animation of a woman having nighttime hot flashes

Menopause and Insomnia
What’s Burning? Oh, It’s Me

Sleeping through menopause is no joke, and sometimes it may seem impossible. If you’re right in the thick of it, you may take comfort knowing there is a light at the end of the tunnel, and understanding what’s going on with your body could help you to find coping mechanisms to combat menopause insomnia. 

 

Depending on when it begins, menopause can trigger a variety of emotions and hormones, but take hope knowing that there is life after menopause, and in many cases, it can be just as, if not more, fulfilling than before.


Section 1

What’s Happening with My Hormones?


Section 2

Perimenopause Vs. Menopause


Section 3

Is It Causing My Insomnia?


Section 4

How Long Does This Last?


Section 5

Holy Hot Flash, Batman


Section 6

What Other Sleep Disorders Are Common?


Section 7

Diabetes & Menopause: Is there Added Sleep Danger?


Section 8

Ask My Doctor


Section 9

Fight Back and Get your Rest


Section 10

Conclusion

01

What’s Happening With My Hormones?

Most of us are aware that menopause is characterized by changes in hormones much like puberty, but this time rather than surges of new hormones, estrogen, testosterone, and progesterone become less regulated.

 

Over a period of months or years, there will eventually be less estrogen and progesterone and usually a little more testosterone. While the most obvious physical change may be the end of the menstrual cycle and fertility, these aren’t the only physical changes most women are likely to notice.

 

Hormones are integral to a normal sleep cycle, from helping us become drowsy to internal timekeeping. So it’s no surprise that during menopause many women experience sleeping problems, but you may be wondering what reproductive hormones have to do with sleep.

 

According to Yale medicine, progesterone has a mild sedative effect, and levels of it are higher throughout two-thirds of the menstrual cycle, helping some women sleep. When the hormone begins to decrease, your period begins along with the cramping and other PMS symptoms. This may explain why it could be harder to rest on your period and throughout menopause.

illustration of a woman having mood swings

These hormones don’t solely affect sleep; they can drastically affect mood. Because progesterone has a calming effect, as it decreases, many women experience mood swings and irritability. Some even begin to develop anxiety and depression that they didn’t experience before according to the North American Menopause Society.

So if you feel like you’re going crazy or becoming extra forgetful, the good news is you’re in good company with every woman who has gone before you. These symptoms are completely normal, though anything but comfortable, so rather than telling you to suck it up, we’ll go over a few possible solutions for coping in a minute.


02

Perimenopause Vs. Menopause

For some women menopause comes on strong, knocking them off their unsuspecting feet, but for others, it can take months or years to finally start. If you find yourself more in the second camp, you could be in Perimenopause or the transition period, like reverse puberty. Sounds fun, right?

 

Perimenopause can begin as early as your late thirties but usually begins somewhere in the forties and is characterized but a variety of changes that can closely resemble menopause. From irregular periods to vaginal dryness and hot flashes, these symptoms may come and go for years before you are officially in menopause, which is characterized by twelve months without a menstrual cycle.

 

During perimenopause, sex hormones like estrogen and progesterone rise and fall in an irregular fashion, meaning at some points in your cycle there may be more or less of these hormones than usual. So while you may have long spells without restful sleep or a period, these could come back suddenly in a confusing pattern.


03

Is It Causing My Insomnia?

If sleep disruptions are new to you and you have other symptoms of menopause, there’s a good chance it’s a contributing factor. Insomnia is much more common in women than in men, and  a CDC report on sleep quality in women aged 40-59 found that 56% of perimenopausal women and 40.5% of postmenopausal women report sleeping less than 7 hours in a 24 hour period. According to the CDC, “Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition.” 

 

A study performed at the Centre for Sleep Research at the University of South Australia found that perimenopausal women received less sleep and experienced more frequent arousals than premenopausal women, and were subsequently evaluated to have more anxiety and depression than the group that received better sleep. The study suggests that the two could be related, meaning less sleep could worsen mental health issues and vice versa.

