How does menopause affect sleep?

According to a recent report published by the Centers for Disease Control and Prevention (CDC), women who are going through menopausal transition are more likely to be sleep-deprived than premenopausal and postmenopausal women.

The report was based on data collected through the National Health Interview Survey (NHIS).

The NHIS is a multipurpose survey that covers a wide range of topics, including health behaviors, health conditions, and healthcare access and utilization.

The subset of data for this particular report was collected from nonpregnant women aged 40 to 59 years old.

“For this whole sample of women, 35 percent indicated that they slept less than seven hours on average in a 24-hour period,” Anjel Vahratian, MPH, PhD, chief of data analysis at the CDC’s National Center for Health Statistics, told Healthline.

“But that ranged from 32 percent in premenopausal women to 56 percent in perimenopausal women,” she continued.

These findings have important implications for the health and well-being of women going through menopausal transition.

“It’s an area for targeted health promotion because we know that sleep is a modifiable risk factor for diabetes and cardiovascular disease and a variety of other health issues,” Vahratian said.

“So, it’s something for women to consider as they age, that their sleep may change over time,” she added. “They should be aware of it and consider how they might make adjustments based on their needs.”

Hormonal fluctuations affect sleep patterns

For optimum health, the CDC encourages adults to get at least seven hours of sleep per day on average.

But for women who are going through menopausal transition, that target can be challenging to meet.

“When women are in menopausal transition, the hormonal fluctuations that occur have an impact on their sleep patterns,” Joan Shaver, PhD, RN, FAAN, a professor and dean of the College of Nursing at the University of Arizona, told Healthline.

These hormonal fluctuations can negatively impact a woman’s mood and her body temperature regulation, which can in turn affect her duration and quality of sleep.

“I did studies a while ago, where we looked at what women said about their sleep at midlife and what we actually measured with polysomnography,” Shaver said.

“We found that for women who had a lot of vasomotor instability, or hot flashes and night sweats, their physical sleep was indeed not very good,” she said.

“And for women who didn’t have excessive hot flash activity but had higher levels of emotional distress, they often sensed and reported that their sleep wasn’t good,” Shaver added.

For the majority of women, menopausal symptoms are a nuisance, but not debilitating.

But for some who are particularly sensitive to fluctuations in their reproductive hormones, the symptoms of menopause can be more disruptive.

“For this subset of women who are very sensitive to hormonal fluctuations and highly bothered by symptomatology,” Shaver said, “we need to pay attention and take them seriously.”

In addition to hormonal fluctuations, other factors can also impact a woman’s sleep around the time of life that most go through menopausal transition.

For example, pressures to juggle multiple roles and navigate changes at home and work can increase midlife levels of stress.

Obstructive sleep apnea and other chronic health conditions that impact sleep also tend to become more common with age.

Healthy habits may help

If you experience trouble sleeping during menopausal transition or other periods of life, adopting healthy sleep habits may help.

“There are several things that people can do, and menopausal women can do, on their own to try to improve sleep,” Sara Nowakowski, PhD, MS, a board-certified clinical psychologist who specializes in behavioral sleep medicine, told Healthline.

“Things such as making sure you have a regular sleep schedule. Getting up at a consistent time, no matter how you slept at night. Going to bed when you’re feeling sleepy, but not really trying to force it,” she continued.

If you’re having trouble falling asleep at bedtime or after waking up in the middle of the night, Shaver and Nowakowski suggest getting out of bed and engaging in a relaxing activity.

“Ironically, the more you try to sleep, the worse it becomes. Instead, try listening to music, reading, or praying or meditating until you feel sleepy,” Nowakowski suggested.

To help alleviate hot flashes, she recommends keeping your bedroom at a cool temperature, layering your bedding for easy removal, and sleeping in light or sweat-wicking pajamas.

It may also help to keep a glass of ice water on your nightstand for sipping and a frozen icepack under your pillow, so you can flip your pillow to the cool side when you feel hot.

Limiting your consumption of caffeine and alcohol in the hours before bedtime can also help prevent hot flashes and improve sleep.

If those strategies aren’t enough, it may be time to seek professional help.

The American College of Physicians recommends cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment for insomnia. It should be tried before medications.

“CBT-I is a structured, short-term, skill-focused psychotherapy aimed at changing maladaptive thoughts and beliefs and behaviors contributing to insomnia,” Nowakowski explained.

While a variety of so-called “sleeping pills” are also available, CBT-I poses fewer risks of negative side effects and tends to have longer lasting impacts.

“If people are looking for CBT-I for insomnia, they can go to the Society for Behavioral Sleep Medicine website and find a list of providers that are certified in behavioral sleep medicine,” Nowakowski said. “There are also some websites that women can check out to get self-help. There’s one, for example, called Sleepio, which offers an online, fully automated program of CBT-I.”