Each woman’s experience of menopause is unique. Nonetheless, approximately 50% of all menopausal women will experience a decline in the quality and duration of their sleep. Worryingly, between 5 and 10% of women will experience chronic insomnia throughout menopause.
During menopause, insomnia is often caused by hormonal changes within the body. Night sweats, body pain, low mood, nocturia (needing to urinate often) and irritability can all cause sleep to become uncomfortable. Having two or more of these complaints puts women at an increased risk of developing chronic insomnia.
Furthermore, the stress caused by sleep disturbances is a tiring experience for the body and mind. As such, many women find themselves in a vicious circle of fatigue. What starts as a physiological response to a hormone change can quickly turn into a lengthy bout of insomnia. Thankfully, menopausal sleep deprivation can be alleviated – and even eradicated, in many cases.
What Helps You Sleep During the Menopause?
Women going through menopause can choose to tackle insomnia directly or indirectly. Insomnia can be treated directly by focusing on alleviating the immediate presentation of symptoms. Alternatively, insomnia can be treated indirectly by managing and/or correcting the hormone imbalances that cause sleep disturbances.
Tackling Insomnia Directly
The following treatments can be considered direct treatments for insomnia:
- Pharmaceutical sleep medication
- Sleep aids – such as white noise machines for sleep
- Improving the sleep environment
- Herbal remedies for sleep
- Improving sleep hygiene
- Listening to classical music
Treating Hormone Imbalances
The following treatments can be considered indirect treatments as they are employed to correct hormone imbalances within the body. Balanced hormones help to protect the body from unpleasant menopausal symptoms such as night sweats, body pain, low mood, and nocturia.
- Hormone replacement therapy (HRT)
- Nutrition – including phytoestrogens
- Stress relief
- Herbal remedies – including phytoestrogens
- Exercise before sleep
Choosing a Treatment for Insomnia
Treating insomnia with ‘direct’ treatments is likely to provide menopausal women with short-term relief. On the other hand, tackling the underlying hormone imbalances through indirect treatments will provide a more long-term solution to the problem.
Moreover, correcting hormone imbalances may also improve menopausal symptoms unrelated to sleep deprivation such as dry skin and hair thinning. However, these indirect treatments do not necessarily provide immediate relief.
On balance, a combination of direct and indirect treatments will break the vicious cycle of fatigue effectively.
Why Does Menopause Affect Sleep?
As mentioned, hormonal changes are responsible for affecting a woman’s quality of sleep during menopause. These hormonal changes vary according to the stage of the transition.
Perimenopause refers to the years leading up to a woman’s menopause (typically mid-to-late forties). A woman’s monthly cycle will change dramatically during the perimenopause. At times, there will be a sharp increase in estriol levels, which will lead to fluctuating levels of estrogen in the body. Typically, this results in intermittent hot flashes, slight mood changes, and occasional periods of disturbed sleep.
The average age for entering menopause is 51. At this stage, a woman’s monthly cycle will cease so she will no longer experience fluctuations in estriol levels. However, a new kind of ‘hormone imbalance’ can occur.
She will produce much smaller amounts of estrogen and progesterone in her ovaries, but her production of testosterone will remain the same. This can result in testosterone dominance. In addition, she will produce large amounts of follicle-stimulating hormone (FSH). These factors can lead to further hormone imbalances which disturb the quality and length of sleep.
If women have managed insomnia effectively during these two stages, it’s thought that sleep will improve during the postmenopausal stage. However, long-term conditions related to menopause such as osteoporosis are likely to impact sleep negatively in the long term.
In What Ways Does Sleep Disturbance Happen?
The hormone imbalances mentioned can disturb sleep in several ways:
- Night Sweats – Low or fluctuating levels of estrogen and progesterone can prevent the body from modulating temperature. As such, it can become overheated very quickly, leading to night sweats.
- Inability to Relax – Testosterone dominance can lead to the body’s stress response becoming aggravated. This increase in adrenaline makes it more difficult for menopausal women to relax and unwind.
- Inability to Fall Asleep – Hormone imbalances can cause irritability and low mood, which can prevent women from falling asleep effectively.
