Everything You Need to Know About Menopause and Sleep

Medically reviewed by Peter Weiss, MD

Menopausal symptoms can affect sleep at various stages of menopause. Menopause, sometimes called the "change of life," causes hot flashes and mood swings. Additional symptoms might include sweating, weight gain, and vaginal dryness.

Sleep disturbances are quite common in menopause, and prevalence seems to increase with age. Sleep disorders in menopause range from 16% to 42% of people in premenopause (before any transition has occurred), 39% to 47% in perimenopause (the transitional phase to menopause), and 35% to 60% in postmenopause (more than 12 months after the last menstrual period).

While anyone can experience sleep problems with menopause, they are reported more frequently and at more severe degrees in Black people than White people. This disparity can be due to socioeconomic factors affecting Black people, such as structural racism in the healthcare community that can affect their care, increased life stress and mental health issues from ongoing discrimination, increased risk of health comorbidities, and more.

This article covers the connection between menopause and sleep, the symptoms and stages of menopause and how they affect sleep, how people of color are affected, treatments for poor sleep in menopause, and more. 

Menopause and Sleep: What's the Connection?

Menopause occurs because of hormone level declines—mainly estrogen, progesterone, and testosterone. These hormones regulate your reproductive function and menstrual cycles. They will also affect your mood, energy, libido (sex drive), cognition, and sleep. 

As these three main hormones fluctuate during the different stages of menopause, they will affect your sleep. In fact, by the time people reach perimenopause, they already struggle with falling asleep and staying asleep at night.

Another reason for sleep troubles as people age is melatonin levels. Melatonin is the body's natural sleep hormone. Melatonin levels decrease with age, and low levels of this hormone impair the circadian rhythms that control sleep onset and maintenance.

Melatonin level decreases are not necessarily related to menopause. They typically decrease before this transition and affect people of all sexes equally.

Not only are Black women more likely than White women to experience insomnia and other sleep disturbances during menopause, a 25-year study also found that Black women were more likely to reach menopause sooner (8.5 months earlier than White women) and they tend to have worse menopausal symptoms, like depression, hypertension, and vasomotor symptoms.

Note that when research or health authorities are cited, the terms for sex or gender from the source are used.

What Menopausal Symptoms Affect Sleep?

Not getting enough sleep can affect all aspects of your life. Lack of sleep makes you forgetful, irritable, and depressed. It also affects your fatigue levels during the day and makes you less alert and attentive, which could increase your risk of a fall or an accident. Research shows poor sleep can worsen menopausal symptoms, especially hot flashes.

Menopausal symptoms will vary from person to person and throughout menopause, starting at perimenopause and continuing throughout menopause. Symptoms that might lead to sleep problems include:

Hot Flashes and Night Sweats

A hot flash can be described as a sudden and unexpected heat sensation over the body. Night sweats are hot flashes that occur at night and disrupt your sleep.  

Hot flashes are typically accompanied by sweating and start in the face, spreading into the chest and down. They can be short lasting and occur for less than a minute or as long as five minutes. Chills might follow a hot flash.

Bladder and Vaginal Symptoms

A 2015 study found up to 63% of people in menopause experienced bladder and vaginal symptoms at night, which affected their sleep. Such symptoms included needing to urinate frequently at night, soreness and irritation, urinary and yeast infections, and painful, penetrative sex. These symptoms result from thinning, drying, and inflammation of delicate tissues.

Mood Changes

Mood changes common in menopause are anxiety, depression, and irritability. Difficulty with falling asleep can lead to these symptoms, and one of the main causes of depression is insomnia, according to a 2019 Journal of Menopausal Medicine report.

That same report finds people in menopause who experience both depression and hot flashes have a lower quality of sleep than those who are not depressed. 

Related:What Is Perimenopausal Depression?

Joint and Muscle Pain

Joint and muscle pain are common in menopause and can keep you up at night. A 2018 study found that musculoskeletal (muscle and joint) pain affects 21% of people in menopause.

Musculoskeletal pain is commonly associated with fatigue, mood changes, sleep disturbances, increased body fat percentage, anxiety, or stress. It is also affected by lack of physical activity and the presence of degenerative conditions like arthritis, osteoporosis, and more.

The circumstance and factors linked to menopause are unique to women based on race, ethnicity, hormones, body differences, and more. Results from a Study of Women's Health Across the Nation (SWAN) show women of color tend to enter perimenopause and menopause earlier than White women. They may also have longer transition times and experience more severe menopause symptoms, including sleep problems, hot flashes, and vaginal symptoms.

The duration of hot flashes and night sweats in non-Hispanic White women was 6.5 years, 8.9 years for Latinx women, and 10.1 years for Black women. The SWAN study also found Black women with higher fat percentages had the most prolonged and severe hot flashes.

What Sleep Issues Are Associated With Menopause?

Menopause sleep troubles will vary from person to person. Sleep troubles associated with menopause include insomnia, breathing troubles related to sleep apnea, and restless legs syndrome. 

Insomnia

Insomnia refers to chronic troubles falling asleep and staying asleep. People with insomnia report not experiencing restful sleep, frequently waking up at night, waking up early, and fatigue and sleepiness during the day. 

Insomnia is common in menopause due to hormonal changes and menopausal symptoms. Your risk for insomnia will increase as soon as you start having hormonal changes. The more significant the changes, the higher your risk for insomnia. 