A Woman Lying in Bed at Night with Her Eyes Wide Open Illustration

So if you find yourself struggling to fall and stay asleep during perimenopause, it could be a good idea to take some time for your mental health to get ahead of the problem. Unfortunately, these symptoms could be exacerbated by hormonal changes, so it’s probably a good idea to talk to your doctor about your treatment options as soon as these issues begin to crop up.

04

How Long Does This Last?

The average duration of perimenopause is four years, but this may vary from person to person and can be affected by other factors such as hysterectomy, tobacco use, and genetic factors. If this fact has thrown you into a panic, this period of your life doesn’t need to be miserable, and thanks to some treatment options and medication, it shouldn’t need to dominate your life.

 

When it comes to Menopause, it isn’t so much a period of time as it is an event and a diagnosis. After a woman has gone twelve consecutive months without a period, menopause is diagnosed and symptoms of menopause like hot flashes, mood swings, and mental fog may continue for the first four to five years. Over time the symptoms should become less frequent and severe though they may carry into post-menopause according to a study at the University of Pennsylvania.

 

There are different symptoms and changes a woman can expect throughout this process, and these will likely vary from person to person.


What about After Menopause?

While perimenopause might last much longer than most women hope, the good news is that eventually it will end, and many symptoms fade after going twelve months without a period. However, there are still a few concerns you should be aware of.

 

A study in the Journal of Bone and Mineral Research found that women who sleep for less than seven hours per night are at a higher risk for low bone density after menopause. While the researchers aren’t positive about what causes the correlation, it’s clear that those who get enough sleep tend to have higher bone density while those who sleep less than seven hours have a lower bone density. It’s no surprise that sleep and cardiovascular health are linked, but after menopause, there seems to be more of a reason to make rest a priority.

Tired Heart Illustration

The article says poor sleep after menopause might make it more difficult to control blood sugar which has its own effect on bone density. To stay healthy and avoid developing osteoporosis, the study recommends regular exercise, which helps control blood sugar, regulate hormones, and strengthens the bones. While we agree that exercise is important, we also think this is just one more reason why women in menopause shouldn’t accept poor sleep as a fact of life.

05

Holy Hot Flash, Batman

One of the most common sleep interruptions in perimenopause is hot flashes that can both make it difficult to fall and stay asleep. According to Harvard Medical School, researchers aren’t certain what causes these symptoms, but they are fairly sure it has to do with changing hormones.

 

According to the article, most women won’t experience this symptom until menopause itself begins, but it can show up fervently in some women going through perimenopause, lasting for up to ten years.

illustration of a woman having hot flashes and night sweats

The Mayo Clinic says these changes could be because the hypothalamus, or the part of the brain that regulates temperature, becomes more sensitive to slight changes in the body and drastically makes up for these, causing hot flashes. While these flashes can occur at any time during the day, when they happen at night, we’re likely to wake up sometimes drenched in sweat.

 

According to an Oxford study, hot flashes are associated with changes in heart rate both when you wake up to them and when you don’t. The study suggests that sometimes when you have hot flashes in your sleep, your heart rate and blood pressure drop significantly to cool your body down, and thus don’t interrupt your rest. However, at other times your heart rate and blood pressure may increase due to the hot flash, waking you up until you can cool yourself down. If you’re wondering why this matters, the study suggests both fluctuations (awake and asleep) can interfere with your cardiovascular restoration.

 

Heart health is extremely important in older women, as heart disease is the leading cause of death for women in the United States. So while hot flashes may be common, we don’t recommend ignoring them. Depending on how frequently they occur, your doctor may prescribe a medication to help stop them, especially if they are preventing you from getting a good night’s sleep.


06

What Other Sleep Disorders Are Common?

While hot flashes and insomnia are some of the more common sleep disorders during menopause, there are plenty of others that can crop up during this time frame. Keeping in mind that these may not affect you, it’s always a good idea to be aware of what you’re up against. If you end up experiencing one or a few of these, we hope to at least validate your experience. 


