Menopause is notorious for causing symptoms like hot flashes, night sweats, and mood swings. Insomnia is another challenge women face during this transition. Between 40 and 60 percent of menopausal women say they have trouble sleeping. For many, insomnia is one of the most distressing symptoms of menopause.
The most often reported sleep-related complaint during menopause is waking up during the night. Taking a long time to fall asleep, waking up too early in the morning, and not getting enough sleep are other common issues, says Mary Rosser, MD, PhD, an ob-gyn and director of Integrated Women's Health at NewYork-Presbyterian/Columbia University Irving Medical Center in New York City.
Something else also happens during those restless nights. “When you're awake, if you're tossing and turning and trying to go back to sleep, you start thinking about other things in life — the stressors,” says Dr. Rosser. Stress is yet another sleep disruptor.
Between 40 and 60 percent of menopausal women say they have trouble sleeping. For many, insomnia is one of the most distressing symptoms of menopause.
— Mary Rosser, MD, PhD, gynecologist and director of Integrated Women's Health at NewYork-Presbyterian/Columbia University Irving Medical Center
Lack of sleep leads to “brain fog, irritable mood, and fatigue the next day,” Rosser adds. Sleeplessness also takes a toll on your health. Women who don't get enough restful slumber are at increased risk for heart disease, dementia, depression, and car accidents.
Menopausal women who experience insomnia have more hot flashes than those who sleep well (42 percent versus 14 percent). Hot flashes cause more nighttime awakenings, and the cycle repeats.
Knowing how menopause affects sleep and how to treat insomnia can help you get back to more restful nights.
A steep decline in the production of estrogen is responsible for most menopausal symptoms, including insomnia. “Hormonal fluctuation leads to hot flashes or nighttime hot flashes — night sweats,” explains Rosser. Around 75 percent of women in menopause experience these intense bursts of heat, in which they wake up during the night soaked in sweat.
Weight gain is another factor contributing to sleep loss. Up to 70 percent of women gain weight in their fifties and sixties, putting on an average of 1.5 pounds per year.Overweight and obesity contribute to obstructive sleep apnea — pauses in breathing that lead to repeated nighttime awakenings, says Rosser. Anxiety and depression, which are also more common during menopause, disrupt sleep even more.
If night sweats are causing insomnia, menopausal hormone therapy (MHP), also known as hormone replacement therapy (HRT) can help. “You're getting back the hormones you lost that are causing issues with sleep,” says Rosser. Estrogen helps regulate your body's internal thermostat to keep you cooler at night. If you still have a uterus, you'll take progesterone with estrogen. Progesterone both lowers the risk for uterine cancer and has a sedative effect that helps induce sleep.
HRT can treat menopausal symptoms beyond just insomnia and can be prescribed in a variety of forms: pills, patches, gels, and more.
Some women are at higher risk of adverse effects from hormone therapy, such as those with a history of breast or ovarian cancer or those at high risk of heart disease. For these women, antidepressants called selective serotonin reuptake inhibitors (SSRIs) are another option. Rosser stresses that taking an antidepressant doesn't imply you have depression or anxiety. “In fact, SSRIs act to control temperature, so they can help with hot flashes and night sweats.” The SSRI doses for sleep are much smaller than those used to treat depression and anxiety. Gabapentin (Neurontin), a drug typically prescribed to treat epilepsy, may also improve sleep when taken at night.
Some insomnia treatments don't come in a bottle. A program called cognitive behavioral therapy for insomnia (CBT-I) addresses the thoughts that contribute to poor sleep, and teaches behavioral changes like relaxation techniques to manage insomnia.
These are the lifestyle changes Rosser recommends to her menopausal patients.
Eat a Well-Balanced Diet
Healthy eating is beneficial at every age and stage of life, but certain nutrients are known to promote better sleep:
Tryptophan is an amino acid the body uses to make serotonin, a chemical messenger that helps regulate sleep. Foods like cheese, nuts, and turkey are high in tryptophan, which is why sleepiness often follows Thanksgiving dinner.
Glycine, another amino acid, calms the nervous system and promotes deeper sleep. It's found in meat, cheese, fish, dairy products, and vegetables.
Resveratrol is a phytoestrogen — a plant-based compound in grapes and wine that mimics the effects of estrogen in the body. It may help with hot flashes.
Isoflavones from foods like soybeans, peas, lentils, and peanuts, also have estrogen-like effects that might help with sleep.
Vitamin E, found in nuts, seeds, and fruits like avocados and mangoes, may improve sleep quality.
Iron and folate from leafy greens and beans can help decrease restless leg syndrome, a common cause of insomnia in women.
