In many cases, the best way to treat sleep problems associated with menopause is to treat the underlying hormonal changes that occur during menopause. For example, hormone replacement therapy (HRT) medications can help reduce hot flashes that disrupt sleep.

However, HRT medications may have serious side effects. The Women’s Health Initiative Study reported an increased risk of heart attack, stroke, blood clots and breast cancer with HRT. Therefore, patients are urged to discuss with their physician the potential risks and benefits of certain medications before using them. Most experts recommend that women who use HRT medications take the lowest possible effective dosage level for the shortest possible length of time.

Some women struggling with hot flashes that disrupt sleep during menopause may find relief from certain other medications. These may include prescription antidepressants or anticonvulsants.

Medications are not the only treatments used to address sleep problems related to menopause. A healthy diet can go a long way toward reducing sleep problems associated with menopause. Spicy and acidic foods, along with caffeine and alcohol, should be avoided because they often trigger hot flashes, which may impact sleep quality. Menopausal women are urged to maintain a healthy weight and to avoid large meals. This is especially important just prior to bedtime.

Some evidence suggests that foods rich in soy may improve the quality of sleep in menopausal women. Soy products such as tofu and soybeans contain a plant hormone (phytoestrogen) that is believed to be similar to estrogen, and therefore may help alleviate hot flashes. However, conclusive evidence to this effect has not been established in clinical trials. In addition, soy products sometimes cause adverse gastrointestinal side effects.

Studies are underway to determine whether specific herbs, including black cohosh, dong quai and wild yam reduce hot flashes in menopausal women. Some people use herbal supplements containing these ingredients in an effort to reduce menopausal symptoms. However, these supplements are not regulated by the Food and Drug Administration (FDA) and the short-term and long-term effects of their use are not fully understood.

Maintaining a cool, comfortable sleep environment may also help reduce sleep problems associated with menopause. Some women may find greater comfort in wearing lightweight clothing and avoiding heavy blankets during sleep. Fans and air conditioning can also help keep a room cool for sleep.

Additional tips to improve sleep during menopause include:

• Keep a regular schedule of going to bed and waking in the morning. A regular sleep routine helps promote sleep.
  
  
• Avoid substances such as nicotine, caffeine and alcohol. This is particularly important before bedtime.
  
  
• Exercise regularly. Vigorous activity for 20 to 30 minutes each day helps promote sleep. However, a person should not exercise within a few hours of bedtime. In addition, women are urged not to begin an exercise routine without first consulting a physician.
  
  
• Learn relaxation techniques. These can help reduce stress and anxiety that may hamper sleep.
  
  
• Drink warm fluids before bedtime. Some women find it easier to sleep after drinking a warm glass of milk or another warm beverage (e.g., noncaffeinated herbal tea).
  
  
• Discuss medication use with a physician. The use of certain medications may be more likely to disrupt sleep.