Menopause and Sleep: What's the Connection?

If you're a woman in midlife and find yourself tossing and turning, waking up multiple times each night (that is, if you're lucky enough to have fallen asleep in the first place), there's a likely reason: hormones.

According to the National Sleep Foundation, the years stretching from peri- to post-menopause are when sleep problems are most abundant, accounting for 61 percent of reported insomnia. In fact, it's fairly common for women who visit their health care providers complaining of insomnia to learn the reason for their sleeplessness is they're beginning the transition into menopause. Known as perimenopause, its average length is four years.

It's been four years since I last brought attention to this topic, and it bears repeating, because there's undoubtedly a new group of women searching for relief.

During perimenopause and continuing onto menopause, the decline in the production of estrogen and progesterone (a hormone that promotes sleep) ushers in a sharp decline in the quality—and quantity—of your sleep. It can be perturbing and disturbing to be stuck in a rut of sleeplessness—but it will get better.

Hot flashes and night sweats—much like a pesky snoring or restless bedmate—can suddenly rouse you out of a deep sleep, filling you with anguish and anxiety. There are a few treatments that have been found helpful in relieving menopausal symptoms, including estrogen replacement therapy (or ERT) and hormone replacement therapy (HRT), which includes a combination of estrogen and progesterone. Given in pills, patches, gels, creams or injections, these have varying effects on women and, of course, are not an option for everyone.

Alternate ways to manage menopausal symptoms that interfere with sleep include the more natural approaches like calcium supplements, phytoestrogens and over-the-counter nutritional supplements like black cohosh, as well as drugs, such as

sleep-promoting drugs, blood pressure medications like clonidine, and low-dose antidepressants like venlafaxine (Effexor) and paroxetine (Brisdelle). Brisdelle is specifically approved for reducing moderate to severe hot flashes associated with menopause.

But hormones aren't the only culprits in midlife sleep issues. Other "garden-variety" things can also make sleep difficult around this age, like:

• The need to get up to urinate in the middle of the night
• Sleep-related disorders like sleep apnea or chronic pain
• Restless leg syndrome or leg cramps
• Stress, anxiety or depression

If you're experiencing sleep issues, take heart: most of the time, they will improve with time. I'm happy to say that mine did (that doesn't mean I don't experience the occasional problem). For years, night sweats and hot flashes plagued me—until they finally didn't. Blissful sleep followed.

Perhaps most importantly, analyze the reasons for your sleep issues and explore solutions. There are so many things you can do to help you sleep better:

• Get regular exercise (but not too close to bedtime).
• Avoid excessive caffeine and alcohol (which can make it easier to fall asleep, but not stay asleep).
• Maintain a regular bedtime schedule.
• Practice a relaxing bedtime ritual, like a warm bath or shower.
• Stop using electronics at least a half hour before bed, and stash all electronics out of reach.
• Make sure your room is cool—temperatures between 65 and 68 degrees Fahrenheit are best.
• Keep your room quiet and as dark as possible.
• Don't go to bed until you are tired.
• Keep a cool cloth nearby so you can cool off from a hot flash.

More helpful reading:
De-stress With Breathing Techniques
How Much Sleep Do We Really Need?
Menopause and Anxiety: What's the Connection?