both those with and without a prior history of depression. 

We know that poor sleep can lead to and/or worsen mood changes and even depression. Targeting sleep disturbances treats depression and improves the quality of life for women. Given the beneficial effect of treatments targeting insomnia and depression, it makes sense to try HRT.4 Perimenopausal women were given estrogen and progesterone, have better sleep quality, and were much more able to improve their depressive symptoms. These types of results suggest that perimenopausal women have the ability to improve their sleep and mood by adding back estrogen and progesterone.4 

Mood improves when sleep quality improves, and perimenopausal women’s depression improves in concert with increases in estrogen and progesterone. The association between sleep and depression is independent of hot flashes.  It is too easy to say that women are depressed because they don’t get enough sleep, and that they don’t get enough sleep because they are woken up by night sweats. Yes, that is part of it, but studies show that sleep disturbance may result from low estrogen and progesterone that play a role in menopause-associated depression beyond waking due to night sweats.4

Low doses of antidepressants (SSRI, SNRIs) can relieve menopausal symptoms, including hot flashes. Some may relieve hot flashes while also increasing sleep quality.5 Always check with your doctor before taking any prescription medications. 

Melatonin, your body’s natural sleep hormone, can also be taken as an over-the-counter medication. Low doses of melatonin improved mood and sleep onset in postmenopausal women. Like estrogen and progesterone, melatonin also decreases as we age.5 Part of the reason low estrogen causes insomnia and sleep problems is that estrogen helps make important sleep neurotransmitters, including melatonin.

Conclusion

You are not alone on your menopause and sleep journey. Millions of women suffer from low estrogen and perimenopause insomnia. Sleep problems, insomnia, and fatigue are common if menopause estrogen and progesterone levels are low. Low progesterone, low estrogen, and insomnia go hand-in-hand. The correlation between low estrogen and sleep problems cannot be ignored. Even if you’re able to power through the day with some serious caffeine help, sleep deprivation will ultimately lead to a cascade of health problems.

Good sleep makes a huge difference in your health and well being and addressing this can greatly improve your quality of life. We know that there are effective treatments for night sweats.1 By taking Hormone Replacement Therapy (HRT), you will increase your estrogen and progesterone levels and can relieve menopausal symptoms including night sweats, insomnia, hot flashes, and mood swings.2

If you have been experiencing problems with getting a good night's sleep and have not been able to resolve them, Winona can help. Our providers can help get to the bottom of what is causing your sleep troubles and get them resolved.  

*For some women HRT is not an option, particularly those who have had blood clotting disorders, strokes, heart attacks, and certain types of cancer. As a result, your Winona doctors will recommend alternative treatments. There are many approaches for managing menopausal symptoms

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”

References:

  1. https://www.sleepfoundation.org/women-sleep/menopause-and-sleep

  2. https://www.webmd.com/menopause/news/20000317/estrogen-treatment-restores-normal-sleep-patterns-in-menopausal-women

  3. https://www.verywellhealth.com/the-four-stages-of-sleep-2795920

  4. https://www.yalemedicine.org/news/women-are-your-hormones-keeping-you-up-at-night

  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3135198/

  6. https://www.sleepfoundation.org/women-sleep/menopause-and-sleep

  7. https://www.dailywellness.com/2017/06/05/youre-sleeping-poorly-mean-estrogen-off/

  8. https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/hormones/progesterone

  9. https://www.leighannscottmd.com/benefits-of-good-sleep/