Red Hot Mamas In Charge of Change.
By: Guest Author
Published: February 21, 2025
Written by Mandy Zenda, PhD and Victor Vanbremeersch- Guest Contributor
Menopause is not just about hot flashes and mood swings. It also brings frustrating sleep disruptions that many women struggle to manage. Research indicates that 40 to 60 percent of women going through menopause experience significant sleep disturbances, including frequent nighttime awakenings and difficulty falling asleep (Baker et al., 2015). Yet, few know that the most effective treatment is not a pill. Instead, a brief, evidence-based therapy called Cognitive Behavioral Therapy for Insomnia (CBT-I) offers lasting sleep improvements.
How Menopause Disrupts Sleep and What You Can Do About It
Menopause triggers significant hormonal shifts, particularly the decline in estrogen and progesterone, which play essential roles in sleep regulation (Freeman et al., 2015). As these hormones fluctuate, women may experience difficulty falling asleep, staying asleep, or waking up too early. Additionally, night sweats, heightened stress levels, and mood changes further fragment sleep, creating a vicious cycle of sleep disruption.
Beyond the biological changes, the struggle with sleep itself often becomes a stressor. Many women begin to anticipate difficulty sleeping, leading to increased worry and frustration at bedtime, which in turn reinforces insomnia. Over time, well-intended behaviors such as spending extra time in bed or relying on naps can unintentionally worsen sleep problems.
As a clinical psychologist with expertise in behavioral sleep medicine, I have seen firsthand that sleep disturbances are one of the most disruptive yet frequently dismissed symptoms of menopause. Too often, women are told that poor sleep is just an inevitable part of aging when, in reality, effective treatment exists.
CBT-I is widely recognized as the first-line treatment for chronic insomnia, often recommended over sleep aids (American College of Physicians [ACP], 2016). Studies have demonstrated that CBT-I not only improves sleep quality but also enhances daytime functioning and overall quality of life in postmenopausal women (Kalmbach et al., 2019; McCurry et al., 2016). While CBT-I is a powerful tool, some women may also find additional benefits from complementary interventions, such as hormone therapy, depending on their individual needs.
CBT-I: The Key to Better Sleep During Menopause
Unlike general sleep hygiene tips, CBT-I is a structured, science-backed approach that directly addresses the underlying causes of chronic insomnia. It is endorsed by the American College of Physicians as the gold-standard treatment, recognized for its long-term effectiveness without reliance on medication (ACP, 2016).
The Science Behind CBT-I
- Transforming Thoughts About Sleep:
If you are going through menopause and struggling with sleep, you may feel trapped in a frustrating cycle. A poor night’s sleep leaves you exhausted the next day, making it harder to focus and increasing stress. As bedtime approaches, the anxiety of another sleepless night sets in, making it even more difficult to relax and fall asleep. This pattern is common, but CBT-I helps by shifting how you think about sleep. Instead of focusing on frustration and worry, a CBT-I trained clinician guides you toward a more helpful mindset that allows sleep to happen more naturally, with less effort (Harvey et al., 2005).
- Modifying Sleep-Disrupting Habits:
In an attempt to get more sleep, you may try things like going to bed earlier, sleeping in, or napping during the day. While these adjustments might seem helpful, they can actually work against your body’s natural sleep rhythms, leading to even more difficulty sleeping at night. A trained CBT-I therapist can help identify these patterns and guide you toward healthier sleep behaviors. With professional support, gradual and intentional changes to your nighttime routine can lead to deeper, more consistent sleep (Morin et al., 2006).
- Managing Stress and Nighttime Restlessness:
The menopause transition can heighten stress levels, making it even harder to unwind at night. Increased stress and anxiety often keep the mind active when it should be settling down for sleep. CBT-I provides evidence-based tools to quiet a racing mind, reduce bedtime anxiety, and establish a relaxation routine that promotes natural sleep. A trained therapist can help tailor strategies to your specific needs, ensuring that your body and mind can transition into deeper, more restorative sleep over time (Joffe et al., 2010).