Related:Menopause and Insomnia Medications

Sleep-Disordered Breathing

Some research shows that sleep-disordered breathing (SDB) and obstructive sleep apnea (OSA) are more common after menopause.

"Sleep-disordered breathing" is a general term for sleep conditions that affect regular breathing patterns during sleep. Obstructive sleep apnea is a type of SDB.

Before menopause, the risk for sleep apnea is much lower than afterward. Around 20% of people will develop OSA during menopause, and the risk for OSA is higher in menopause than at any time before and increases postmenopause.

Related:Menopause and the Higher Risk of Sleep Apnea in Women

Restless Legs Syndrome (RLS)

RLS causes an uncontrollable urge to move the legs, especially when sitting or lying down at night. While RLS is not explicitly linked to menopause, the condition is common with aging.

Periodic limb movement disorder (PLMD) can also affect sleep and leads to cramping or jerking of the legs every 20 to 40 seconds. One or both conditions can affect people in menopause and disrupt their sleep.

Menopause Stages and Sleep

Menopause can be a long-term transition in which hormones shift and decrease. With each phase, people can experience sleep problems, many of which can affect their health and quality of life.

Premenopause

Premenopause is the reproductive years when you do not experience menopausal symptoms. Throughout your life, your hormones will shift, and there will be changes to estrogen, progesterone, and testosterone. These different shifts can affect your sleep and even lead to sleep problems.

Some people experience sleep troubles before and during their periods due to hormonal fluctuations. Both premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are linked to insomnia, frequent night awakenings, and non-restorative sleep.

PMS causes emotional and physical symptoms leading to menstruation, whereas PMDD appears to be a more severe form of PMS.

Related:Why Am I Always Sleepy?

Perimenopause

Perimenopause is the transitional phase toward menopause. For most people who menstruate, perimenopause typically begins in their 40s, although it is possible to experience it earlier. Perimenopause lasts about seven years but can last as long as 14 years. 

According to a 2017 Centers for Disease Control and Prevention (CDC) survey, more than 25% of perimenopausal women report trouble falling asleep, and 30.8% report trouble staying asleep for at least four days a week. At least half of perimenopausal women report awakening at night and feeling tired four or more days a week.

Menopause and Postmenopause

You reach menopause when you have not had periods for 12 straight months. The time after that is called postmenopause. Progesterone is no longer produced, and estrogen is produced at low levels. While the symptoms of menopause might ease, sleep troubles might continue. 

According to the previously referenced CDC study, more than 55.1% of postmenopausal women report poor sleep, waking up tired and unrefreshed four or more times a week. Around 27% of postmenopausal women report trouble falling asleep, while around 36% report difficulty staying asleep.

Related:Signs and Symptoms of Perimenopause

Can Menopause Treatments Improve Sleep?

Estrogen and hormone replacement therapies can increase estrogen and progesterone levels. When hormone levels are balanced, symptoms like hot flashes, mood swings, and insomnia will improve.

But these therapies can present serious risks for some people, especially those with a personal history or risk for blood clots, heart attacks, and some cancers. If your healthcare provider prescribes hormone therapy, they will prescribe the lowest effective dose for a short period. 

Lower doses of antidepressant drugs, including Paxil (paroxetine) and Celexa (citalopram), can relieve menopausal symptoms, including hot flashes. Some antidepressants might even help improve your sleep quality.

Over-the-counter (OTC) sleep aids, such as melatonin, can help improve your sleep. Your healthcare provider can also prescribe sleep medicines to help you sleep. Prescription sleep medicines should only be taken for short periods and do not cure sleep problems like insomnia.

Some alternative medicine practices, such as yoga, acupuncture, and meditation, can help you to relax and improve your sleep. They might also improve hot flashes, night sweats, and other menopausal symptoms.

Cognitive behavioral therapy (CBT) might also help improve sleep and menopausal symptoms. With CBT, a therapist can help you recognize behaviors affecting your sleep quality and recommend healthy habits to promote better sleep.

How to Sleep Better During Menopause

If you are experiencing sleep problems related to menopause, you should contact a healthcare provider. They can recommend treatments and sleep strategies to help manage menopausal symptoms and improve sleep.

The National Institute on Aging recommends the following ways to improve your sleep during your menopausal transition and beyond:

• Follow a regular sleep schedule and avoid naps in the afternoon or evening.

• Develop a bedtime routine. A bedtime routine that can help with sleep might include reading, listening to music, or taking a warm bath.

• Avoid watching television or using a mobile device in your bedroom.

• Keep your bedroom quiet and at a comfortable temperature.

• Exercise regularly but not too close to bedtime.

• Avoid large meals, alcohol, and caffeine close to bedtime.
  

Summary

Sleep problems in menopause are common and might be attributable to hormone changes and symptoms like hot flashes, mood swings, joint and muscle pain, and vaginal dryness. Sleep problems seem to increase based on the stage of menopause and can vary from person to person. Sleep troubles are also more common and more severe in Black women. 

You can improve sleep troubles by managing menopausal symptoms with hormone replacement therapies and antidepressants. Melatonin and prescription sleep aids might also improve sleep. Additional options for managing menopausal symptoms and sleep are CBT, alternative medicine practices like acupuncture and meditation, exercise, and good sleep habits.