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Women’s Sleep Series: The Impact of Menopause on Sleep

According to research shared by the Huffington Post, hormonal changes can often be the culprit in lost sleep for women. Women have a more difficult time getting enough sleep at certain points in their menstrual cycles each month. Pregnant women also frequently lose sleep or suffer from insomnia as hormone levels surge during their pregnancy. Menopause can also bring about hot flashes and restlessness at night that prevent women from getting adequate or restful sleep. This is the third, and final, post in a series of blogs that focus on the various conditions that affect women’s sleep, and what they can do to help ensure they get a better night’s rest.

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The Effect of Menopause Sleep

Sleeping may seem like an impossible dream when you are going through menopause.

Menopause is part of a woman’s normal reproductive cycle, one that signals the end of monthly menstruation and a woman’s fertile years. During this time in a woman’s life, sleep disturbances are extremely prevalent and present a challenging problem. It is important to try and figure out what exactly is disturbing your sleep. Most often, it is the hormonal changes related to menopause and hot flashes. Sometimes, the problem is a different age-related health problem like joint pain or incontinence. Stresses and anxiety over family life and work may also be keeping you awake at night. If you were already a troubled sleeper, entering menopause can make your sleep disturbances, like insomnia, even worse.

According to the National Sleep Foundation, 61 percent of perimenopausal and postmenopausal women report frequent bouts of insomnia. Insomnia and other sleep disturbances during menopause are often caused by hot flashes.  In fact, per the American Congress of Obstetricians and Gynecologists, fluctuating levels of estrogen and progesterone that occur during perimenopause and menopause can cause hot flashes in about 85 percent of American women. Of these women, 25 percent will experience hot flashes for five or more years. A hot flash leaves women tossing and turning at night, and waking up soaked with sweat. Some women will even have to change clothes or bed linens in the middle of the night. All this extra nighttime activity can make it difficult to resume sleeping, resulting in insomnia.  The following day these women will commonly find themselves irritable, anxious, fatigued, and having difficulty concentrating.

 

Menopause Treatments

Estrogen Replacement Therapy (ERT) and Hormone Replacement Therapy (HRT)

Both ERT and HRT have been found to be helpful in relieving menopausal symptoms. The effects vary depending on the form taken- pill, patch, cream, gel, or injection- and how long it is taken.

Women using HRT to reduce the symptoms of menopause should only take it at the lower doses, for brief periods. It is no longer recommended to use for the long-term due to government studies by the Women’s Health Initiative. The studies found that using HRT for a prolonged period of time put women at a higher risk of cardiovascular disease and dementia. Women who are at high risk for breast cancer or have a history of blood clots and certain other medical conditions should not use HRT. Talk to your physician about your symptoms, the risks, and benefits of HRT and alternative approaches for managing menopausal symptoms, including sleep.

Alternative Treatments

  • Nutritional Products and Medications- Calcium supplements, vitamin D, and bisphosphonates for the preventing or treating of osteoporosis. Estrogen creams and rings for vaginal dryness. Sleep-promoting drugs, like melatonin, for insomnia. All forms of estrogen that enter the blood stream reduce hot flashes.
  • Phytoestrogen- Phytoestrogen is found in soy products like tofu, soybeans, and soy milk. It is a plant hormone that is similar to estrogen. There are no consistent results for soy products ability to relieve hot flashes, but it may help some. Soy products can also have gastrointestinal side effects. Phytoestrogens are also found in over-the-counter supplements like ginseng, extract of red clover, and black cohosh. These supplements are not regulated by the FDA. Proper doses, long-term effects and risks, and safety of these products are still unknown. Remember, natural doesn’t always mean safer.
  • Antidepressants– Low-dose antidepressants such as fluoxetine (Prozac) may be effective help for insomnia caused by hot flashes, anxiety, and stress.
  • Birth Control Pills– Perimenopausal women may find that low-dose combination birth control pills can help control hot flashes and even out irregular periods.

Remember that deciding what product(s) to use and for how long is something that should be discussed with your doctor. Treatment is different for each woman depending on her personal and family medical history, and other factors like age and symptoms.

 

Tips to Handle Menopause for Better Sleep

If menopause symptoms continually keep you up at night, make an appointment to see your doctor. And in the meantime, use these tips to better your sleep at night.

  • Choose cotton at bedtime. Wear breathable, light-weight cotton sleepwear and choose cotton sheets over synthetic materials.
  • Keep the room cool. Add and remove blankets on your bed as needed, but keep the room temperature between 60 and 70 degrees.
  • Cool your body. As a hot flash comes on, drink some ice water or chew on crushed ice. The ice will cool you from the inside. Take a cold shower before bed to lower your body temperature, and use a fan in the bedroom to keep the air circulating and cool.
  • Watch what you eat. Foods that are spicy or acidic can trigger hot flashes. Avoid eating large meals, especially close to bedtime. As mentioned above, eating foods rich in soy may help minimize your hot flashes.
  • Stay away from caffeine. Caffeine is found in coffee, colas, teas, and chocolate. It is a stimulant that can take up to eight hours to leave your system. Not only can it keep you awake, but for some women, it may also trigger hot flashes. Avoid it altogether if you suffer from insomnia or night sweats that continually wake you up. If you must have it, drink it early in the day and never after noon.
  • Quit smoking. Smoking makes estrogen levels fall more rapidly, so, women who smoke are more likely to have moderate to severe hot flashes.
  • No alcohol before bed. Alcohol a potential hot flash trigger. And, though it may help you relax and fall asleep, it makes it hard for you to stay asleep. Alcohol also keeps you from the deep restorative stages of sleep.
  • Exercise. A study from Northwestern University found that regular aerobic exercise can improve sleep quality, mood, and vitality. The timing of exercise is important. Avoid stimulating exercise within two to three hours of bedtime as it can interfere with your ability to rest. Also, regular exercise helps you maintain a healthy weight- this is important because, in the earlier stages of perimenopause, women who have more body fat tend to have worse hot flashes.
  • Relax. If anxiety is keeping you awake at night, try a relaxation technique to help you fall asleep. Meditation, yoga and deep breathing are all great options. Include it in your bedtime routine, like brushing your teeth. Talk to a behavioral health professional if you are feeling depressed and/or anxious.
  • Get up. If hot flashes (or anything else) wake you, don’t torture yourself lying awake in bed. If you haven’t fallen asleep after 20 minutes, get up and do something relaxing until you feel sleepy again. Avoid turning on too many bright lights or using electronics as they are stimulating and may wake you more. Remember, worrying about not sleeping can keep you from sleeping!

If you find that you are regularly having trouble sleeping and feeling rested, then you may have a sleep disorder. You may benefit from an appointment at one of the Valley Sleep Center’s five convenient locations for a sleep consultation with one of our board-certified sleep physicians.

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