Catching Your Zzzs: Sleep and Menopause

By: Red Hot Mamas

Published: May 26, 2010

Among other things, sleep disturbances, including insomnia and sleep apnea, are a frequently reported complaint in menopausal women. Fluctuating hormone levels and hot flashes may disrupt a woman’s ability to sleep. Hot flashes during sleep (night sweats) are caused by widening of the blood vessels near the skin’s surface and are associated with decreased levels of estrogen. A woman can wake repeatedly during the night. Some experts estimate that a woman may wake up hundreds of times a night due to hot flashes. Her heart rate may increase and she may feel anxious.

In a National Sleep Foundation (NSF) poll, 43 percent of menopausal and postmenopausal women reported waking at night and needing to go to the bathroom often or always during the previous month. On average, the women polled reported experiencing hot flashes during sleep three nights a week. In addition, hot flashes caused sleeping difficulties an average of five nights a month.

Compared with perimenopausal women, those who had been through menopause were more than three times as likely to have had severe sleep-disordered breathing in a study from the University of Wisconsin-Madison. Sleep disordered-breathing is characterized by snoring and repeated breathing pauses during sleep, known as sleep apnea. The condition is a common cause of daytime fatigue, and may also increase the risk of high blood pressure and cardiovascular disease. Postmenopausal women often experience increased problems breathing and a significant increase in sleep apnea due to decreased levels of estrogen. Younger women, who have undergone surgical menopause in addition to those who are overweight and/or sedentary, are also at risk for this condition.


Insomnia is the most common sleep problem. Women are more likely than men to report insomnia. In fact, according to the NSF poll, 53% of women aged 30-60 experience difficulty sleeping often or always: 47% aged 40-49, and 50% aged 50-60. Fortunately, there are a number of approaches to improving sleep, including those you can do yourself such as exercise, establishing regular bedtimes and wake times, dietary changes (less or no caffeine and alcohol) and improving your sleep environment.

Sleep Solutions

If you sense the main problem is a poor quality sleep and not insomnia, it is important to see your physician for a sleep study which can diagnose sleep apnea or other sleep disorders. The treatment of the problem will be based on what is found. For insomnia, the following measures may be useful:

  • Make sure bedroom noise is controlled and temperature is cool
  • Maintain a fixed schedule to going to bed and getting up. Try not to vary it.
  • Avoid alcohol and exercise within 5-6 hours of bedtime and no caffeine after noon.
  • Do not look at the bedroom clock after you lie down in bed or if you get up at night
  • Eat a light snack containing protein, especially tryptophan, before bed. This would include milk, cheese, yogurt, cottage cheese, bananas, fish, and turkey.
  • Do not reflect upon the day’s events or your “to do” list in the hour or two before bed

Taking estrogen therapy (ET) or estrogen plus progestin (HT) lowers has been shown to lower the incidence of sleep apnea and generally improves menopausal sleep difficulties that would be classified as insomnia. This estrogen improvement of sleep is a long term rather than a short term effect. For surgical menopause especially, and for natural menopause within the first 5 years, ET should be at higher levels to prevent both hot flashes and sleep disturbances than doses used later in menopause.

Non-prescription and other medical alternatives to treat sleep disturbances include melatonin and sleeping medication. Melatonin is a brain hormone that is secreted according to a person’s biorhythm. It is low during the day and peaks in the middle of the night. Exposure to light and dark controls its secretion rather than when sleep occurs. It has been well documented to be lower than normal in subjects with insomnia and administration of it may improve sleep problems in some people. Melatonin levels are lower in menopausal women who have insomnia. You can have your level checked with a home test or by your healthcare professional. A dose of 10 mg a day by mouth seems to be safe over a 30 day period but whether it should be used on a regular basis for insomnia or other sleep disorders has not yet been determined. Skin cream with melatonin can also be used.

Short acting sleeping medications are preferred whenever something is prescribed so that there is not a residual daytime sedative effect. Most people who take sedatives for sleep report that their sleep is better, but when questioned about symptoms, they seem to have the same amount of symptoms as insomniacs who do not take any prescribed medications. For this reason and also because sleeping medications can produce undesirable side effects, most physicians do not recommend long term treatment with medications. It follows that long term melatonin treatment would not be recommended for the same reasons.

Read the Red Hot Mamas’ Sleepless in Menopause City Newsletter for more information about sleep problems at menopause.

Also check out our other articles on Ways to Treat Menopause Insomnia.