The 411 on Perimenopause, Menopause, and Sleep Disturbances

Calling all women in their 40’s and 50’s! Did you know that insomnia can be one of the early signs of menopause? Indeed, according the National Sleep Foundation, up to half of all menopausal women experience sleep complications. That’s compared to 15% of the general population. As many as 61% of post-menopausal women report insomnia symptoms. Here’s what’s going on, what to watch for, and how to get rest despite it all.

Shifting Hormones

First a refresher on the different stages of menopause…

Perimenopause: The time period (usually about 3–10 years, says the National Sleep Foundation) before the end of your menstrual cycles. During perimenopause, a woman’s ovaries gradually decrease production of the hormones estrogen and progesterone. Given that progesterone is often called a “sleep-promoting” hormone, it’s no wonder perimenopause can result in some long, restless nights. While perimenopause typically begins in a women’s 40’s, it can start in the 30’s for some women. During the last few years, menopausal symptoms tend to become more identifiable. These include headaches, anxiety, fatigue, difficulty focusing, hot flashes, and discomfort or dryness during sex.

Menopause: Menopause is considered a normal part of aging when it happens after the age of 40.  A woman is said to have gone through menopause if she has not had a period for 12 consecutive months. The ovaries have stopped releasing eggs and making most of their estrogen. Often, however, we use the term menopause to describe the time period and the symptoms women experience in the few years around the actual cessation of periods.

Post menopause: The years after menopause has occurred.

Hot, Sweaty, and Not Asleep

From a sleep perspective, the hot flashes associated with perimenopause and menopause are a problem. As you likely know, a hot flash (or if it happens at night, a “night sweat”) is a sudden feeling of heat and resultant sweating likely due to circulation changes. Some women may experience a rapid heart rate or chills, too. These symptoms can last about three minutes. The National Sleep Foundation reports that approximately 75–85% of women are affected by hot flashes around menopause. And if the hot flashes happen at night, they certainly can disrupt sleep and lead to feelings of fatigue during the day. Fortunately, hot flashes typically only impact an individual woman for about a year, although some women (as many as 25% according to the National Sleep Foundation) can suffer with them for several years. A lucky few (2 out of 10, says WebMD) will never experience them at all.

Sleep Breathing Disturbances, Including Sleep Apnea

Disordered nighttime breathing can become more common in women around menopause due to hormonal shifts, aging, and age-related weight gain. Talk to your doctor if you’re experiencing day time sleepiness or if your partner notices that you snore loudly, gasp, or breathe erratically at night. Sleep breathing disorders like sleep apnea can and should be treated to avoid more serious complications.

Stress, Depression, Mood Swings

About 20% of women, according to the National Sleep Foundation, experience depression during perimenopause and menopause. Typically, this has been linked to waning estrogen, but keep in mind too that mid-life can be a time of change, stress, and added responsibility and that these factors can impact emotional wellbeing. Indeed, experts at Psychology Today remind us that women’s middle adult years are busy and complicated thank to active careers, raising children, caring for aging parents, and more. Regardless of the cause of a mental health concern, keep in mind that depression and anxiety can often go hand in hand with insomnia. Each condition can contribute to making the other worse and so should be discussed with a healthcare provider.

Survival Strategies

Fortunately, there are things women can do to help improve their sleep around menopause:

  • If hot flashes or night sweats are disturbing your sleep, keep a cloth in a bucket of ice close by so you can cool yourself quickly. Also have a glass of ice water on your bedside table and sip it as needed. Wear loose, lightweight, moisture wicking pajamas. Consider a special pillow that’s designed for cooling, and stay away from heavy, insulating blankets. Avoid triggers, such as spicy food, alcohol, and caffeine.
  • Be consistent with the time you go to bed and the time you get up every day, even on weekends.
  • Exercise on a regular basis, but not too close to bedtime.
  • Avoid daytime naps.
  • Eat healthy, balanced meals and avoid heavy meals close to bedtime.
  • Refrain from using your smartphone, laptop, or tablet before bed. The light from electronic devices can make it difficult for you to fall asleep. You may even want to experiment with avoiding the television in the evenings.
  • Wind down with a predictable, soothing bedtime routine that signals sleep. Ideas include a relaxing warm bath, reading a book, meditating, or listening to soft music.
  • Keep your room cool and dark. Consider blackout curtains or blinds, a fan, or an air conditioner. Make sure electronic or digital devices are not adding unnecessary brightness.
  • Avoid alcohol, caffeine, and tobacco products. Alcohol may seem to help you relax and fall asleep but can cause you to wake up later.

The Good News

There are treatments that can help ease the symptoms of perimenopause and menopause. Options may include a low-dose birth control pill or the addition of soy-rich foods like tofu, edamame, and soymilk into your diet as soy contains plant-based hormones similar to estrogen. Hormone replacement therapy is an option, although it’s not for everyone and warrants a real discussion of pros and cons with your healthcare provider. You and your physician may also consider medications like antidepressants or supplements like melatonin to help support quality sleep.

The National Institute on Aging also recommends cognitive behavioral therapy for insomnia (CBT-i), especially if self-help improvements in your bedtime (and daytime) routines don’t improve your sleep as much as you’d like.

As mentioned above, a woman reaches official menopause when she has not had a period for 12 consecutive months. After that, hormone fluctuations subside and many of the symptoms she may have been experiencing – hot flashes, headaches, anxiety, lack of focus, mood swings, and sleep problems – often ease as well. Welcome to the new normal.