Menopause and Insomnia: A Guide

As the seasons of a woman’s life unfold, one of the most significant and transformative stages is undoubtedly menopause. While it brings an end to the menstrual cycle and marks the conclusion of the reproductive years, menopause also ushers in a host of physical and hormonal changes that can have a profound impact on a woman’s overall well-being. Among the myriad challenges that women may face during this transitional period, one particularly elusive adversary is insomnia.

Menopause, commonly occurring in the late 40s to early 50s, is characterised by a natural decline in reproductive hormones such as estrogen and progesterone. This hormonal shift triggers a cascade of changes in the body, including hot flashes, mood swings, and, for many women, disruptions in their sleep patterns. Insomnia during menopause is not merely a fleeting inconvenience; it can become a persistent companion, affecting not only the quantity but also the quality of sleep.

According to recent studies, up to 61% of women entering menopause report experiencing sleep disturbances, ranging from difficulty falling asleep to night sweats that jolt them awake. The hormonal fluctuations that characterise menopause play a pivotal role in these disruptions, as declining Estrogen levels contribute to an increased susceptibility to insomnia. Beyond the hormonal realm, lifestyle factors and the burdens of stress further amplify the challenges women face in achieving restful sleep during this phase of life.

Insomnia treatment during menopause often requires a holistic approach and lifestyle modifications aimed at reducing stress and enhancing relaxation.

How Does Menopause affect your sleep?

Many things start to change for a woman during a menopause transition (perimenopause). This is the time when hormone levels start to change and their menstrual cycles become irregular. One of the key changes is a drop in estrogen and progesterone. The human body is a complex and intricate thing, and sometimes when there is a change in one of the “systems” (such as your hormone levels), it can have a ‘knock-on’ effect. A lot of these so-called, knock-on effects will impact sleep and that is why sleep disturbances and sleeping problems are common symptoms of the menopause transition.

  • Hot flushes: The most common complaint of women is in regards to their sleep, having hot flushes, or overheating in bed. The hormone irregularities result in the thermo-regulating system of your body to also become disrupted. We know that temperature plays a very important role in sleep and so an increase in body temperature will cause an awakening during the night.
  • Sleep-producing hormones: A drop in estrogen and progesterone will impact the ability to fall into and maintain sleep. Falling asleep is a complex occurrence and the hormonal changes can disrupt this.
  • Medications: Some medications that are prescribed for symptomatic relief of other menopausal symptoms can unfortunately affect the quality of your sleep. If you’re concerned about some of the medications you may be taking, then it is best to speak to your doctor.
  • Changes to vitamins and minerals: The changes that a woman goes through with her menopausal transition can also have a negative impact on various vitamins and minerals that are key in their sleep, as they can become deficient. Magnesium, Calcium, Zinc, Vitamin D and your B Vitamins can be negatively impacted, so if you feel this could be the case, then it is best to follow up with your doctor for a routine blood check.
  • Other sleep conditions: As a woman goes through their menopausal transition, they can be more susceptible to developing other sleep disorders. Such as snoring, waking up tired, or waking up with a headache and a dry mouth; then it may be that they have developed sleep apnea. Such occurrences as twitching and having small spasms while sleeping, feeling an uncomfortable restlessness in the limbs (particularly in the evening), and feeling tired after a long sleep could cause restless leg syndrome. These can be diagnosed by a sleep test from a general practitioner.
  • Change in habits: Going through this part of life can be difficult, so, unsurprisingly, many women start to change other behavioral aspects of their lives. They may start exercising less due to exhaustion or eating a poorer diet, negatively impacting sleep. Additionally starting to experience emotional changes that can increase stress and anxiety, which will also cause sleeping problems.

Why does Menopause cause Insomnia?

The experience of menopause or perimenopause can be quite intense. It’s stressful, and when you look at everything involved, it is no wonder that many women who go through this change develop insomnia. For many patients, it can come down to an increased level of stress. Stress can present itself in many different ways, but a common reaction to this stress is that your stress hormones will increase and your body can go into a fight or flight response. This response and increase in your stress hormones (cortisol) will start to impact sleep. Once a patient starts to have poor sleep continuously, then it will start to impact their day-to-day lives, and can subtly result in a few changes in their behaviours and their thoughts around sleep. This adds to the sleeping problems and can make it difficult to get back to normal sleep.

How long will my Menopause-induced Insomnia last?