- Inability to ‘Sleep-Through’ – Once women have fallen asleep, it may be difficult to sleep deeply because of the frequent need to urinate. This urge is caused by hormonal shifts in the body.
- Discomfort – Lowered levels of estrogen can make the body more susceptible to pain in the joints. Increased sensitivity to pain may be responsible for the sleep disturbances commonly felt in menopause. Osteoporosis – a common condition in postmenopausal women – may also cause body pain in the long term.
- Sleep Apnea – Loss of estrogen during menopause encourages weight gain. Weight gain causes disruptive sleep conditions such as sleep apnea. Sleep apnea is more commonly diagnosed in postmenopausal women.
- Fatigue – This is both a cause and symptom of menopausal insomnia. As mentioned, sleep deprivation can be maintained by a vicious cycle of fatigue. Hormone imbalances cause temporary sleep deprivation, which causes a stress response. The stress response heightens cortisol levels in the body, which makes sleeping even more difficult – leading to chronic fatigue.
How to Sleep Better During the Menopause
Thankfully, there’s a multitude of ways to help improve sleep disturbances during menopause. The 10 most popular methods are described in detail below.
Hormone Replacement Therapy to Combat Insomnia
Hormone replacement therapy (HRT) alleviates insomnia by correcting hormone imbalances within the body. Several types of hormone replacement therapy can be utilized, depending on the presentation of symptoms or stages of menopause.
For example, estrogen replacement therapy (ERT) offers menopausal women a top-up of the hormone estrogen. It can be administered in the form of a drug, cream, spray, injection, or emulsion. Estrogen replacement therapy decreases the severity of hot flashes and night sweats. It may also help prevent the development of mood disorders associated with menopausal insomnia.
In addition, to ERT, there is a combined form of HRT which contains both estrogen and progesterone. Combined HRT is suitable for certain women, particularly those with a uterus as it may decrease their risk of developing uterine (endometrial) cancer.
What’s the Evidence?
There is quite a lot of controversy surrounding the use of HRT. Prior to 2002, HRT was prescribed in quite high doses. It’s since been discovered that high doses prescribed over the long-term put some women at an increased risk of developing certain cancers.
Today the consensus suggests that low doses of combined HRT are usually the safest option and can be useful for alleviating menopausal symptoms in some women. A study in The Journal of Clinical Endocrinology & Metabolism has shown that HRT is safe and effective when prescribed to perimenopausal women younger than 49 years of age.
Crucially, there is no ‘one-size-fits-all’ prescription of HRT and it should always be considered in discussion with a health care provider as they’ll decide whether the benefits outweigh the risks.
Improve the Environment to Prevent Menopausal Night Sweats
Although physiological changes in the body are responsible for causing night sweats, it’s possible to limit their intensity by making the bedroom more comfortable. Increasing air circulation is likely to improve sleep quality.
This can be achieved by sleeping near a fan or an open window. In addition, loose-fitting cotton nightwear will help the body stay cool. Keeping a cold glass of water and a cooling spray on the bedside table can also provide relief during the night.
During the perimenopausal stage, women can suffer from both shivers and night sweats, as the body struggles to regulate its temperature. Some women find it useful to sleep with 2 or 3 layers of blankets and to add or discard these depending on how warm or cold they feel.
What’s the Evidence?
In their 2014 book ‘Managing Hot Flushes and Night Sweats’ Hunter and Smith state that increasing air circulation in the bedroom is the most effective non-invasive intervention for managing night sweats. As the first line of treatment, they recommend purchasing a fan or sleeping near an open window.
Using Nutrition to Treat Sleepiness
Nutrition may impact menopausal insomnia in several ways. Firstly, a sensible balanced diet will promote overall health and wellbeing, which will enable women to become more resilient to the effects of menopausal symptoms. Secondly, eating manageable portions and resisting the urge to snack late at night will ensure digestive concerns are not the cause of sleep disturbances.
Thirdly, and perhaps most significantly, certain foods have been shown to increase levels of estrogen in the body – thereby alleviating many symptoms of menopause.
Foods such as broccoli, carrots, and soya are Phytoestrogens. This means they are plant-based forms of the estrogen humans produce in their bodies. As such, when women consume foods such as soya, food may function as a very low dose of estrogen hormone therapy. Therefore, by eating a plant-rich diet, it may be possible to promote hormone balance and improve the symptoms of menopausal insomnia.
