How does menopause affect sleep?

Menopausal woman sleeping in front of a fan wearing an eye mask

Getting a good night’s sleep brings a bucketload of benefits for our health – but this can be tricky if you’re experiencing menopause. Come along and learn how menopause affects your sleep and discover a few tips and tricks for a successful snooze, so you're ready to take on daily life fearlessly.

Menopause and sleep aren't the most compatible pair – it can be challenging to rest your head on the pillow after a long day if you are kept awake by hot flushes, night sweats and heart palpitations. Thankfully, there are ways to make sleeping during menopause a little bit easier, but first, we’ll take a look at why menopause messes with your sleep and some of the symptoms you could experience as a result.
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Do you need more sleep during menopause?

Although research tells us that women in general should aim for 7-8 hours of quality, uninterrupted sleep [1], there’s no hard and fast rule. Some of us might need less sleep, while others might need more, and that’s completely normal.

While it's tempting to dive into the details of how many hours of sleep you need during menopause, putting too much emphasis on the exact time can actually add more stress and anxiety to the mix. What’s most important is the quality of sleep. Try testing a couple different schedules with more and less hours until you find that sweet spot where you feel rested in the morning.

And if you’re struggling to fall asleep, why not meditate or make yourself a cup of night-time caffeine-free tea to help you wind down?

Why does menopause affect sleep?

When we transition into menopause, a stage known as perimenopause, the levels of hormones that are responsible for the menstrual cycle (oestrogen and progesterone) start to fall gradually. This causes changes in our bodies and in turn the symptoms that can make sleeping a real challenge. Let’s break these changes down to understand them a bit better.

Increased sensitivity to temperature changes

Feeling too hot one minute then too cold the next? This is all down to your hypothalamus – the part of the brain that controls body temperature. During menopause, when your oestrogen levels fall, your hypothalamus can become more reactive. When your hypothalamus thinks that your body is too hot, it tries to cool you down with those pesky hot flushes and night sweats.

Less melatonin & more cortisol

A crucial part of restful sleep is melatonin, often known as the sleep hormone. As we age, our levels of melatonin naturally decrease, which could contribute to sleep challenges during the menopausal phase. A decrease in melatonin, combined with an increase in cortisol (the stress hormone that also wakes us up in the morning) due to aging can lead to another level of sleep struggle.

Disrupted circadian rhythm

The circadian rhythm is a scientific term for the process of how our bodies operate over 24 hours. If it is disrupted, you might notice that you're a bit drowsy and tired during the day, or that you find it more difficult to focus and have a bit of trouble remembering things. During menopause, a combination of decreased hormone levels and ageing shake up our circadian rhythm, therefore disrupting the sleep-wake cycle. [2]

Mood fluctuations

Have you found yourself feeling irritable? Or getting more annoyed than usual at the rush hour traffic? You could be experiencing menopause mood swings, which have the ability to affect your quality of sleep. 
 
Sleep problems associated with mood are common for many of us, but the changes in progesterone levels associated with menopause can make regulating our emotions even more challenging, increasing symptoms such as mood swings and mental health disorders like depression and anxiety. This can cause a vicious cycle of changing moods leading to lack of sleep, and lack of sleep leading to further emotional distress.
 
If your sleeplessness is making you feel down, it might be a good idea to talk to friends who might be going through the same experiences as you. Knowing that you’re not alone can make you feel comforted and supported. You can also reach out to your doctor and find out more about the kind of extra support that's available out there. 

Which menopause symptoms impact sleep quality?

Menopause insomnia

Now we know why our sleep is affected during this life stage, we can tackle the signs and symptoms of menopause that potentially cause sleep disturbances.

Hot flushes and night sweats

If you suddenly start feeling warm, particularly in your upper body, you could be experiencing hot flushes. Hot flushes are a very common symptom of menopause, they’re so common that more than 80% of us will experience them at some point during menopause.[3] These hot flushes are caused by sensitivity to temperature and likely leave you feeling uncomfortable, agitated, and anxious.

A lower core body temperature is part of the natural process we go through to kickstart sleep. That’s why the increase in body temperature tends to mess with your rest.

Menopause insomnia

When lower progesterone levels cause body clock changes and mood fluctuations, we can develop menopause insomnia. This isn’t just a fancy term for a lack of sleep, it’s a specific condition that can affect you at every stage of the sleep cycle. People suffering from menopause-induced insomnia can find it difficult to fall asleep, stay asleep throughout the night, and often wake up far too early.

Insomnia during the menopausal phase can also be down to changes in life circumstances, whether you’re going through relationship difficulties or balancing your daily life with caring for ageing relatives. These stresses can make us feel overwhelmed and send our minds racing, making it even more difficult to sleep.

Sleep apnoea and snoring

Many of us know how difficult it can be to get a good night’s sleep when you add snoring into the mix, whether you wake yourself up from a loud snoring session, or your partner makes for particularly noisy bedtime company. During menopause, a combination of lower oestrogen and progesterone levels plus the possibility of weight gain can mess with the soft tissues in your throat, which could lead to snoring.

The change in the soft tissues in your throat can also cause a condition called sleep apnoea, which makes it more difficult to breathe as you sleep. Around 20% of us develop sleep apnoea during menopause, [4] so it’s more common than you might think. It can be scary to wake up gasping for air, and this experience can understandably make it hard for you to go back to sleep. Try to stay calm and prioritize having a chat with your doctor about your symptoms so they can discuss possible treatment with you.

