Menopause is the time of a woman’s life when the body no longer releases monthly eggs, and the production of the hormones estrogen and progesterone is substantially reduced. As a result of these changes, many women experience difficulties with sleep.

Symptoms associated with menopause may cause discomfort and interfere with sleep. Menopausal symptoms that may disrupt sleep include:

• Reduced hormone production. Menopause causes a woman’s ovaries to produce reduced amounts of the hormones such as progesterone. This hormone helps to promote sleep, among other functions.

  

• Hot flashes. Hormonal changes that occur during menopause affect the hypothalamus, which is the region of the brain responsible for controlling body temperature and sleep cycles. These hormonal changes may cause the body temperature to rise, resulting in hot flashes that typically last about three minutes. Hot flashes may occur at any time of the day or night. Hot flashes that occur at night are sometimes called “night sweats” due to the excessive perspiration involved.
  
  
• Mood disorders. Some women experience depression during menopause, which can also interfere with sleep.

In many cases, the best way to treat sleep problems associated with menopause is to treat the 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 identified increased risks for heart attack, stroke, blood clots and breast cancer with HRT. Patients are urged to discuss with their physician the potential risks and benefits before using HRT medications to treat their symptoms.  

A healthy diet, regular exercise and a cool, comfortable sleep environment may also help reduce sleep problems associated with menopause.

Menopause is when a woman stops menstruating (having menstrual cycles). During menopause, women may begin to experience side effects related to the hormonal changes that take place at this time. Sleep disorders are among the most common symptoms reported by women during menopause.

Natural menopause, sometimes referred to as “the change” or “change of life,” occurs when the body no longer releases eggs every month, and the ovaries produce substantially less estrogen  and progesterone. Surgical removal of the ovaries (oophorectomy) will cause immediate menopause in a woman, regardless of age. Surgical menopause also causes more severe symptoms than natural menopause because the change in hormone levels is so abrupt.

A woman is considered to have entered menopause when she does not have a menstrual cycle (also known as a period) for 12 consecutive months. In most cases, this occurs when a woman is between 45 to 55 years old, although for various reasons it can happen earlier or later in life. The average age of menopause for women in the United States is 51, according to the National Institutes of Health.

Natural menopause is preceded by a period of transition known as perimenopause. This can begin as early as a woman’s 30s. Perimenopause may end after several months, or may unfold over many years.

Women experiencing menopause report more sleep problems than any other group of women, according to the National Sleep Foundation. In many cases, women begin complaining of sleep disturbances, such as insomnia, in the late 30s and early 40s without realizing that they may have entered perimenopause. For such women, this period of transition is the cause of sleeping problems.

Symptoms associated with menopause cause discomfort that can interfere with a woman’s ability to sleep soundly. Menopausal symptoms that may disrupt sleep include:

• Reduced hormone production. Throughout perimenopause and menopause, the ovaries produce reduced amounts of estrogen and progesterone. This latter hormone helps promote sleep. Thus, as progesterone levels drop, women may have more trouble sleeping.
  
  
• Hot flashes. Hormonal changes that occur during menopause affect the hypothalamus, the region of the brain that regulates body temperature and sleep. These hormonal changes can cause the body temperature to rise, which is usually felt first in the face and chest. These hot flashes may occur at any time of day or night. When they occur at night, they can disrupt sleep. Hot flashes tend to occur more frequently in the first part of the night and less frequently later in the night, when a person reaches REM stage sleep (when dreaming occurs). Menopausal women will often awaken just prior to the beginning of the hot flash, as the body temperature begins to rise. Most hot flashes last about three minutes. Hot flashes that occur at night are often called “night sweats” due to the excessive perspiration that commonly occurs along with the hot flash, further disrupting a woman’s sleep.
  
  
• Mood disorders. About 20 percent of women experience depression during menopause, according to the National Sleep Foundation. Depression can lead to sleep disruptions.

Women who experience sleeping difficulties during menopause are more likely to feel tired and to experience anxiety and depression. Headaches are also associated with inadequate sleep during menopause.

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.

Preparing questions in advance can help patients have more meaningful discussions with healthcare professionals regarding their condition. Patients may wish to ask their doctor the following questions related to sleep and menopause:

1. What are some tips for how I can sleep better during menopause?
   
   
2. Should I consider hormone replacement therapy? What are the risks?
   
   
3. Are there other medications that might help me sleep?
   
   
4. Are there are other ways I can improve my sleep during menopause?
   
   
5. Can you recommend someone who can teach me relaxation techniques?
   
   
6. Do you recommend psychotherapy to help me cope with my anxiety?
   
   
7. Where can I learn more about diets that help promote sleep?
   
   
8. What is your opinion on using soy products or herbal supplements to promote sleep?
   
   
9. My partner has noticed that I’m snoring more often. Should I be screened for sleep apnea?
   
   
10. Do you have tips for how I can stay cool at night without making the room too cold for my partner?
    
    
11. How long will my sleep problems last?