What’s the Evidence?
Research in this field was inspired by the observation that American women are much more likely than Asian women to experience menopausal symptoms. Given that the average Asian diet includes a rich variety of phytoestrogenic foods (fruit, vegetables, seeds, soya), this led scientists to predict that diet may help protect against hormone imbalance.
A study published by NCBI found that consuming a diet rich in phytoestrogens significantly decreased the prevalence of hot flashes in menopausal women. This suggests that phytoestrogens may help increase the availability of estrogen in the body. Other studies have shown that about a third of menopausal women who adopted an Asian-style diet saw an improvement in their insomnia within 3 months.
Use Mechanical Sleep Aids to Encourage Sleep in the Menopause
Mechanical sleep aids may improve insomnia across all population groups. When it’s dark, the body produces melatonin, which signals to the body that it is time to sleep. Blackout masks may improve sleep because they prevent the body from becoming stimulated by external sources of light.
Alternatively, a white noise machine may help women to sleep better during menopause. White noise machines produce a small amount of ‘background’ noise. As such, they provide the brain with a very low level of sensory stimulus which dampens and relaxes the body’s internal systems. This means that a sleeping person is less likely to be roused by a sudden movement such as a creaking floorboard.
What’s the Evidence?
A study in the Journal of Research in Nursing and Health published by WileyOnline reported that white-noise machines helped adults sleep for longer. Indeed, these machines may be useful for all insomnia suffers – not just women facing menopause.
Cutting out Stimulants to help Menopausal Sleep Deprivation
Cutting out caffeine and nicotine will improve sleep. This is because they stimulate brain activity – making it more difficult to ‘switch off.’
Reducing the use of stimulants is crucial for menopausal women because stimulants have a greater impact on the body when there is an existing hormone imbalance. For example, if a woman’s estrogen and progesterone levels are lower, and she has testosterone dominance, this means that her adrenaline levels are already aggravated. Adding a stimulant to the system will increase levels even further, making relaxation difficult.
To prevent stimulants interfering with sleep, it’s recommended to avoid caffeine after midday and to cut out nicotine altogether where possible.
What’s the Evidence?
There is ample clinical evidence to suggest that caffeine interferes with sleep quality in all population groups. A large-scale study published by Taylor and Francis Online found that menopausal women who smoke are likely to experience more negative symptoms during menopause – including insomnia and depression.
Exercise Therapy for Menopausal Insomnia
Moderate exercise is the primary treatment for menopausal insomnia. Firstly, for women who live a sedentary lifestyle, moderate exercise will tire them out and create an additional ‘need’ for sleep. Also, exercise can treat menopausal insomnia indirectly by helping to balance hormones.
It should be mentioned that intensive exercise is not recommended for menopausal women. Intensive exercise increases cortisol levels which can cause further damage to the delicate balance of hormones in the body. Active women are encouraged to exercise in the morning, as this will ensure their cortisol levels have returned to normal by bedtime.
What’s the Evidence?
Clinical research demonstrates that moderate exercise is useful for alleviating almost every symptom of menopause. According to the Journal for the North American Menopause Society, gentle exercise such as Yoga is excellent for reducing sleep disturbances in menopausal women. Moreover, yoga is a manageable exercise therapy that most women can practice daily. As such, yoga is likely to provide menopausal women with a long-term solution.
Herbal Remedies for Menopause Insomnia
Herbal remedies can work by tackling the underlying hormone imbalance, or by encouraging rest and relaxation more generally.
As mentioned, it’s thought that phytoestrogens may be useful for tackling hormone imbalances in the body. Several herbal remedies contain phytoestrogens. These include:
- Dong Quai
- Black Cohosh
- Red Clover
- Chaste-Tree Berry
- Evening Primrose
Although these herbal products are ‘natural,’ they shouldn’t be taken without advice from a medical or homeopathic specialist. There have been limited clinical trials exploring the long-term effects of these remedies, and they will not be suitable for all women.
