The Best Sleep Solutions during the Menopause

Menopause and peri-menopause are times of enormous physical, hormonal and psychological change for women. Sleep problems are a common feature of peri-menopause, menopause and post-menopause, and as many as 60% of women report troublesome sleep during this stage of their lives.

The most common causes of menopausal sleep disturbance are hot flushes, insomnia, snoring and sleep apnoea.

Hot flushes commonly include a feeling of intense heat, usually beginning around the face and spreading to the chest, with sweating and a fast heart rate. They usually last a few minutes to half an hour and affect 75-85% of women around menopause. A fall in blood levels of oestrogen is thought to be the causative factor. Hot flushes are a major cause of sleep disturbance, particularly in early menopause.

Peri- and postmenopausal women often complain of difficulties initiating and/or maintaining sleep, with frequent nocturnal and early morning awakenings. Insomnia during the menopause is likely due not only to decreased levels of oestrogen, but also possibly to reduced levels of melatonin, which also gradually declines as a woman approaches menopause. A decline in the levels of these hormones, and their complex interactions, can significantly contribute to sleep problems and fatigue.

Symptoms and signs of sleep abnormalities in midlife women should not be attributed primarily to menopause before ruling out other underlying sleep disorders. Sleep apnoea (OSA) is more common in post-menopausal women, and since unrecognized OSA can have dramatic health-related consequences, menopausal women complaining of symptoms suggestive of sleep apnoea (loud snoring, witnessed pauses in breathing during sleep, unrefreshing sleep and/or daytime sleepiness) should be referred to a sleep specialist for a comprehensive sleep assessment.

Hormone replacement therapy (HRT) has been found to help relieve menopausal symptoms, including hot flushes and sleep disturbance. However, long-term HRT may put women at an increased risk of heart disease, blood clots and breast cancer. For those taking HRT to reduce menopausal symptoms, it is recommended that HRT be prescribed at the lowest effective dose and used only for brief periods, not long-term. It is recommended you talk to your physician about your symptoms, the risks and benefits of HRT, and alternative approaches for managing menopausal symptoms, including sleep disturbance. Some antidepressants are moderately effective at reducing hot flushes and can thereby improve sleep. In addition, melatonin has been shown to reduce the time taken to fall asleep and may improve subjective sleep quality and mood in menopausal women with insomnia.

To minimise night sweats and hot flushes, avoid spicy meals, caffeine and alcohol, particularly before bedtime. Wear lightweight cotton sleepwear and avoid heavy, insulating blankets. If sweating at night is problematic, wear fabrics which wick moisture away from the skin to avoid drenching sweats disturbing your sleep. Keep the room cool: consider using a fan, air conditioning, or simply leave a window slightly open to cool the air and increase circulation. Try a hot bath before bed: this will help reduce your core body temperature, signalling to your brain that it’s time to sleep.

Try to ensure you go to bed and get up at the same time each night, even at weekends. A regular sleep/wake cycle with adequate hours of sleep will help to entrain your body’s circadian clock, enabling you to fall asleep more quickly, and reducing the likelihood of wakening during the night. Developing a regular sleep schedule is the “amour” of good sleep, and will stand you in good stead to maintain healthy sleep in the long term.

A recent study demonstrated that telephone-delivered cognitive behavioural therapy for insomnia (CBTi) resulted in significant improvements in sleep quality in peri-menopausal women with hot flushes. CBTi is a form of specialised therapy for insomnia, which works on the sleep behaviours that perpetuate and worsen poor sleep, as well as helping develop relaxation and coping techniques. It may be delivered by a psychologist or sleep specialist, although smartphone apps for CBTi also exist. Finally, mindfulness techniques can aid sleep, and research suggests they may also improve the distress caused by hot flushes.

If your sleep problems persist despite these steps, or if you have symptoms suggestive of sleep apnoea (see above), restless legs, or another sleep abnormality, see your GP to discuss referral to a sleep specialist for further tests and appropriate treatment.