Why CBT-I is a Game Changer for Menopause-Related Sleep Issues
Rather than just addressing the symptoms of insomnia, such as difficulty falling or staying asleep, CBT-I helps women identify and change the underlying patterns that contribute to their sleep problems. Instead of relying on short-term solutions like sleep medications, CBT-I provides lasting strategies that empower women to improve their sleep naturally by adjusting their thoughts, behaviors, and routines.
While some sleep strategies can be applied independently, clinician-guided CBT-I offers personalized recommendations tailored to individual sleep patterns and needs. Research shows that structured guidance improves adherence and long-term success rates, making it especially effective for menopause-related insomnia (Kalmbach et al., 2019).
Despite CBT-I’s proven effectiveness, many women face barriers to accessing it, from long waitlists to high costs. There are emerging telehealth platforms such as Moona Health—to make high-quality, insurance-covered CBT-I more accessible with tailored, practical tools designed for menopause-related sleep challenges. Clinician-led support helps women navigate sleep challenges and achieve lasting improvements.
One Moona Health patient shared, “Before CBT-I, I would wake up multiple times with a racing mind and struggle to fall back asleep. Now, my awakenings are brief, and I no longer worry about sleep.” (Testimonial provided with permission.)
Key Takeaways
● Menopause can cause sleep disruptions due to hormonal changes, night sweats, and increased stress.
● Cognitive Behavioral Therapy for Insomnia (CBT-I) is an effective non-medication treatment for chronic insomnia.
● CBT-I helps by addressing maladaptive sleep thoughts, modifying unhelpful habits, and managing stress.
● Clinician-guided CBT-I offers personalized strategies that lead to lasting sleep improvements.
Author Bios
Victor Vanbremeersch, CEO of Moona Health, and Dr. Mandy Zenda, VP of Clinical Care, are dedicated to making high-quality insomnia treatment more accessible and affordable for women. Learn more at www.moona.health.
Sources
American College of Physicians. (2016). ACP recommends cognitive behavioral therapy as initial treatment for chronic insomnia. https://www.acponline.org/acp-newsroom/acp-recommends-cognitive-behavioral-therapy-as-initial-treatment-for-chronic-insomnia
Baker, F. C., Willoughby, A. R., Sassoon, S. A., Colrain, I. M., & de Zambotti, M. (2015). Insomnia in women approaching menopause: Beyond perception. Psychoneuroendocrinology, 60, 96–104. https://doi.org/10.1016/j.psyneuen.2015.06.005
Edinger, J. D., & Carney, C. E. (2015). Overcoming insomnia: A cognitive-behavioral therapy approach, therapist guide. Oxford University Press.
Freeman, E. W., Sammel, M. D., Gross, S. A., & Pien, G. W. (2015). Poor sleep in relation to natural menopause: A population-based 14-year follow-up of midlife women. Menopause, 22(7), 719–726. https://doi.org/10.1097/GME.0000000000000392
Harvey, A. G., Tang, N. K. Y., & Browning, L. (2005). Cognitive approaches to insomnia. Clinical Psychology Review, 25(5), 593–611. https://doi.org/10.1016/j.cpr.2005.04.005
Joffe, H., Massler, A., & Sharkey, K. M. (2010). Evaluation and management of sleep disturbance during the menopause transition. Seminars in Reproductive Medicine, 28(5), 404–421. https://doi.org/10.1055/s-0030-1262900
Kalmbach, D. A., Cheng, P., Arnedt, J. T., Anderson, J. R., Roth, T., & Drake, C. L. (2019). Treating insomnia improves depression, maladaptive thinking, and hyperarousal in menopause: A randomized controlled trial. Sleep Medicine, 55, 124-134. https://doi.org/10.1016/j.sleep.2018.11.019
Morin, C. M., Bootzin, R. R., Buysse, D. J., Edinger, J. D., Espie, C. A., & Lichstein, K. L. (2006). Psychological and behavioral treatment of insomnia: An update of recent evidence. Sleep, 29(11), 1398-1414. https://doi.org/10.1093/sleep/29.11.1398
The views expressed herein this article, written by a guest contributor, do not necessarily represent those of the Red Hot Mamas organization. The content is for informational purposes and should not substitute the advice of your doctor.
