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Menopause and difficulty sleeping: why and what you can do about it

Menopause and difficulty sleeping: why and what you can do about it


What is happening to my body?

If you were expecting to experience symptoms like hot flashes and night sweats but never anticipated so many sleepless nights, you’re not alone and what you’re experiencing is entirely normal. In this section, we’re going to expand on what’s going on in your body when you experience (peri)menopause-related sleep difficulties. 

Here are some of the most common sleep difficulties you might experience in (peri)menopause:  

  • night sweats due to hot flashes at night, which might make you wake up unexpectedly 
  • insomnia, or the inability to fall or stay asleep more than three nights a week 
  • chronic sleep problems, like obstructive sleep apnoea, i.e., disordered breathing during sleep  

Hot flashes affect around 75–80% of women experiencing menopause; we cover more on how they’re linked to stress and might contribute to night sweats here. Let’s explore some other causes of your sleep difficulties during (peri)menopause.  

Changing hormone levels

During (peri)menopause, your hormone levels are likely to decrease as a result of ageing. These usually include:  

  • oestrogen  
  • progesterone 
  • melatonin (the sleep hormone) 

This, in turn, might mean that you experience:   

  • difficulties getting restorative sleep, or sleep from which you wake up feeling rested and refreshed 
  • waking up earlier than usual; and waking around 3–4 am with difficulty getting back to sleep 
  • aches and pains in your joints at night, which might make it difficult to fall or stay asleep  
  • urinary problems, which might make it difficult to stay asleep 
  • sleep apnoea, or disordered breathing during sleep  

Progesterone might play a role in sleep apnoea since it affects the muscles at the back of your throat, which help you breathe. When it declines with age, it might partially obstruct your upper airway and create disordered breathing during sleep.  

Oestrogen is also linked to regulation of body temperature; when it decreases with time, you might experience sleep disturbances from hot flashes during the night. We cover how oestrogen therapy might be one of your options for dealing with sleep difficulties in a later section in this article. 

Stress, depression, and/or anxiety 

Experiencing your (peri)menopause symptoms could be quite understandably distressing; as a result, you might experience more stress and/or anxiety, or even depression. All these factors can affect your sleep — i.e., the more you experience anxiety, stress, or depression, the more disturbed your sleep, and vice versa.  

We cover what self-care steps you can take to manage these in a later section of this article. 

Chronic sleep conditions 

Night sweats (i.e., hot flashes during the night as you sleep) might make you more likely to experience chronic sleep conditions like sleep apnoea, or disordered breathing during sleep. Sleep apnoea might manifest as snoring or when you stop breathing normally while asleep. As a result, you might experience headaches, insomnia, and excessive daytime tiredness. 

You might be more likely to experience sleep apnoea if:  

  • you’ve had your ovaries surgically removed, sooner than you would have expected natural menopause 
  • you’re above a healthy weight range for your height 
  • you have a history of smoking  
  • you have been diagnosed with metabolic syndrome or diabetes 

We cover how medical devices like mouth guards and continuous positive airway pressure (CPAP) machines can help address sleep apnoea in a later section in this article.

What does it mean for me?

(Peri)menopause-related sleep problems might cause you to feel excessive fatigue daily, which can disrupt your routine and lifestyle. They might also affect other menopause symptoms, including forgetfulness, brain fog, and difficulty concentrating. Since your sleep-wake cycles change naturally with age, this might lead to a worse experience of these symptoms.  

In the long term, sleep difficulties can worsen into other chronic health conditions:  

  • 61% of post-menopausal women report experiencing chronic insomnia 
  • The risk of obstructive sleep apnoea increases by 4% each year after menopause 
  • The risk of metabolic syndrome and obesity increases with inadequate sleep 

Sleep disturbances tend to persist throughout the (peri)menopause years, even into post-menopause — around 39–47% of perimenopausal women and 35–60% of postmenopausal women experience sleep difficulties.   

