In middle age, there are many concerns that can affect your ability to get a good night’s sleep. You might be worried about a child, an aging parent or an issue at work. But if you’re a woman, your sleep issues could be caused by the hormonal changes associated with the menopause transition.
These sleep issues aren’t something you should ignore or hope go away with time; lack of sleep is associated with increased risk of high blood pressure, heart disease, diabetes and weight gain.
Plus, it’s just miserable to be sleep-deprived.
“Sleep is so important to your emotional and physical well-being,” says UNC Health family nurse practitioner Stephanie Roberts. “It can affect your mood, your job performance, your relationships. Sleep is vital to your ability to show up as a healthy human being, so if anything is persistently interrupting your sleep, you need to talk to a health care provider.”
Roberts explains why sleep problems occur during menopause and what you can do to treat them.
Why Sleep Problems Can Occur During Menopause
Menopause is the point at which a woman has not had a menstrual period for 12 months. In the five to eight years before that, called perimenopause, a woman’s estrogen levels fluctuate before beginning to decline. They drop and remain low for the rest of a woman’s life.
“Those estrogen changes impact sleep in a variety of ways,” Roberts says. “Hot flashes and night sweats might disrupt sleep. Many people have insomnia for the first time. You might be waking up throughout the night, which can affect your quality of sleep in ways you don’t even realize. As a result, you’ll feel more tired throughout the day and can experience brain fog.”
Estrogen plays an important part in regulating the body’s internal temperature, so when it fluctuates, it can cause hot flashes and night sweats and make it difficult to stay asleep. Estrogen also interacts with various neurotransmitters in the brain—ones that affect our ability to go to sleep and stay asleep, as well as ones that affect our mood, causing depression or anxiety that may affect sleep. Additionally, loss of estrogen can cause an increase in sleep apnea in women and has been linked with restless legs syndrome, causing more frequent awakenings and less time in deep, quality sleep.
“Any time estrogen changes, you can experience those symptoms,” Roberts says, which is why you may notice changes in your sleep at certain parts of your menstrual cycle or during pregnancy. “Everyone is different in how they’re affected, though. You may start seeing more symptoms in perimenopause, then things improve after menopause. For some, the problems continue or get worse after menopause.”
Roberts says you may not even notice that you’re waking up more frequently, but if you never feel rested, notice increased daytime fatigue, or always feel like you need a nap, you should talk to your health care provider. They should consider the impact of estrogen, but also the many other things that can affect your ability to sleep—stress, medications, lifestyle factors and health conditions.
“Talk to your provider about all the things in your life,” Roberts says. “You might need lab work and a full review of what’s going on to make sure everything is OK.”
Lifestyle Changes to Improve Sleep During the Menopause Transition
Any time you’re having trouble sleeping, the first line of treatment is ensuring you’re following the guidelines of good sleep hygiene, Roberts says. That means sticking to a set schedule of waking up and going to sleep at the same time each day and having a comfortable sleeping environment that’s dark and cool. Try to exercise during the day, cut off caffeine at noon, and avoid alcohol and large meals in the two to three hours before you go to bed.
“There should be no screens in your bedroom, so no television playing while you’re going to sleep or while you’re asleep,” Roberts says. “You should have no screentime at all in the hour or two before bed. I know it’s hard—we’re all conditioned to scroll or play a game on our phones before bed, but it’s bad for your sleep.”
If scrolling on your phone has become your default pre-bed routine, Roberts says to create a new relaxing ritual that will help your brain know that it’s time to go to sleep.
“The brain runs on patterns, so if you wash your face, put on lavender foot lotion and get into pajamas every night, that can trigger the brain to recognize that these are the things we do before we go to sleep,” she says.
You also need to train the brain that your bed is a place for sleep and sex only—not for doing work, watching television, or even lying awake in the middle of the night.
“Have a plan if you do wake up, because it’s better for your sleep overall if you don’t stay in bed and stare at the clock,” Roberts says. “I tell patients to have a cozy nook with a boring book—a real book, not a screen. It shouldn’t be a mystery or anything absorbing. Use dim light, and read the boring book for a bit. Once you’re ready to sleep again, then you can go back to bed.”
Treatment Options for Sleep Problems
Practicing good sleep hygiene is within your control, but Roberts cautions against trying any over-the-counter sleep aid or supplement before talking to your health care provider.
“There are a lot of things people use to try to help their sleep or to combat their fatigue that only worsen sleep quality,” she says. “You really need to talk to someone who can dive in and direct treatment to the underlying causes.”
If you are kept awake by night sweats or hot flashes, menopause hormone therapy may help, or you can ask your provider about non-hormonal options for menopause symptoms. If stress, anxiety or depression are affecting sleep, an antidepressant or working with a mental health professional might be more appropriate.
Your provider can help diagnose and treat sleep apnea or restless legs syndrome. They may also conduct a physical exam or blood work that reveals a medical condition that requires treatment.
“There are a lot of causes of sleep disturbances, but there are also a lot of different treatments,” Roberts says. “Your provider can help you consider all the options.”
Trouble sleeping? Talk to your doctor. If you need a doctor, find one near you.