Sleep Apnea

illustration of a man who can't fall asleep because of his wife's snoring

Sleep apnea, specifically Obstructive Sleep Apnea is a common sleep disorder in menopausal women. A Massachusetts study of over fifty thousand women found that women who go through menopause early and those who surgically experience menopause via hysterectomy or oophorectomy (removal of one or both ovaries) are at a higher risk for developing the sleep disorder. Additionally, those who are overweight tend to have a higher risk of developing the condition.


Depression

sad woman walks by young couple

Depression might be common among women in menopause, but that doesn’t make it something we should ignore or shrug off as normal, especially when it comes to sleep. It’s a common statistic that around twice as many women experience depression in their lives as men and the reality of this statement might hit home when you’re transitioning into menopause.

 

It’s important to recognize that this could be due to hormonal changes or it could be a result of the sometimes negative connotations of getting older and moving on to a new phase of life.

 

While some women are overjoyed to not need to fear pregnancy anymore, others may feel a sense of loss. Whatever the cause, your depression is your own, and you won’t catch us saying it’s not valid or justifiable, but we do suggest talking to your doctor or therapist about your options and ways to make your life feel more worthwhile during menopause, especially when it’s interfering with your ability to get a good night’s rest.


Anxiety

Illustration of a woman having anxiety attack while in crowd

If you’ve never dealt with anxiety before but suddenly you feel it coming on over seemingly small things, you aren’t alone. This is a common symptom of menopause, but when it comes to mental health issues, it’s important to remember that just because something is common doesn’t mean it’s normal, and crippling bouts of anxiety aren’t normal in any phase of life.

 

The Cleveland Clinic says that while mild anxiety and depression may be expected, panic attacks or frequent and troubling anxiety shouldn’t be, and those experiencing them should discuss their condition with a doctor. So if you’re struggling to get some shut-eye more than a few nights a week due to your racing thoughts and heartbeat, you shouldn’t just have to write it off as another symptom of menopause, there is help available.


Fatigue

Fatigue may be trickier to deal with than other symptoms because it can be caused by sleep interruptions like hot flashes and anxiety, but it can also result from waves of hormones, especially during perimenopause when you may have more progesterone than usual at some points.

Chronic insomnia could also cause fatigue, as it steadily decreases the hours of restful sleep you get each night. In turn, this can lead to other issues like decreased sex drive and other life-altering consequences.

A woman Lying Awaken in a Bed wishing She Is Being Asleep Illustration

Some naturopathic doctors say energy and mental fatigue aren’t the only types of exhaustion your body experiences in menopause. Adrenal fatigue has become a buzzword surrounding menopause and, and Dr. Martin Gleixner, MSc, ND at Moncton Naturopathic says the condition could also lead to a myriad of other issues like hot flashes and memory changes.

 

According to Gleixner, when the ovaries begin to decrease in their hormone production, the adrenal glands kick into overtime to make up the difference. Over time, they can wear out without proper nutrition and support, which is where the market for a variety of expensive adrenal support vitamins come in.

 

While adrenal fatigue is commonly diagnosed by naturopaths, it’s important to note that the condition is not recognized by the Endocrine Society. According to Harvard Medical, recent studies suggest that many of the symptoms of adrenal fatigue have more to do with an overactive lifestyle, sleep issues, and other causes of stress in life.

 

We’ll let you pass judgment on whether there’s any merit to the issue, but before shelling out lots of money on expensive supplements for a condition you may not have, it’s probably a good idea to discuss your options with your doctor.


07

Diabetes & Menopause:
Is there Added Sleep Danger?

For those with type 1 or type 2 diabetes, you could be at extra risk for health issues and sleeping problems during and after menopause because of the way sex hormones (or the lack thereof) affect blood sugar. According to the Mayo Clinic, progesterone and estrogen can affect the way your body responds to insulin, so your blood sugar could become unstable and unpredictable.

