How to Getting A Good Night’s Sleep During The Menopausal Transition Update 05/2024

Hot flashes and mood swings were referred to be the “change of life” by our mothers and grandmothers, and it was also the unofficial beginning of middle age. The unpleasant side effects of menopause are expected by many women However, in addition to increased perspiration and weight gain, many women do not expect to experience sleep disturbances.

According to Grace Pien, M.D., M.S.C.E., an assistant professor of medicine at the Johns Hopkins Sleep Disorders Center, poor sleep quality and sleep disruption are less prevalent yet highly common changes during this time of life.

Once you reach a certain age, getting a decent night’s sleep may seem like a fantasy. During perimenopause, the time before menopause when hormone levels and menstrual cycles become erratic, many women find it difficult to sleep. Menopause and the postmenopausal period are two times when sleep deprivation tends to linger. It’s good news, adds Pien, that there’s assistance available.

What constitutes a “good” night’s sleep? According to Pien, women should aim for seven to eight hours of undisturbed excellent sleep per night. However, this isn’t a set rule; some people require less sleep than others. You may not be receiving enough restful sleep, she explains, if you find yourself waking up frequently during the night and unable to get back to sleep.

What Sleep Issues Are Associated With Menopause

Symptoms of menopause can vary greatly from woman to woman and from perimenopause to menopause, depending on the individual. As many as 39% to 47% of women in their peri- and post-menopausal stages suffer from sleep disturbances.

Sleep issues such as hot flashes, sleeplessness, and sleep-disordered breathing are among the most commonly reported by women going through menopause.

Hot Flashes

Flashes of heat all over the body are accompanied by a rush of perspiration. Hot flashes begin on the cheeks and then travel to the chest and the entire body. Their duration might vary widely, from 30 seconds to five minutes. Around the time of menopause, 75-85% of women have hot flashes. Hot flashes usually last seven years, although they can last up to ten years or longer.

Night sweats are also known as hot flashes that happen at night. When a woman experiences a hot flash, she experiences an increase in her core body temperature and increased blood flow to her face. A surge in heat and adrenaline can make it difficult to fall back asleep after a hot flash. It is possible for women to return to sleep quickly, but this does not alleviate their exhaustion the following day as a result of their frequent awakenings and discomfort. Nearly 44% of women who suffer from severe heat flashes fulfill the criteria for chronic insomnia.


When you have trouble getting asleep or staying asleep for more than three nights in a row, you have insomnia. Many of the same symptoms as those who suffer from sleep deprivation and excessive daytime sleepiness are experienced by those who suffer from insomnia. Anxiety and irritation are often exacerbated, as are concentration and memory loss, as well as headaches and inflammation when people are unable to get enough sleep due to insomnia.

Chronic insomnia affects one in seven people. Insomnia affects one in every four women, roughly twice as many as it does males. As many as 61% of postmenopausal women suffer insomnia symptoms, which represents an increase in the likelihood of insomnia during menopause.

Sleep-Disordered Breathing

During menopause, snoring and sleep apnea becomes more common and severe in women. As the name suggests, Obstructive Sleep Apnea (OSA) occurs when breathing stops or slows down for brief periods of time. This causes snoring, gasping, and sometimes choking noises during sleep.

OSA is a condition that affects 2% of women. Perimenopause raises a woman’s chance of breast cancer by 4% every year she’s in it. A lack of progesterone in postmenopausal women has been linked to the development of sleep apnea, according to new studies. OSA-related breathing lapses may be prevented by progesterone by preventing the relaxation of the upper airways. OSA is less common in postmenopausal women who are on hormone replacement therapy.

Other Mood and Sleep Disorders

Restless legs syndrome and periodic limb movement disorder are two more sleep disorders that can arise during menopause. Uncomfortable sensations and sleep disturbances are also linked to these illnesses, which are characterized by irregular, involuntary movements of the legs.

Depression and anxiety can exacerbate sleep problems in women who are going through menopause. Sleep deprivation, on the other hand, can lead to or exacerbate anxiety and despair.

How Does Menopause Affect Sleep?

Menopause is caused by the cessation of estrogen and progesterone production by the ovaries in women. Mood, appetite, sleep, sex desire, and other biological processes are all influenced by these two hormones. Progesterone, for example, has been linked to sleep apnea and other sleep disorders, thus reduced levels may be a contributing factor.

Because of its role in the metabolism of serotonin and other neurotransmitters, estrogen has a significant impact on our sleep-wake cycle. Estrogen also helps us sleep better at night because it lowers our body temperature. Estrogen also has a calming impact on the mind and body. When estrogen levels drop, it’s possible that women will feel hotter, sleep worse, and have a worse mood.

