Sleep and Menopause

Sleep and Menopause

Insomnia or trouble sleeping is very common, even more so in women as they age. The changing hormone levels of menopause add yet another factor to the increased rate of  insomnia. In fact, long-term (chronic) insomnia occurs in over half of the women who are menopausal/perimenopausal.

What is Insomnia and What is Menopause?

Knowing what doctors mean by “insomnia” and “menopause” may help you to understand the connection between the two.

Insomnia is more than having trouble sleeping from time to time. It is trouble falling asleep or staying asleep, or both, with impaired daytime functioning at least 3 times a week. It may be short-term (acute) - lasting up to 3 months or long-term (chronic) - lasting 3 months or more. 

Menopause refers to the time when women no longer menstruate - i.e. have their periods. By definition, it means you haven’t had a period for twelve months or more. Perimenopause or menopausal transition, more commonly known as "the change of life," refers to the years leading up to menopause - on average, about four years.

Perimenopause/menopause affects sleep in various ways. The impact of disrupted sleep also varies. It may range from occasional sleep problems with minimal interference to acute or chronic insomnia that is frequent, severe, and disturbs overall health and quality of life.

What is the Connection between Insomnia and Menopause?

Perimenopause/menopause factors include changing hormone levels; association with middle-age; and lifestyle, social, and economic influences.

First, the hormonal changes and symptoms of menopause impact sleep.

  • Lower levels of female hormones - premenopausal estrogen levels may decrease the time it takes to fall asleep and nighttime awakenings; premenopausal progesterone levels may decrease anxiety and improve relaxation; female hormones also affect body temperature at night; other menopause-related hormone changes can also impact sleep.

  • Hot flashes are very common - up to 4 out of 5 perimenopausal women experience them.  Combined with night sweats, they often disrupt sleep. Severe hot flashes are extremely common in women who are diagnosed with chronic insomnia.

Many factors are related to the age at which women enter menopause, usually between 45 and 55 years including age-related:

  • Sleep cycle and sleep hormone (melatonin) changes

  • Emotional and physical changes, e.g. increased presence of mood disorders like anxiety and depression, and increased chronic health problems like musculoskeletal pain, diabetes, etc.

  • Presence of other sleep disorders, like obstructive sleep apnea (OSA) and restless leg syndrome (RLS)

    • Women are more likely to develop snoring and OSA after menopause. One of the factors is weight gain and the related increase in neck size.

    • Both of these conditions interrupt sleep. With OSA, you may snore and briefly stop breathing when you’re asleep. RLS is a problem with the nervous system that involves unusual sensations in your legs when you’re at rest. 

There are also lifestyle, social, and economic factors that contribute to menopausal symptoms, sleep problems, etc. in middle-aged women. For example smoking status, physical activity, and life stressors like family changes, job loss, etc.

How Are Menopause-Related Sleep Problems Diagnosed?

Your doctor will talk with you about your menstrual history and menopausal symptoms. Testing, to check for menopause, is usually unnecessary. 

They may ask you to complete a questionnaire about your sleep or a sleep diary to review your sleep patterns. They may also check you for other sleep problems. This may include a sleep study. 

What is the Treatment for Menopause-Related Sleep Problems?

Sleep hygiene, complementary therapies, and medications may be part of your treatment for menopause-related sleep problems. Treatments may also be combined. For example, you may receive cognitive behavioral therapy for insomnia (CBT-I) with a melatonin supplement, and perhaps a prescription medication.

Treatment depends on the severity of your symptoms, whether or not you have other health problems, etc. Treatment for other sleep-related conditions like OSA or RLS is recommended. The same is true for mood disorders like anxiety and depression or other conditions with sleep-related symptoms.

Sleep Hygiene

Sleep hygiene refers to activities and practices that help promote sleep. What you do and what you don’t do can improve your sleep.

Some best practices include keeping a regular sleep schedule with the proper amount of rest, considering how exercise or naps during the day may impact your sleep, and how meals, snacks, medicines, or stimulants play a role in sleep quality (for instance, heartburn or reflux caused by certain foods can have a strong negative impact on sleep).

Complementary Therapies for Menopause-related Sleep Problems

Mind-Body 

Cognitive behavioral therapy for insomnia (CBT-I) is the preferred treatment for chronic insomnia, in general. It combines cognitive therapy, behavioral treatments, and educational interventions. For menopausal women with hot flashes, CBT-I delivered by phone effectively lessened moderate-to-severe insomnia.

Other mind-body therapies including yoga, relaxation training, hypnosis, etc. may be helpful.

Nutritional Supplements, Melatonin, and Other Products

Many supplements have been studied to help lessen hot flashes and insomnia symptoms in menopausal women with conflicting results. 

The level of the sleep hormone, melatonin decreases with age, with the decline impacting sleep. Many studies have looked at the effects of melatonin supplementation on sleep with inconsistent results.

Some studies have shown positive results with improved sleep and mood in menopausal women. Melatonin is available over-the-counter in the U.S. and many other countries. However, some countries require a prescription.

Phytoestrogens, derived from plants like soy, red clover, and flaxseed, may have estrogen-like effects. They have been studied to relieve menopausal symptoms, however, results are mixed.

Essential oils may be used for aromatherapy - either through inhaling or applying to the skin. Aromatherapy with lavender oil, combined with other treatments, may help relieve insomnia symptoms, although further study is recommended.

Prescription Medication for Menopause-related Hot Flashes

Your doctor may prescribe medication for your menopause-related insomnia. They may be used when hot flashes cause regular disruptions to sleep. The types include:

  • Hormone replacement therapy (HRT) for hot flash-related sleep problems. It may be in the form of pills, skin patches, or vaginal creams

  • Low-dose selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants

  • Gabapentin, an anti-seizure medication that’s also used to treat nerve pain and other conditions

  • Sedatives for short-term use only 

Menopause/perimenopause is a challenging time for women. A lack of sleep only adds to the difficulties. Your Goodpath sleep program can help improve your sleep and your coach can offer support and answer your questions.