Hormonal shifts during menopause can cause hot flashes, mood swings, and brain fog. But for a lot of women, it also messes with their sleep.
Like periods and negative pregnancy symptoms, menopause has long been considered taboo to talk about above a whisper. And that’s probably why so many women are blindsided by the symptoms they experience as their bodies make this natural transition.
“We get the puberty talk, but we don’t get the menopause talk,” says Pauline Maki, a professor of psychiatry, psychology, and obstetrics and gynecology at the University of Illinois at Chicago, in an article from Vox.
On average, women reach menopause at age 51. A woman has officially arrived at this stage of life once she’s gone 12 months without a period. But the journey can take years, and for some, can begin as early as their mid-30s. That in between time (also known as perimenopause), can last between two and eight years and often comes with symptoms most of us have heard of — hot flashes and mood swings — as well as one that’s not often discussed: disturbed sleep.
So, we spoke to Dr. Jessica Shepherd, an OBGYN, menopause expert, Chief Medical Officer at Hers, and author of Generation M: Living Well in Perimenopause and Menopause, about the connection between menopause and poor quality sleep, how it can impact womens’ health, and tips for getting better zzz’s during this life transition.
Read more: Do Women Really Need More Sleep?
What’s happening in a woman’s body during menopause that makes sleep challenging?
During menopause, hormone levels shift dramatically, especially estrogen and progesterone. These changes can throw off your body’s natural sleep cycle, making it harder to fall and stay asleep.
Then there are the night sweats and hot flashes (also known as vasomotor symptoms — a clinical term for sudden heat surges that can cause excessive sweating and discomfort). These episodes can jolt you awake multiple times a night, making quality sleep feel impossible. This is all regulated by the hypothalamus in the brain, which controls temperature regulation and plays a crucial role in these disruptions.
Is there a difference in sleep struggles during perimenopause versus postmenopause?
Yes, and it all comes down to fluctuating versus stable hormone levels. In perimenopause, estrogen and progesterone are on a rollercoaster, which makes sleep unpredictable. You might have nights of solid rest followed by stretches of insomnia, night sweats, and frequent wake-ups. Post-menopause, hormones settle at lower levels, and while some women find their sleep improves, others continue to struggle due to aging, stress, or other health factors.
A lot of women wake up multiple times a night during menopause. Is the cause related to more than just hot flashes?
Absolutely. While hot flashes and night sweats are major culprits, other issues come into play. Sleep apnea (which is more common after menopause), increased stress, anxiety, and even restless leg syndrome can contribute to waking up repeatedly. Hormonal shifts also impact melatonin production, the hormone that helps regulate sleep, making it harder to stay in deep sleep.
There are also other things to consider for sleep, such as getting 7-9 hours per night and, most importantly, maintaining regularity — going to bed and waking up at the same time each day. Progesterone is very important, and when addressed, it reduces sleep complaints, increases total sleep time, and decreases wakefulness after sleep onset.
Can sleep issues during menopause have long-term effects on things like heart health or brain function?
Yes. Poor sleep isn’t just frustrating, it can have real health consequences. Chronic sleep deprivation is linked to a higher risk of heart disease, high blood pressure, and cognitive decline.
Heart disease remains the leading cause of death for women in the U.S., so maintaining good sleep habits is an important step in supporting long-term heart health. Research also suggests that disrupted sleep may increase the risk of Alzheimer’s disease and dementia. Addressing sleep issues early can help protect long-term brain and heart health. Poor sleep quality has also been associated with a 60 percent increase in overall mortality, a 55 percent rise in cancer-related mortality, and a 43 percent increase in heart disease risk.
How does a lack of good sleep during menopause affect things like mood, focus, or energy levels?
It’s a domino effect. Poor sleep can lead to irritability, mood swings, and even increase the risk of anxiety and depression. Mentally, it affects focus, memory, and decision-making. Physically, it leaves you feeling drained, making daily tasks feel overwhelming. When sleep is off, everything feels harder.
What are some simple, everyday changes women can make to sleep better during menopause?
- Stick to a sleep routine. Going to bed and waking up at the same time every day helps regulate your body’s internal clock.
- Keep it cool. Lower the bedroom temperature, use breathable sheets, and consider a fan or cooling mattress pad to combat night sweats.
- Consider Hormone Replacement Therapy (HRT). Restoring estrogen levels can help decrease night sweats and improve sleep quality.
- Try CBD and CBN therapy. With well-sourced products, these can aid in better sleep.
- Cut back on caffeine and alcohol. These can disrupt sleep, especially when consumed later in the day.
- Move your body. Regular exercise improves sleep quality, but try to avoid intense workouts close to bedtime.
- Try relaxation techniques. Meditation, deep breathing, or a warm bath before bed can signal to your body that it’s time to wind down.
- Look into cognitive behavioral therapy for insomnia (CBT-I). It’s one of the most effective, non-medication approaches to improving sleep.
If sleep issues persist, talk to a healthcare provider. Options like hormone therapy or other treatments may help, depending on your individual needs. The key is to prioritize sleep as part of your overall health — it’s not just about rest, it’s about feeling your best every day.
Read more: The Mattress Certifications You Need to Know
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