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What to expect from your sleep during menopause
Author: Eleanor Riches, Women's+ Health Writer
April 27, 2023
Menopause is a time of major hormonal, physical and psychological changes for many women. These changes can be a lot to process, especially when they impact areas of your life as important as sleep. In this blog, we explore what you can expect from your sleep during menopause.
Symptoms of menopause vary between people but one thing that remains consistent is that as women age, they become more likely to struggle with their sleep.
Women in general are more likely to struggle with their sleep. According to the Sleep Foundation, 1 in 7 people suffer from insomnia. For women, that figure rises to 1 in 4, with a 61% chance of insomnia among postmenopausal women. But why exactly is that?
Mental and physical challenges
Firstly, this stage of life can bring both mental and physical challenges.
Mentally, you may be navigating caring for your parents, supporting adult children, taking on more responsibilities at work or reflecting on your priorities as you grow older.
Physically, you may be dealing with symptoms of ageing – such as joint pains, body aches and bladder problems – which can all make it difficult to get a restful night’s sleep.
Hormonal changes in menopause
As your hormone production slows during menopause, your body no longer produces the same amounts of estrogen and progesterone – both of which can seriously impact your sleep.
Progesterone impacts your breathing drive, with lower levels causing sleep-disordered breathing. Whereas low oestrogen levels can make it more difficult to regulate your body temperature and mood, as well as your sleep/wake cycle.
This means that menopause can impact your sleep quality in multiple ways, including:
- Hot flashes
- Sleep-disordered breathing
- Mood changes
Hot flashes happen when low oestrogen levels make it difficult for your body to regulate its temperature. They affect around 85% of women in menopause and can last between 30 seconds and 5 minutes.
Hot flashes are also sometimes known as night sweats because they often happen at night. They can contribute to poor sleep quality because they cause a strong spike in body temperature, discomfort and a surge of adrenaline that can make it difficult to fall back asleep.
Insomnia is defined as chronic difficulty falling or staying asleep for more than 3 nights per week. Symptoms may include:
- Restless sleep
- Being tired and irritable during the day
- Poor focus or memory
- Increased headaches or inflammation
Of menopausal women who experience hot flashes, around 44% meet the criteria for chronic insomnia, suggesting there’s a strong correlation between these symptoms. This is likely due to low oestrogen levels making it more difficult for your body to regulate both its temperature and sleep/wake cycle.
Sleep-disordered breathing refers to changes in breathing including snoring, sleep apnea and obstructive sleep apnea (OSA).
Once perimenopause begins, a woman’s risk of developing sleep-disordered breathing increases by 4% each year. Lower progesterone levels are thought to be responsible for preventing the relaxation of the upper airways – causing breathing difficulties.
Mood and Mental Health
Fluctuating hormone levels during perimenopause and menopause can make it difficult to maintain a stable mood. This leads to mental health challenges such as anxiety and depression which can worsen sleep issues by putting your body into a state of stress. This can be self-fulfilling in some cases because poor sleep can worsen your mental health and vice versa.
How to improve your sleep
Here are some helpful tips from the Sleep Foundation on ways you can improve your sleep:
- Maintain a healthy weight, since a higher weight is associated with OSA.
- Avoid stimulants such as nicotine, caffeine and alcohol – especially in the evenings.
- Stop drinking liquids a few hours before bed and use the bathroom right before sleep.
- Reduce stress through lifestyle changes – such as regular exercise, fresh air and sunlight.
- Seek professional support if you’re struggling with your mental health.
- Create a sleep schedule and bedtime routine – and stick to it. This encourages your body to recognise when to wind down.
- Have a routine for falling back asleep if you wake up at night and avoid doing anything that will wake you up further.
- Stay cool at night with lightweight pyjamas or sleep naked – placing a fan next to the bed can help too.
If you’d like to learn more about the menopause and the hormone changes that take place, read our guide.
Metabolic Syndrome and Psychiatric Illness (2008) Basal Metabolic Rate. Available at: https://www.sciencedirect.com/topics/neuroscience/basal-metabolic-rate
McCargar, LJ. (1996) Can Diet and Exercise Really Change Metabolism? Available at: https://pubmed.ncbi.nlm.nih.gov/9746638/
Thyroid UK. 2021) How Your Thyroid Gland Works. Available at: https://thyroiduk.org/how-your-thyroid-gland-works/
 Current Opinion in Behavioural Sciences (2016) Impact of stress on metabolism and energy balance. pp 71-77. Available at: https://www.sciencedirect.com/science/article/pii/S2352154616300183
 Clegg, D. (2012) The Year in Review of Estrogen Regulation of Metabolism. Available at: https://academic.oup.com/mend/article/26/12/1957/2614784
This information has been medically written by Dr Thom Phillips
Thom works in NHS general practice and has a decade of experience working in both male and female elite sport. He has a background in exercise physiology and has published research into fatigue biomarkers.
Dr Thom Phillips
Head of clinical services
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