Also, essential oils can encourage sleep more generally. For example, lavender oil is thought to relax the body and mind so can be sprinkled in a warming bath, or on a pillow, to aid sleep. Finally, herbal teas containing valerian root may be useful for encouraging sleep.
What’s the Evidence?
Initial studies have suggested that valerian root may help to stimulate the brain’s GABA receptor.
The GABA receptor is responsible for mediating relaxation and sleep. Clinical trials have shown that valerian tea can improve sleep quality and duration in certain people. However, the therapeutic benefit of drinking a warm drink close to bedtime may go some way towards explaining the improvement in sleep.
The evidence in support of herbal remedies is limited because clinical trials do not frequently focus on this area. While there is some evidence to suggest that phytoestrogens can correct hormone imbalances in the body, medical advice should always be taken before experimenting with the herbs mentioned here. In the first instance, experimenting sensibly with essential oils is fantastic for using herbal remedies to alleviate insomnia.
Using Medication to Sleep Better in the Menopause
Medication for insomnia is usually only prescribed on a short-term basis. Nonetheless, it can be a useful tool for breaking the vicious cycle of fatigue. Most sleep medications are sedatives, and they work by slowing down the body’s functions.
Benzodiazepines are a type of drug typically prescribed for anxiety and insomnia. In some circumstances, these may be offered to menopausal women who are suffering from significant sleep deprivation. Also, another type of medicine called SSRI’s (typically used to treat depression) may assist with the treatment of menopausal insomnia. A medical professional will be able to advise on the best option, depending on women’s symptoms.
What’s the Evidence?
A recent clinical trial published on ScienceDirect found that Zolpidem (a sedative) helped menopausal women sleep for longer. Also, women taking this drug were less likely to wake throughout the night, and more likely to function better during the day.
This suggests that sedative drugs may well improve the symptoms of insomnia. Nonetheless, there are risks associated with sleep medication, so they should not be considered a ‘first-line’ or long-term treatment.
Improve Sleep Hygiene During the Menopause
Good sleep hygiene is crucial for encouraging restful sleep. Before trying anything else, menopausal women should follow these steps:
- Establish a bedtime routine – This may involve taking a bath, doing stretches, reading a book or journaling
- Try not to nap during the day
- Try to establish a regular sleeping pattern but do not ‘fight’ sleep
- Sip water throughout the day to prevent dehydration and nocturia
- Reserve the bedroom for sleeping only – watch TV, read and work in a separate room
- Make sure the bedroom is dark enough – consider blackout curtains
- Ensure adequate exposure to natural light during the daytime
- Try not to use electronic devices after 8 pm. If this is not possible, install a blue-light filter on all electronics and activate it at least 3 hours before bedtime
- Eat light, healthy meals throughout the day and try not to snack before bedtime
- Wear loose-fitting night clothes (or sleep without clothes) and choose comfortable bedding
What’s the Evidence?
Numerous studies have shown that self-help management for insomnia is highly effective when done consistently. Although menopausal women may not receive immediate relief by implementing these tips, a consistent approach is likely to reap many health-related benefits.
Stress Relief to Aid Insomnia in the Menopause
Stress relief is perhaps the most critical defense against insomnia. Women who manage their stress levels effectively are more likely to show resilience. This means they can ‘cope’ with the symptoms of menopause more effectively. Also, reducing stress levels may help to encourage positive hormone functioning. The following activities may be useful for promoting stress relief:
- Yoga and Meditation – to relax the mind and body
- Talking with a friend or family member – to talk through any grief associated with the menopause
- Journaling – to manage the emotions associated with going through the menopause
- Creative activities – to provide a distraction
- Mindfulness – to prevent ruminating thoughts
What’s the Evidence?
Studies suggest that practicing mindfulness helps menopausal women feel less stressed, and more in control of their symptoms. As a result, they are more likely to try a variety of interventions to help improve their insomnia. Stress relief is an essential foundational tool for encouraging effective self-management during menopause.
As mentioned, menopausal women should consider using a combination of treatments to tackle insomnia effectively. Direct treatments such as sleep medication can provide short-term relief, whereas stress-management and good sleep hygiene can improve sleep quality in the long term. Indeed, there’s a suite of treatment options available to help banish sleepless nights for good.