Woman Injecting Insulin Into Her Stomach Illustration

In some cases, menopause can lead to weight gain, so you may require more insulin or oral diabetes medication to keep sugars controlled. This could mean more alarms to check your sugars in the night hours and more adjusting of your insulin to carb ratio to account for your body’s changes. While most people with diabetes are accustomed to daily adjustments in care, after menopause women are at an increased risk for heart disease and sleep problems, so uncontrolled sugar could become even more dangerous.

 

If you are struggling to manage your disease, there is no shame in admitting you need some help. Even if you’ve successfully managed it yourself for years, recruiting a doctor to help you manage your case could be a good idea at least when you start to notice some changes taking place. It may also be a good time to set up check-up appointments with your endocrinologist to ensure everything is running smoothly.


08

Ask My Doctor

A Doctor Standing Next to a Woman on an Exam Table Illustration

Once you know you’re experiencing symptoms of menopause, it's probably a good idea to talk to your doctor about how you can treat them and find ways to help improve your quality of life. Here are a few questions we think could be helpful at your next visit. 

Are there natural remedies?

Many women take adrenal support vitamins to help with their hot flashes in case they are caused by adrenal fatigue. When it comes to other issues like insomnia, others take melatonin to help them fall asleep at the right hour. There are even vitamins that claim to help with breast tenderness due to hormones.

 

Which option is right for you will likely depend on a variety of factors that your doctor can help you navigate.

Is there a way to balance these hormones?

Balancing hormones can be tricky in perimenopause because your body will cycle through waves of both high and low hormone levels, but doctors often prescribe medications and lifestyle changes to try to balance them out. From eating more protein-rich meals to increasing physical exercise, there are a variety of natural ways to balance these hormones, though sometimes these efforts might not be enough.

 

In these cases, doctors may prescribe supplemental estrogen pills which can help prevent bone density loss and reduce negative symptoms of menopause. Other commonly prescribed medications include Gabapentin, an anti-seizure medication that could help reduce hot flashes according to the Mayo Clinic, and even vaginal estrogen which could help with dryness and sex-related discomfort. Your doctor should know which option is best for you.

Bottle of Medications On the Bedside Table Illustration

Does taking estrogen cause breast cancer?

Hormone replacement therapy (HRT) has been the subject of speculation for years regarding its link to breast cancer and other potential risks, and not without merit.

 

According to Breastcancer.org, your risk level varies based on which type of HRT you choose to use. Combination HRT, containing progesterone and estrogen, has the highest risk for breast cancer, increasing the likelihood of developing the disease by 75 percent even when it’s only taken for a short time.

 

However, the estrogen-only option only increases the risk of breast cancer when taken for over ten years. These risks should be the same whether you choose to use bioidentical (identical to hormones used in your body) or natural hormones.

 

Choosing to use HRT is a decision that should always be made after consulting a doctor and discussing the possible risks. If you decide to use HRT to combat menopause symptoms, your doctor will likely recommend the smallest dose possible to lower your risk of developing cancer.

Are there safe sleeping aids?

When it comes to using sleeping aids to help with insomnia, they can be just as risky and controversial as HRT, but when you’re struggling to sleep, we don’t blame you for wanting to know if they’re an option.

 

While there are plenty of natural remedies for sleep aids, sometimes you may want something a bit stronger to keep you asleep. Your doctor should be able to discuss the risks associated with developing a dependency on sleeping pills and advise you on the right decision for your case.

 

One important factor to consider is how you feel after taking them. While some pills may increase the length of sleep you get, they might not always increase your restfulness and combat fatigue the way you hope.

Can my hormone replacement keep me up?

While hormone replacement therapy is often helpful for reducing hot flashes and insomnia, in some cases, it could be getting in the way of your rest. According to Yale Medicine, lower levels of progesterone may cause irritability and make it more difficult to fall asleep, so if you’re taking HRT without this hormone, you might not be getting the benefits you’re looking for.

 

Talking to your doctor about the way you’re responding to your hormone replacement therapy is the first step to resolving any sleep issues you may be experiencing.