While eating more healthy foods, try to cut back on unhealthy ones, especially those high in sugar. Taming your sweet tooth can be harder to do when you're not sleeping well. “When people are sleep-deprived, they tend to crave carbs or simple sugars, and that leads to diabetes and weight gain,” Rosser says.
Stay Active
A daily fitness routine can help you fall asleep faster and improve sleep quality. Exercise acts like a natural sleep aid, in part by increasing the production of the hormone melatonin that regulates the sleep-wake cycle, and also by regulating body temperature.
The fitness recommendations during menopause are similar to other stages of life: a combination of aerobic exercises like cycling, walking, running, or dancing, plus strength training with weights or resistance bands, and exercises to improve balance.
Starting an exercise routine can be daunting, especially for busy women. “When people are told to exercise, they think it's going to classes that take an hour or driving to the gym,” says Rosser. She recommends starting with “bite-sized” amounts of exercise to make it more manageable. Run in place while watching TV or dance around the house for 10 minutes. Just don't exercise too close to bedtime, she cautions. That could make it harder to fall asleep.
Practice Good Sleep Hygiene Habits
To sleep longer and more soundly, try incorporating these tips:
Get into a sleep routine. Try to go to bed and wake up at the same time each day.
Do something relaxing before bed: read a book, listen to calming music, take a warm bath or have a mug of warm milk.
Keep your bedroom dark, quiet, and cool. Experts say the optimal temperature for sleep is between 65 and 68 degrees F.Rosser suggests wearing moisture-wicking pajamas and outfitting the bed with cooling sheets, pillows, and mattress pads to ease night sweats.
Turn off phones, computers, and other screens at least 30 minutes before bedtime.
Don't eat too close to bedtime, especially heavy meals.
Avoid nicotine products like cigarettes and vapes, as well as caffeine. These substances stimulate the brain and make it harder to sleep.
Stop drinking alcohol four to six hours before bedtime. It can disrupt sleep.
Try Alternative Therapies
A few natural treatments also have shown promise for improving sleep during menopause.
Acupuncture This traditional Chinese medicine technique stimulates various pressure points around the body using thin needles. Acupuncture improves sleep quality during perimenopause, the period right before menopause. Exactly how acupuncture promotes sleep is unknown, but it may work by boosting estrogen levels.
Supplements A few natural remedies have shown promise for treating sleep issues in menopause:
Melatonin is a hormone that regulates the body's sleep-wake cycles. A drop in melatonin could contribute to sleep problems during menopause. Replacing it with a supplement might improve sleep quality, although it doesn't work for everyone. “Some women swear by it. Others have bad dreams or it doesn't work,” says Rosser.
Magnesium is an essential mineral found in foods like leafy greens, nuts, whole grains, and dairy products. It's thought to promote sleep by calming the nervous system. Some women find that taking magnesium helps them sleep better, says Rosser.
Black cohosh is a medicinal plant that is well-known for easing menopausal symptoms like hot flashes and night sweats.Some menopausal women find that it helps them sleep longer and more deeply.
Tend to Your Mental Health
When your mind is preoccupied with worries, it's hard to fall asleep and sleep through the night. Relaxation techniques such as mindfulness meditation and deep breathing calm your mind so you can drift off to sleep more easily.
Yoga, which combines movement with meditation, may be particularly helpful for promoting sleep. Yoga can improve not only sleep quality, but also menopausal anxiety and depression that contribute to nighttime wakefulness.
When choosing from these insomnia treatments, remember that everyone responds differently. “Just like with anything in life, perimenopause and menopause are unique experiences,” explains Rosser. “We have to individualize and tailor care. What works for one person may not work for another.”
Insomnia often starts during perimenopause, and continues through the menopausal transition.Some women should start to sleep better after menopause, says Rosser.
If menopause symptoms are to blame for your sleep issues, you can stay on hormone therapy for five years or longer if you need it. “Hopefully by that time, those classic symptoms of menopause will have abated,” Rosser says. Often when women sleep better, many of their other menopause symptoms improve, too, and they feel better overall.
Don't try to tough out insomnia, or any other menopause symptoms. Advocate for yourself and ask your ob-gyn or primary care doctor for treatment to help you sleep more soundly, says Rosser.
The Takeaway
Up to 60 percent of women in the menopause transition have trouble sleeping, and insomnia can be one of the most upsetting symptoms.
Common sleep complaints during menopause are waking up during the night, taking a long time to fall asleep, and waking up too early in the morning.
HRT, antidepressants, and CBT-I are treatments for menopausal insomnia.
Lifestyle changes like a well-balanced diet, exercise, and good sleep hygiene can also promote better sleep during menopause.