But while sleep disturbances might be common during the (peri)menopause years, you’re not alone, and we’re here to help you understand your experiences better. Let's explore how you can manage them with a combination of conventional medication as well as self-care steps.

Overcoming your sleep troubles with confidence 

It might seem overwhelming to start (and stick to) new habits to address your (peri)menopause-related sleep troubles — especially when you might already be struggling with fatigue or daytime sleepiness. You could consider picking 1–2 sleep habits you find easy to stay consistent with and take it from there.   

We hope we can help you feel a bit more reassured and confident about managing your (peri)menopause-related sleep difficulties. At Third Nature, we want to provide you with the helpful, informative content you need to navigate your hormonal health with confidence. If you’re looking for some inspiration or support, you could consider connecting with our online community to share your experiences and learn more about women’s hormonal health as a whole. 

Sleep disturbances during menopause might negatively impact your mental health — but speaking up about it and taking some practical action steps can help you feel more empowered and confident on your journey. We cover this topic in greater detail here.


What medical options are available?

Experiencing (peri)menopause symptoms on top of sleep difficulties can be challenging — but seeking professional help can go a long way. Your healthcare provider might prescribe you different types of medications, many of which might positively impact other (peri)menopause symptoms as well, including hot flashes.  

Professional recommendations may include:  

  1. Medical devices: like mouth guards and CPAP machines, which can help with obstructive sleep apnoea. Both keep your airways open and ensure you’re able to breathe properly during sleep. 
  2. Melatonin: might help you fall asleep more quickly.  
  3. Anti-seizure medication: which may help reduce hot flashes and sleep difficulties. 
  4. Oestrogen therapy: to supplement declining natural oestrogen levels.  Oestrogen might play a role in sleep-wake cycles, regulate temperature at night, and support bone health.  
  5. Seeking the advice of a sleep specialist: especially if you’re experiencing chronic conditions like insomnia and/or obstructive sleep apnoea.   

Before choosing any treatment option, it’s highly advisable to discuss your options with your healthcare provider to find a treatment that works best for you and doesn’t include any severe side effects. This is to ensure you’re managing your health holistically so that you can experience the benefits of both conventional medications as well as self-care steps to improve your sleep habits.

What self-care options are there?

 For example, you could consider:  

  1. Stress reduction techniques: like cognitive behavioural therapy (CBT), might be effective in relieving insomnia and other menopause symptoms, especially anxiety, stress, and depression. Other helpful techniques include journaling, seeking social support, breathwork, and mindfulness meditation.  
  2. Adjusting your meals: to include fruits and vegetables, legumes and beans, nuts and seeds, and whole grains — studies have found these can improve sleep quality and reduce your risk of insomnia. You could also consider reducing the amount of added sugar in your overall diet (including white and brown sugar, syrups, honey, and even sugar substitutes like molasses), as well as foods with a higher glycaemic index (like baked goods and white rice) since these are linked to a greater risk of developing insomnia.  Risk of insomnia and decreased sleep quality is directly correlated with alcohol intake, so reducing alcohol may significantly improve sleep.    
  3. Developing a bedtime routine: including sleeping and waking up around the same time, staying in bed with the lights off, and using cotton bedsheets and sleepwear.  Consider a familiar “wind down” routine prior to bed every night. You could keep a nearby glass of water to cool you down in case you experience night sweats. Avoiding napping during the day might help you avoid difficulties in falling asleep later. 
  4. Avoiding triggers: like alcohol, caffeine, or nicotine in the late afternoon or early evening. All these substances can negatively impact your sleep quality. 
  5. Following a regular screen schedule: avoid the blue light from electronic screens (like from your phone, TV, laptop, or iPad) one to two hours before going to bed.  
  6. Sleeping in a cool environment: ideally between 60-67 degrees Fahrenheit (or 15-19 degrees Celsius) by adjusting your bedroom’s thermostat. This can help counter night sweats and sleep disturbances.  



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