09

Fight Back and Get Your Rest

Now that we’ve discussed all of the ways menopause interferes with your health and rest, we want to share a few techniques that could help you to fight the sleep deprivation and ride the hormone waves to better rest.

Establish a Sleep Routine

Having a good routine is one of the best ways to combat insomnia because our bodies tend to respond well to routines. If your body knows you reserve your bed for sleep only, and you go to it at the same time every night, you might have an easier time of winding down and relaxing after a long day.

Exercise (But Not at Night)

Exercise can be a great way to naturally balance your hormones and boost serotonin levels, helping with insomnia, anxiety, and depression. While this shouldn’t be the only solution you use to combat these issues, it’s a great way to start that shouldn’t have adverse effects so long as you don’t do it too close to bedtime.

 

If you have underlying conditions that could make exercise dangerous, be sure to talk to your doctor before launching into a rigorous routine that could be damaging to your health.

Cut Down on Caffeine

If you’re experiencing fatigue, you’ve probably been using caffeine to help you make it through the day. While this may make it easier to function in the morning after a rough night’s rest, it’s probably a good idea to begin to taper off on the caffeine by the afternoon. Because caffeine binds to adenosine receptors in the body, it can prevent you from getting sleepy at the right time, and research from the Cleveland Clinic shows it can even cause hot flashes.

Lady In Bed Thinking about Coffee

So while a mid-morning cuppa might help you with your presentation, you might want to switch to decaf after lunch.

Be Mindful about Napping

We get it, after months of fatigue and not getting enough rest, you take when you can get when it comes to sleep. If that means a few hours after lunch, most of us would take it. However, these naps can throw off our sleep schedules when they become regular and could make it more difficult to sleep later.

 

According to the Mayo Clinic, taking too long of a nap could increase grogginess and worsen insomnia. If staying awake isn’t an option, the key is short naps lasting from 10 to 20 minutes.

 

When you pull an all-nighter or are experiencing jet lag, indulge away, but in your regular time zone, if you can make it until bedtime you’ll probably be thanking us later.

Invest in Bedding with Cooling

We can’t forget about hot flashes. While we hope your doctor can find some better preventative measures to avoid them happening in the first place, it’s never a bad idea to have some emergency measures in place. Many mattresses now integrate cooling technology into their models, from heat-conducting copper infusions to actual fans built into a base. Menopause isn’t usually a quick event, so we’d say they’re worth the investment. You can find our top bed picks for menopause right here.

Woman sleeping while fan is cooling her off

If you already have a cooling bed and it’s not enough, attaching a bed fan to your cooling sheets could be a good option for when you wake up in a sweat. Many have remote options for quick cooling and drying that shouldn’t disrupt partners.

Plan a Balanced Diet

Many doctors recommend a balanced diet as a healthier way to balance hormones during menopause, including eating more protein and soy and avoiding spicy food to help increase estrogen and reduce hot flashes.

 

Additionally, it’s important to consider that weight gain can increase the risk for sleep apnea, and menopausal women are at a higher risk for both of these conditions. Eating a healthy and balanced diet could be a good way to reduce the risk of health conditions associated with weight gain.

Greek yogurt with almonds and honey Illustration

10

Conclusion

There is a reason why many women call it, “The Change,” menopause is no picnic, but with some help from doctors and some lifestyle changes it can be manageable. Understanding the way your body is affected is a great step toward seeing improvement. 

 

Whatever phase you’re in regarding menopause, we encourage you to be diligent in looking for ways to improve your quality of life and to be as kind to yourself as you would be with a young girl going through puberty. After all, the experience isn’t so different.

<span style="border-left: 6px solid #f4772c; padding-left:10px;">Katie</span> Harris
Katie Harris

Katie is a content writer and serial hobby collector who enjoys naps almost as much as her pets do. When she isn't writing, she likes to ride her motorcycle, catch Pokemon with her hubby, and practice yoga with her dog.

The Sleep Advisor