The menopausal transition brings a wave of physical and emotional changes, with sleep disruptions being among the most common complaints, affecting about 50% of women in this phase. Often, sleep issues coincide with hot flushes or other symptoms. In perimenopause—the transition period before menopause—sleep problems may start suddenly. Interestingly, women in some cultures, like Japan, report fewer sleep issues, possibly due to dietary or social differences.
Why sleep becomes a challenge during menopause
Hormonal shifts in menopause significantly impact sleep quality. Estrogen, which promotes deep sleep and regulates body temperature, declines during menopause, making it harder to fall asleep, causing more frequent wake-ups, and shortening the refreshing deep sleep phases. At the same time, progesterone—a hormone with calming effects—also decreases, leading to more restless nights. Melatonin production, which regulates the sleep-wake cycle, diminishes as well, intensifying sleep problems. These hormonal fluctuations can be especially challenging in perimenopause, disrupting restful sleep patterns.
"I often woke up in the middle of the night, usually around 3 am, and felt suddenly wide awake. It took me hours to fall back asleep, leaving me completely drained the next day."
- Emily, 54
Symptoms and consequences of sleep disruptions
Sleep issues during menopause often involve waking up suddenly at night, accompanied by hot flushes or general restlessness. Over time, poor sleep quality can lead to chronic sleep deprivation, resulting in fatigue, difficulty concentrating, and irritability. Extended periods of poor sleep can increase the risk of burnout, depression, and significantly impact quality of life.
In the workplace, the effects can be significant. A UK study found that around 20% of women experiencing menopausal symptoms regularly missed work due to sleep issues and other challenges. A survey in Germany reported that 33% of women over 45 reduced their working hours due to menopausal symptoms, resulting in income losses for women and economic impacts for businesses.
Diagnosing sleep disruptions
Diagnosing sleep issues in menopause isn’t always straightforward, as other conditions like depression, thyroid problems, or general stress can also be factors. Typically, diagnosis involves close observation of symptoms and a detailed medical history. In some cases, further tests, such as a sleep lab or blood tests, may be needed to rule out other causes.
Sleep struggles during menopause are real, but don’t let your memory fool you—recall bias makes us focus on the bad nights and forget the restful ones. Sleep tracking tools like wearables or sleep mats provide an objective view of your sleep, showing both the challenges and the good nights. It’s a great way to understand your patterns and start improving quality.
Tracking sleep: logs and wearables as support
A sleep log can help track sleep patterns and reveal factors impacting sleep quality. Modern wearables and sleep tracking devices offer valuable insights, measuring sleep duration, wake periods, and sleep cycles. These tools can be a helpful first step before considering more advanced evaluations like sleep studies.
What you can do: treatment options
Sleep disturbances in menopause can be mild, manageable through lifestyle adjustments, but severe cases may require medical intervention. Left unchecked, serious sleep issues can disrupt daily life and health, increasing risks for heart conditions like heart attacks and strokes. Sleep deprivation is also linked to mental health challenges, including depression and anxiety, as well as weakening the immune system. It’s essential to seek medical advice if sleep disruptions significantly impact life quality.
Lifestyle adjustments
Good news: Simple tricks can outsmart your brain! Here are some tips to improve sleep quality:
Set regular sleep times: Try going to bed at the same time every day, even on weekends—your body will appreciate the routine.
Room temperature: Keep it cool! The ideal sleep environment is around 18–19°C. Cozy blankets, optional!
Limit screen time: We know it’s tempting, but try avoiding screens at least an hour before bed. Your sleep will thank you.
Use bed for sleep only: Train your brain to associate your bed with sleep, not Netflix marathons.
Limit caffeine in the evening: Simple, yet effectiveno coffee after 4 pm!
Cognitive Behavioral Therapy (CBT) and additional treatments
Cognitive Behavioral Therapy for Insomnia (CBT-I) has proven very effective for sleep problems, helping to change thought patterns and behaviors that disrupt sleep. Studies show that CBT-I can bring lasting improvements. Mindfulness techniques, like meditation and breathing exercises, also help reduce stress, which often interferes with sleep. Discuss with your healthcare provider if these therapies might work for you.
Non-hormonal treatment options
There are several non-hormonal approaches to help ease sleep problems:
Melatonin supplements: They support your body’s natural sleep-wake cycle.
Valerian and hops: These herbal relaxants can be gentle yet effective.
Antidepressants (e.g., SSRIs): These can boost mood and improve sleep when hormonal shifts are causing trouble. Prescription only, of course—talk it over with your doctor.
Blood pressure medications (e.g., clonidine): Surprisingly, medications like Clonidine can help manage night sweats, improving sleep in the process. Prescription required.
GABA supplements: GABA, a neurotransmitter that calms brain activity, can help ease nighttime restlessness as a supplement.
Menopausal hormone therapy (MHT)
Menopausal hormone therapy (MHT) remains one of the most effective treatments for sleep disturbances, especially when hot flushes worsen the issue. A meta-analysis shows that MHT can significantly improve sleep quality for many women, with estrogen and progesterone combinations proving especially effective. However, current guidelines don’t recommend MHT exclusively for sleep issues. Talk with your doctor to determine if MHT is the right fit for your symptoms.
Sources
HWR Berlin – Prof. Rumler et al. MenoSupport-Studie. https://blog.hwr-berlin.de/menosupport/wp-content/uploads_menosupport/2024/09/MenoSupport_Ergebnisueberblick-Befragung-Wechseljahre-am-Arbeitsplatz.pdf
McKinsey – Closing the Women's Health Gap. https://www.mckinsey.com/mhi/our-insights/closing-the-womens-health-gap-a-1-trillion-dollar-opportunity-to-improve-lives-and-economies
Baker FC et al. Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nat Sci Sleep. 2018 Feb 9;10:73-95. doi: 10.2147/NSS.S125807. PMID: 29445307; PMCID: PMC5810528.
Xu Q et al. Examining the relationship between subjective sleep disturbance and menopause: a systematic review and meta-analysis. Menopause. 2014 Dec;21(12):1301-18. doi: 10.1097/GME.0000000000000240
Schaedel Z et al. Management of sleep disorders in the menopausal transition. Post Reprod Health. 2021 Dec;27(4):209-214. doi: 10.1177/20533691211039151.
Cintron D et al. Efficacy of menopausal hormone therapy on sleep quality: systematic review and meta-analysis. Endocrine. 2017 Mar;55(3):702-711. doi: 10.1007/s12020-016-1072-9. Epub 2016 Aug 11. :