Similarly, as we get older, our sleep-wake cycle shifts and loses its regularity. Early fatigue and a more early rise in the morning lead to less overall sleep. This may also explain why menopausal women, as well as older persons, are more likely to suffer from sleeplessness.
Menopausal symptoms, such as mood swings, may or may not be linked to hormone changes. Other life stressors may also be a contributing factor. In addition, women may experience stress due to empty nests, caring for elderly parents, and worries about their own aging.

Due to menopause or other aging signs, women may begin taking drugs that can disrupt their sleep. A lack of sleep can be exacerbated by age-related symptoms such as joint discomfort, muscle aches, and bladder issues.

Can Treating Menopause Improve Sleep?

Both estrogen replacement therapy (ERT) and hormone replacement therapy (HRT), both of which enhance estrogen and progesterone, are standard menopausal treatments. Both of these treatments have been found to be successful in alleviating menopausal symptoms, such as hot flashes, sleeplessness, and mood swings, among others.

Women who have had a history of blood clots, stroke, heart attack, and some types of cancer should not use HRT because of the substantial hazards it poses. Therefore, doctors are advised to give HRT at the lowest effective dose and only for a limited period of time. Discuss the potential dangers and advantages of HRT with your doctor because there are numerous options for addressing menopausal symptoms.

Menopausal symptoms, especially hot flashes, can be alleviated with lower doses of antidepressants and SSRIs, including fluoxetine, paroxetine, and venlafaxine Bazedoxifene, for example, has been shown to reduce hot flashes while simultaneously improving sleep.

Because soy contains phytoestrogen, it is used in a variety of soy-based goods. A diet high in soy has been shown to reduce hot flashes and improve sleep, according to several studies. Over-the-counter supplements including ginseng, black cohosh, and red clover extract contain phytoestrogens similar to those found in soy. As a result, the usefulness of natural supplements in treating menopausal symptoms and the potential negative effects of these supplements are unknown. The best course of action is to discuss your options for therapy with your physician.

Even if you’re not suffering from insomnia, melatonin can be taken as a supplement. In postmenopausal women, low dosages of melatonin enhanced mood and sleep onset. Age-related declines in melatonin levels are common, as are those in estrogen and progesterone.

For insomnia, cognitive behavioral therapy (CBT) is an effective treatment option. It is possible to improve your sleep quality by engaging in cognitive behavioral therapy (CBT) in conjunction with a professional therapist.

Tips for Sleeping Better With Menopause

Consult your doctor if you’re having trouble sleeping because of menopause. Medications and lifestyle changes that may help you sleep better can be recommended by them because they are familiar with your medical history. In addition, the following sleep advice may be helpful.

  • Diet and exercise should be done in a manner that promotes a healthy weight. After menopause, women’s bodies tend to gain weight, which may contribute to OSA symptoms. Stay away from heavy meals and spicy and acidic foods before going to bed, as these may cause hot flashes.
  • In the late afternoon and early evening, stay away from stimulants like caffeine and alcohol. These substances can interfere with your ability to fall asleep and stay asleep, resulting in poorer quality sleep.
  • Preparing for bed by using the bathroom will help you avoid having to get up in the middle of the night to pee. A few hours before going to bed, try to cease consuming all liquids.
  • Reduce your level of stress whenever feasible. Sleep deprivation is exacerbated when you’re plagued by anxious or unpleasant thoughts. The benefits of regular massage, exercise, and yoga can help alleviate your tension. Consult a mental health expert if you’re experiencing depression or anxiety.
  • Get into the habit of winding down and calming yourself before going to sleep. Listen to music while you bathe or read a book. Relaxation methods such as deep breathing and meditation can be helpful.
  • Having a sleep regimen in place when you wake up in the middle of the night is a good idea. Don’t watch television or do anything else that will keep you awake, including reading. Keep a change of clothes or a glass of iced water on your nightstand in case you need to change out of your pajamas in the middle of the night.
  • To keep cool at night, use lightweight pajamas or sleep naked. Another helpful approach is to wear clothing that wicks away moisture when working out. Similarly, choose natural fibers like cotton for your bedding, which will keep you cooler in the summer.
  • Keep the temperature in your bedroom at a level that is comfortable for you and your family.
  • Make sure your bedroom temperature is no higher than 65 degrees Fahrenheit. To further cool the air and improve circulation, turn on the air conditioner or install a fan next to your bed at night.
  • Consistently observe a regular sleep routine, including the time you go to bed and when you wake up. Avoid taking more than a 20-minute nap throughout the day, as this can disrupt your sleep at night.

Menopausal women often have trouble sleeping, but there are various ways to remedy this. A CBT-trained therapist with expertise working with menopausal women should be sought out if your sleep problems continue.