There is no clear answer to this, the recovery of a woman’s sleep disturbances from their menopause can vary, depending on their specific scenario. If their sleeping problems are only caused by their menopause symptoms (such as hot flushes) and if they don’t have these menopausal symptoms and sleep with no issues, then the insomnia is less likely to be long-term. Symptomatic relief, such as a cooler bedroom environment may be enough to stop all sleeping difficulties. It may be that by effectively treating the hormonal imbalance caused by menopause (with treatments such as Hormone Replacement Therapy – HRT), the frequency of nighttime disturbances and hot flushes will dissipate with treatment.

However, in some cases, Menopause/Perimenopause is just merely the catalyst that starts a woman’s sleeping problems. Insomnia is often started by an initial stressor on the body or mind and even when menopause has ran its course, the insomnia will remain. If you have difficulties falling asleep or maintaining sleep, or your menopause has finished but you still have sleeping difficulties, then it is time to reach out to a sleep specialist to see if Cognitive Behavioural Therapy for Insomnia (CBT-I) is an appropriate treatment for your sleeping problems.

How can I treat my Menopause-induced Insomnia?

It depends on how your sleeping problems are related to your menopause. For some women, this is easy to determine, whereas for others, it may take an outside perspective to determine the issue. Book a 15-minute free consultation if you would like to talk to a trained sleep professional.

My sleeping problems only occur when I have menopausal symptoms.

If you have a night free of hot flushes or other sleeping troubles that are directly related to your menopausal transition, then this is not necessarily an insomnia issue. If you fall back asleep as soon as your hot flush is over, then this section is probably for you. By treating your menopausal symptoms, you will eliminate the sleeping difficulties you may be facing.

  • Hot Flushes: Temperature plays a very important role in sleep. We cannot get into deeper layers of sleep unless our core body temperature drops and so if your body is having difficulties controlling its temperature (a very common symptom whilst going through your menopausal transition), the ability to sleep deeply becomes jeopardised. Ideally, our bedroom temperature should be at 18 degrees Celsius, so having a heater on in your room can make falling asleep more difficult. Try sleeping with the window open, have a ceiling fan on, or if you live in a warm climate, the air-conditioner. The aim is not to be cold in bed, but to breathe in cold air whilst staying warm.
  • Hormone Replacement Therapy (HRT): You should be consulting your doctor during this transition in your life. If you feel your menopausal symptoms are out of control and you are not coping, it may be time to start Hormone Replacement Therapy. Speak to your doctor or specialist on this matter who will provide you with tailored treatment.
  • Vitamins and Minerals: During a menopausal transition, one of the side effects can be that some of our vitamin and minerals become depleted. Some of these vitamins and minerals (such as magnesium, calcium, zinc, iron and B vitamins to name a few) are essential in inducing and maintaining healthy sleep. If you feel like this may be the case, speak to your doctor about getting a comprehensive blood examination to determine if any of these deficiencies may be contributing to your sleeping difficulties.

I sleep badly whether I have menopausal symptoms or not.

Unfortunately, as your body adapts to the sleep disruptions associated with menopause, it continues to perpetuate sleep disturbances even after menopausal symptoms have diminished. If this has become the case, then it’s best to talk to a sleep specialist about it. 

  • Make sure your Sleep Hygiene is correct. Ensuring that every aspect of our daily activities, including sleep hygiene, contributes positively to our sleep at night is crucial. This encompasses not only our sleeping environment but also how we structure our day, our activities, and their timing.
  • Insomnia Therapy. When your insomnia has become chronic, then it may be time to get help from a qualified sleep professional to conduct personalised insomnia therapy that aims to improve your overall sleep. Cognitive Behavioural Therapy for Insomnia (CBT-I) is considered the most effective insomnia therapy by all leading sleep and medical foundations worldwide.

Help! I still can’t sleep….

If you find that your sleep issues have become unmanageable, it’s advisable to schedule an appointment with a qualified sleep professional. They can evaluate your unique situation, examining both your sleep disruptions and various aspects of your overall health and lifestyle. Taking a holistic view of these factors is essential in determining the most effective treatment approach for insomnia.

At TM Insomnia Treatment, we conduct these one-on-one initial sleep consultations online with a trained sleep professional who has years of treating women going through their menopausal transition. If you or someone you know has trouble sleeping, then book an appointment today! No doctor referrals are needed.