Does Menopause Cause Insomnia?
Studies show that there’s a link between menopause and insomnia. Up to 60% of menopausal people experience sleep disturbances like nighttime wakings, insomnia, and unrefreshing sleep.
Sleep disturbances are one of the most commonly reported symptoms of menopause, alongside night sweats, hot flashes, and weight gain. These disturbances aren’t limited to people who have had them before, either. A review of menopause-related literature shows that sleep disturbances can happen to people during menopause, even if they haven’t ever had any sleep related-problems before menopause.
And this can have serious health implications, regardless of the initial cause of insomnia. Sleeping fewer than seven hours a night can lead to increased risk for hypertension (high blood pressure), weight gain, diabetes, heart disease, stroke, and depression.
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Why Does Menopause Cause Insomnia?
Many of the sleep disturbances that stem from menopause, including insomnia, are due to hormonal changes. Menopause is a natural part of aging that everyone with female reproductive organs will experience. It typically happens between ages 45 and 55, and symptoms can last up to eight years.
Changes in Hormone Levels
Many menopause-related sleep problems stem from declining levels of estrogen and progesterone. These hormones play important roles beyond reproduction, helping regulate mood, brain function, and the sleep-wake cycle.
As estrogen levels fall, serotonin production may also decrease, contributing to mood changes and sleep disturbances. At the same time, lower progesterone levels can affect the activity of GABA, a brain chemical involved in relaxation and sleep, and reduce progesterone's natural sedative effects. Together, these hormonal changes can make it harder to fall asleep and stay asleep.
Hot Flashes and Night Sweats
About 75% of those in menopause experience hot flashes that give them sudden and intense feelings of heat. Often, people who get hot flashes wake up more and have poor sleep quality. Night sweats are another frequent menopause symptom. Like hot flashes, night sweats are ultimately caused by lack of estrogen.
Excess heat and sweating can make sleep quite uncomfortable. Because they can come on suddenly and without warning, it’s tough to set your bedroom temperature to accommodate night sweats or hot flashes.
Anxiety, Stress, and Mood Changes
As estrogen levels drop, so can serotonin levels, which may lead to mood swings, anxiety, and cognitive issues. Mood changes and stress are widely experienced menopause symptoms. And there’s a bi-directional relationship between sleep problems and stress: Lack of sleep can make stress levels worse and vice-versa.
Other Menopause Symptoms That Affect Sleep
Some people experience bladder problems like incontinence, frequent urination, and urinary tract infections (UTIs). Each of these can cause people to wake up often throughout the night. Menopause can also cause weight gain, joint pain, and fatigue — all of which can affect sleep duration and quality.
What Are the Symptoms of Menopause Insomnia?
There are several common symptoms of menopause-related insomnia and sleep disturbances.
- Frequent nighttime awakenings
- Trouble falling asleep
- Waking up from hot flashes
- Waking up from night sweats
- More time awake than usual
- Poor quality and non-restorative sleep
- Waking up early
Does Menopause Insomnia Go Away?
Menopausal symptoms can last between two and eight years, depending on the person’s age, race, and family history. Once hormone levels equalize, uncomfortable symptoms, including insomnia, usually go away. Evidence shows that as people age past menopause, their sleep often improves.
Menopause insomnia can also go away with treatment, whether that’s treatment for insomnia, menopause, or both.
How Long Does Menopause Insomnia Last?
Unfortunately, there’s no specific time frame for how long menopause sleep problems may last. However, if the insomnia is due to menopause-related hormone and body changes, symptoms could ease and disappear as menopause progresses. Most people go through menopause between ages 45 and 55, and the whole process can last years.
How to Treat Menopause Insomnia
Treating both insomnia symptoms and menopause symptoms may help you get back to better quality, more restful sleep.
Improve Sleep Hygiene
By improving your sleep hygiene, you can train your body to fall asleep easier and stay asleep. Go to bed at the same time each night, and get up at the same time in the mornings, even on weekends. Avoid alcohol and other depressants, especially in the hours leading up to bedtime.
Shut your phone and other screens off and steer clear of blue light before bed. Some people find that meditating or reading before bed gets their mind into a restful place that makes falling asleep easier. Finally, make an inviting sleep environment with the right mattress, bedding you like, and a room temperature that’s conducive to sleep.
Manage Hot Flashes and Night Sweats
Hot flashes and night sweats commonly cause nighttime awakenings and uncomfortable sleep. Hormone replacement therapy (HRT) is one of the most effective methods for treating hot flashes, as it boosts the hormone levels that have been depleted by menopause.
For those who can’t or don’t want to do HRT, there are non-hormonal methods. Selective serotonin reuptake inhibitors (SSRIs) and selective nonepinephrine reuptake inhibitors (SRNIs) have been studied as effective alternative treatments for hot flashes. Yoga, acupuncture, and relaxation training have all been studied as treatments for hot flashes as well, but with varying degrees of success.
Cognitive Behavioral Therapy for Insomnia (CBT-I)
CBT-I is a multi-session treatment that uses multiple strategies to help people fall asleep and stay asleep. The main components are sleep restriction therapy (SRT), stimulus control therapy (SCT), sleep hygiene (SH), and cognitive therapy (CT).
Professionals use these four components to reshape a person’s relationship with sleep and to train them into utilizing healthy sleep habits. CBT-I isn’t a quick fix; it usually takes six to eight sessions. However, there’s evidence suggesting that it’s more effective at treating insomnia long-term than hypnotics.
Hormone Therapy
The first-line treatment for menopause symptoms is hormone replacement therapy. People undergoing hormone therapy boost their hormone levels by taking estrogen, progestin (the synthetic version of progesterone), or both. Replacing depleting hormones can ease many symptoms, including hot flashes, night sweats, brain fog, and sleep problems.
HRT isn’t right for everyone. People who’ve had certain types of cancers, liver disease, blood clots, strokes, heart attacks, and vaginal bleeding should avoid HRT. People who are pregnant should also steer clear.
Medications for Insomnia
The Food and Drug Administration (FDA) has approved certain prescription drugs to treat insomnia, including those known as Z-drugs. These medications slow brain activity enough to help you fall asleep and stay asleep.
Melatonin is a popular over-the-counter supplement that many people take to help them fall asleep. Some people also take antihistamines like Benadryl to fall asleep, but there are risks associated, especially for older adults.
Address Underlying Mental Health Concerns
Stress, anxiety, and mood swings are all common symptoms of menopause, and symptoms that can have a negative effect on your sleep. You may be able to help treat menopause insomnia by considering your mental health as a coexisting condition.
CBT-I is an effective treatment for insomnia, and CBT is an effective treatment for overall mental health. Speak with your physician or therapist to learn which is the right option for you.
Consult With a Sleep Coach
Menopause-related insomnia can be complex. If you're struggling to identify the causes of your sleep problems or determine which treatments may be most effective, Sleep Doctor's Sleep Consult connects you with a sleep professional who can review your symptoms, discuss potential contributors to poor sleep, and help you better understand your options for improving sleep.
For those looking for more ongoing support, Sleep Doctor's Sleep Coaching provides personalized guidance, education, and accountability to help you build healthier sleep habits and address behaviors that may be interfering with sleep.
When to Talk to a Doctor
If your menopause-related insomnia is unmanageable and affecting your daily life, you should speak to your doctor. Consider making an appointment if you experience any of the following.
- Uncontrollable hot flashes and sweating
- Mood swings that don’t improve
- Frequent nighttime awakenings
- Daytime grogginess
- Trouble falling asleep and staying asleep
- Bladder problems
- Sleep that’s not restorative
