Hormonal changes that occur during menopause can put women at higher risk for sleep disorders including insomnia, sleep apnea, and restless leg syndrome.
If you’re experiencing sleep problems, your health care team can help through lifestyle changes, medication, and other options.
Getting enough rest is important – it allows your body to heal and gives you the energy you need to do the things you want and need to do.
Poor sleep is a common concern for women as they age. During perimenopause and menopause, there are several evidence-based reasons for that.
Fortunately, that means there are also evidence-based steps you can take to get the rest you need!
Pallavi Khanna, MD, OB/GYN and Certified Menopause Practitioner, leads Regional One Health’s Menopause Support Group. She hosted sleep medicine specialist Ariel Long, DO to discuss the risk factors, symptoms, and treatment options for sleep disorders during menopause.
“A good night’s sleep is important, and you don’t have to wait until you stop having a cycle to seek treatment,” Dr. Khanna said. “Perimenopause can actually be the most difficult time because your hormones are fluctuating and it’s the fluctuations that cause these symptoms.”
Dr. Long said menopausal women are at higher risk of several common sleep disorders, and 50-55 percent of women in perimenopause report sleep problems.
“Hormone levels change during menopause, with estrogen and progestin levels decreasing,” Dr. Long explained. “That can cause hot flashes that disturb you and wake you up, which can contribute to your risk of insomnia. It can also cause increased upper airway collapse, which can put you at higher risk of sleep apnea.”
Dr. Long starts with a detailed conversation about your symptoms and how they impact your life. This way, she can reach an accurate diagnosis and develop a personalized treatment plan.
“Sleep, especially deep sleep, is essential for the body’s recovery – it’s when we regenerates produce proteins that help restore our energy for the day ahead,” said Dr. Ariel Long. “If you’re having difficulty sleeping, talk to your doctor so we can understand what’s going on and help you get the restful sleep you need.”
For some patients, sleep problems are due to lifestyle factors rather than an official diagnosis or medical condition. Caffeine and alcohol can cause sleep disruption, as can working an overnight shift and trying to sleep during the day.
During menopause, the three most common diagnoses are insomnia, sleep apnea, and restless leg syndrome.
Insomnia is sustained difficulty falling and staying asleep, with symptoms lasting for over three months and occurring at least three times a week. “Not everyone who has difficulty falling and staying asleep has insomnia,” Dr. Long said. “Insomnia causes daytime impairment and can impact quality of life.”
Sleep apnea is a repeated upper airway collapse during sleep that can cause snoring, gasping during sleep, and daytime sleepiness. It can put you at higher risk for serious conditions like high blood pressure, diabetes, heart attack, and stroke.
“Sometimes women don’t present the same way as men,” Dr. Long cautioned. “You might have a headache in the morning or wake up not feeling rested. You may feel more irritable or have a harder time dealing with emotions. It’s really important for women to get screened.”
She said women in menopause are 2-3 times more likely to be diagnosed with sleep apnea. In addition, obesity with BMI greater than 35 can increases the risk further.
If Dr. Long suspects sleep apnea, she recommends completing a sleep study for appropriate evaluation. Many patients can do a home sleep apnea test (HSAT) unless they have certain health conditions.
Restless leg syndrome is a crawling or tingling sensation that causes the urgent need to move the legs at night. This can be related to iron deficiency, genetics, chronic health conditions, medications, and lifestyle factors.
“A good night’s sleep is important, and you don’t have to wait until you stop having a cycle to seek treatment,” Dr. Pallavi Khanna said. “Perimenopause can actually be the most difficult time because your hormones are fluctuating and it’s the fluctuations that cause these symptoms.”
While some patients with these conditions require medical intervention – such medications for insomnia or restless leg syndrome or a CPAP for sleep apnea – Dr. Long seeks non-pharmaceutical solutions first: “I don’t jump straight to medication. There are a lot of ways to make adjustments without taking more medication, because medication can have side effects.”
She starts with sleep hygiene.
“Sleep hygiene is important,” Dr. Long said. “It does mean making changes to daily habits which can be hard. Especially, the use of electronics or screens in the evening can contribute to sleep quality or disruption. I recommend putting your phone away at least 30 minutes before bed. If you wake up, avoid checking your phone. Stick to a consistent sleep schedule. Keep your bedroom cool and dark room.”
For shift workers, she suggests wearing sunglasses on your way home so your body has less chance to respond to the bright light. Don’t turn on the TV or look at your phone when you get home, and keep your bedroom cool and dark.
Dr. Long added many patients can improve their sleep with regular exercise, yoga, meditation, and limiting alcohol and caffeine. Melatonin helps some patients, and she advises finding a product that is approved by the FDA so the dosage in each serving is consistent.
Getting enough sleep is important, and Dr. Long said menopausal women should aim for 8 or 9 hours each night.
“Sleep, especially deep sleep, is essential for the body’s recovery – it’s when we regenerates produce proteins that help restore our energy for the day ahead,” she said. “If you’re having difficulty sleeping, talk to your doctor so we can understand what’s going on and help you get the restful sleep you need.”