Hot Flashes and Sleep

Hot flashes are frequently linked to menopausal insomnia. Extreme heat symptoms can strike at any time of day or night. Hot flashes during the night are typically accompanied by a sudden awakening.

Research demonstrates that many menopausal women really wake up shortly before a hot flash starts, despite the fact that it is normal to feel like a hot flash has awakened you.

During a hot flash, there are changes in the brain that lead to the sensation of heat, and these changes may also be what causes the awakening, she says. Hot flashes can cause sleep problems even in women who don’t suffer from them, according to a study published in the Journal of the American Medical Association.

Other Menopausal Sleep Disruptors

The decrease of reproductive hormones, such as estrogen and progesterone, can cause sleep disturbances including apnea in women at this stage of life. Menopausal symptoms, such as excessive daytime sleepiness, sometimes go unrecognized because women tend to blame them on menopause itself.

It’s two to three times more common among postmenopausal women than in their younger counterparts, according to Pien, a sleep specialist. Prior to menopause, hormones appear to have a significant protective impact, but this effect diminishes with menopause.” In addition, the signs and symptoms of sleep apnea in women tend to be more modest. As a result, individuals may be less inclined to have their sleep apnea symptoms evaluated. Sleep apnea may also be overlooked by their doctors, resulting in further delays in diagnosis and treatment.”

Menopausal women who are depressed or anxious may also have trouble sleeping.

Can Alternative Treatments Treat Hot Flashes and Help Me Sleep?

Soy products, such as tofu and soybeans, have been used to alleviate hot flashes and improve sleep in the past. Phytoestrogen, a plant hormone found in soy products, mimics the effects of estrogen in the body. Soy products haven’t been demonstrated to significantly reduce hot flashes in most studies.

The buttercup family perennial black cohosh has also been used to alleviate hot flashes and excessive sweating. Despite promising results, studies on black cohosh’s involvement in lowering menopausal symptoms have been problematic.

Keep in mind that, unlike pharmaceuticals, dietary supplements are not subject to FDA regulation or monitoring. Before using any of these products, make an appointment with your physician.

Getting a good night’s sleep during the menopausal transition

During and after menopause, here are some tips to help you sleep better:

  • Maintain a consistent bedtime routine. Maintain consistent sleep and waking schedule.
  • If you can, try to avoid taking a late-afternoon or early-evening nap. It’s possible that it’ll keep you up at night.
  • Plan your evening routine. A nice bath or reading a good book might help some people relax.
  • Maintain a strict no-screens-in-the-bed policy, especially in the bedroom.
  • You may have trouble sleeping if the light from these gadgets bothers you.
  • Ensure that the temperature in your bedroom is just right—not too hot or too cold—and that it is as silent as possible.
  • Avoid exercising right before going to sleep. It’s best not to eat a big dinner right before going to bed.
  • Stay away from caffeine (found in many coffees, teas, and chocolate) after lunch and before going to sleep.
  • Don’t rely on booze to help you get to sleep. Even a teeny-tiny amount can make it difficult to sleep.

Tips for improving sleep long term


  • Get up and go to bed at the same hour every day. Routine is critical to having a healthy sleep schedule. Keep in mind that it may take a few weeks to establish and adhere to strict schedules.
  • Daytime naps should be avoided at all costs. Allow yourself no more than 30-40 minutes in the early afternoon if you do.
  • Don’t overdo it within two hours of going to bed, but keep up your usual exercise routine.
  • Find out how much sleep you require. The typical amount of sleep is 6-8 hours, however, this varies from person to person and decreases as you become older.
  • In addition to the physical symptoms of menopause, there are many other variables that might disrupt sleep. In the event that you are taking medication for any other reason, be sure to take it at the time of day it was prescribed.

Before going to bed:

  • Establish a habit for yourself, such as taking a warm bath or reading a light book.
  • Take care not to go to bed hungry or full. A small snack is acceptable.
  • Consume your final caffeinated beverage, whether it’s a soda or chocolate, in the late afternoon or evening.
  • Alcohol does not aid in sleep, thus avoiding it is preferable.

Your environment:

  • Maintain a peaceful atmosphere in your bedroom. Rooms that are chilly but not too cold, but also shut out as much noise or light as possible, are ideal.
  • Get a good night’s rest! A nice mattress and good sheets are a must.
  • Rest and pleasure are the only purposes of your bedroom.
  • Avoid using your laptop or phone when you’re in bed.

If you wake up in the night:

  • Get out of bed and go to another room if you can’t fall back asleep after 20 minutes.
  • If you’re having trouble sleeping, try doing something quiet, and then go back to bed.
  • Avoid using a stopwatch or watching TV.
  • Even if it’s difficult, try your best not to think about your troubles or anxieties during this time of reflection.

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