Menopause and sleep

When we asked what health goals were most important, many of you said improving sleep came #1. But with jobs, children, husbands, and already juggling fifteen other things, how can you sleep more? One of the worst ways to wake up is feeling more exhausted than when you went to bed the night before but menopause, alongside everything else, can really impact your sleep. So we wanted to share some information on sleep during menopause and tips for improving it. 

There are many types of menopause sleep problems, including difficulty getting to sleep, difficulty staying asleep, early morning waking, poor quality of sleep, fewer hours sleeping, and daytime sleepiness. In fact, surveys show sleep related symptoms affect over 6 in 10 women, with around a quarter saying that a lack of sleep affects their daytime activities. Poor and insufficient sleep has health impacts beyond menopause, too. Insufficient sleep is associated with detrimental effects on our mental, heart, and cognitive health. (6)

How does menopause affect sleep?

The changes in hormones during menopause can disturb your sleep. You can see our article on the stages of menopause to better understand these changes. What's important to note is that hormonal changes may be directly affecting your sleep cycles, or indirectly affecting your sleep, by causing symptoms like night sweats, anxiety, or low moods. Needing to pee more frequently during the night, restless legs, or joint aches and pains can also affect the quality and quantity of sleep you get.

Sleep itself is regulated by two processes called the circadian rhythm and homeostasis. Changes in these processes can affect how much you want to sleep and the quality of sleep itself. (2) Between 32 and 40 percent of women experience sleep problems during early menopause, towards the end of menopause this percentage rises to between 38 and 40% of women. (1,3)  

Understanding how hormones underpin sleep

Oestrogen and progesterone are hormones that can affect your sleep. Lower levels of oestrogen are common during menopause and they are responsible for many of the indirect symptoms listed above. Oestrogen replacement can be very effective at reducing these symptoms. However, it is menopausal progesterone decline that can directly affect sleep. Let us explain. (1)

Progesterone helps to promote a sense of calm and relaxation by acting on brain pathways that increase a substance called GABA. (4) Do you remember the last time you had a glass of wine, and that comforting, relaxing feeling after 10 minutes? That was the alcohol acting on your brain to increase GABA activity. 

Going into more detail, progesterone triggers the body to produce GABA production. GABA plays an important part in relaying messages around the brain, and this results in decreased brain activity. You will notice this by feeling less stressed, more in control of your moods and achieving normal sleep. So declining levels of progesterone during menopause can mean less GABA, and increased anxiety or restlessness when trying to sleep. (5)

Besides GABA, melatonin is another important hormone that reduces with age, and its release is stimulated by oestrogen and progesterone. Melatonin coordinates our circadian rhythms, giving us the sleepy sensation at night time. (1)

Other explanations for menopause sleep problems 

Another cause of sleep disturbance is a condition called sleep apnoea. Sleep apnoea around and after menopause is thought to be caused by weight changes and progesterone. Weight gain can lead to changes in the upper respiratory tract, which can cause sleep apnoea. On top of this, declining progesterone levels can affect how the muscle at the back of the throat functions (2,1). These can affect breathing and how open the airway, all of which affects your sleep. Along with breathing changes, sleep apnoea affects the quality of your sleep and can also cause depression, headaches, insomnia and other problems. (1)

Lastly, many women experience restless legs syndrome. If you have restless legs syndrome you may experience a tingling feeling in your legs which can contribute to sleep disturbance due to the discomfort it causes and a strong desire to move. (1)

What can I do to help with menopause sleep problems?

Menopause and sleep problems can really impact how you are feeling and coping in your life. If your lack of sleep is affecting your daytime activities and mood, you can consider treatments such as hormone replacement therapy (HRT) or cognitive behavioural therapy (CBT). Research shows both are effective, though you may have to try them in order to determine which works best for you. Another alternative to help with sleep during menopause is taking over the counter melatonin, which some studies have shown to be beneficial. (1)

Developing healthy waking and sleeping habits can help too. There's even a term for it, "sleep hygiene". Tips for practising good sleep hygiene include:

  1. daily exercise (try a 30-min walk),
  2. avoiding screens and blue light 1 hour before bed,
  3. eating a healthy balanced diet without too much food before bed,
  4. avoid drinking caffeine, even one cup of coffee in the morning can affect your night's sleep as the body can take a full day to process the caffeine,
  5. reducing alcohol will improve the quality of your sleep,
  6. practices for reducing stress, such as acupuncture or hypnotherapy. (6)

If you are up in the middle of the night and can’t fall back asleep, we recommend reading a book by a low light. For more reading on sleep, we like Matthew Walker's book Why We Sleep, which is all about the science of sleep. And the author himself says that he'll take it as a compliment if you fall asleep reading it!