Restless Leg Syndrome (RLS)

While the cause of Restless Leg Syndrome (RLS) during menopause is still unknown, we do know it can often be worse at night, leading to fragmented sleep. RLS can involve a lot of peculiar feelings in your body, including tingling, pins and needles, numbness and pain — not only in the legs, but also feet, hands and arms. If you’re experiencing symptoms of Restless Leg Syndrome, there are a few treatment options that could help, from iron supplements to prescribed medications. So, don’t hesitate to reach out to a medical professional for ways to better cope with it!

How can I sleep better during menopause?

It can be overwhelming knowing how much menopause potentially affects your slumber. Luckily, there are some simple and even enjoyable ways to improve it and self-care can be a great starting point to getting a better night’s sleep.

Create a relaxing pre-sleep environment

How you’re feeling before you drift off can have a big impact on your quality of sleep, so find an activity that makes you feel calm and make it part of your pre-sleep relaxation routine. Try a few options to discover what works for you, whether it's reading a book, listening to soothing music, or lighting a candle while taking a warm bath. 

Fix your sleep schedule, then stick to it

Having a regular sleep schedule is important to keep your circadian rhythm working as it should. But it can be hard if you’re in a pattern of late nights. To fix your sleep schedule, try shifting your wake-sleep pattern by 15-30 minutes every couple of days until you have a regular bedtime that works for you. Then, all you have to do is stick to it!  
And remember, although it can be very tempting after a busy day, try to avoid napping in the late afternoon or evening to keep your body clock in check. 

Exercise regularly

Better rest can start outside the bedroom too! Exercise is not only a great way to improve sleep, but also upgrade overall physical health and reduce stress. Just make sure you don't hit the gym or that yoga class too close to bedtime, as this can cause an increase in hormones and core body temperature that potentially hinder sleep. Saving workout sessions at least 3 hours before bedtime is usually best.

Fully switch off before bedtime

Sometimes it feels like the only time you have to catch up on that TV show you've been bingeing is just before bed. The problem with this is the blue light that comes from devices like televisions, phones, and laptops can suppress the release of melatonin and make it more difficult for you to fall and stay asleep. The longer you go device-free before bedtime, the better your sleep will be, but even just avoiding the screen glare 1 hour ahead should make a difference. 

Try to avoid large meals before bed

There can always be room for some indulgence in life, just not before bedtime! Eating large meals before bed can cause reflux and heartburn, potentially affecting your quality of sleep. Try to avoid large dinners and spicy food at least 2 hours before bedtime.

Limit alcohol and caffeine

Both alcohol and caffeine have the ability to impact your quality of sleep, as alcohol can disrupt the release of melatonin and caffeine has a stimulating effect on the brain. They can also make hot flushes and night sweats more intense. To reduce your risk of disrupted sleep, try to avoid alcohol 4 hours before bed, [5] and avoid caffeine 8 hours ahead. [6]

What are professional treatments for menopause sleep problems?

If you’ve given self-care a go and still find yourself struggling to sleep, there are professional treatment options to help you manage your symptoms effectively. Whether you’re looking to fight hot flushes or manage your mood, consider having a chat with your doctor. They’ll be able to reassure you and guide you towards the right treatment, which could include:

Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT) is a common and effective treatment that works by rebalancing the hormones in your body so it can combat menopause symptoms. Elevating the necessary hormone levels through Hormone Replacement Therapy can help reduce symptoms such as chronic insomnia and hot flushes. 
 
While HRT is a great option for some people, just like with any medical treatment, it can come with some side effects and risks. But try not to worry, your doctor will make sure that you know all the pros and cons so that you can decide together if it’s the best option for you.

Cognitive Behavioural Therapy (CBT)

While HRT focuses on your body, CBT is all about what’s going on in your mind. This type of therapy can be very effective for insomnia, as it teaches you how to modify thoughts and behaviours that cause poor sleep, even if you are experiencing chronic insomnia. Cognitive Behavioural Therapy can also be useful to help you cope with fluctuations in mood associated with menopause. 
 
In general, having a therapist to talk to when you’re going through major life changes is a good idea.
 
Keep in mind that while menopause is a completely normal part of life, sleep issues don't have to be. So whether you practice a bit more pre-sleep self-care or consider therapy options, a deep, restful sleep during menopause could be just a few nights away! It’s just a matter of seeking help and testing a few options... patience will be key in finding what suits you best.
 
And if you’d like to learn more about menopause and how it can affect you, why not explore everything you need to know about the hormonal changes that occur during menopause or the relationship between menopause and intimacy?  

Medical disclaimer

The medical information in this article is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. Please consult your doctor for guidance about a specific medical condition.

This article has been reviewed on 19th April 2024 by Karen Joash BSc (Hons), MSc, MBBS, MRCOG PGCert, ILM and MBA, Consultant Obstetrician and Gynaecologist at Queen Charlotte's and Chelsea Hospital and The Portland Hospital for Women and Children. You can find out more about mS Karen on her LinkedIn and X pages.

[References]

[1]  https://www.hopkinsmedicine.org/health/wellness-and-prevention/how-does-menopause-affect-my-sleep

[2] The circadian variation of sleep and alertness of postmenopausal women - Rafael Pérez-Medina-Carballo, Anastasi Kosmadopoulos, Philippe Boudreau, Manon Robert, Claire-Dominique Walker, and Diane B Boivin

[3] de Zambotti M, Colrain IM, Javitz HS, Baker FC. Magnitude of the impact of hot flashes on sleep in perimenopausal women. Fertil Steril. 2014;102:1708–150

[4] Hall MH, Kline CE, Nowakowski S. Insomnia and sleep apnea in midlife women: prevalence and consequences to health and functioning. F1000Prime Rep. 2015;7:63.

[5]  https://www.sleepfoundation.org/nutrition/alcohol-and-sleep

[6]  https://www.sleepfoundation.org/nutrition/caffeine-and-sleep

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