Is menopause wrecking your sleep?

Menopause symptoms don’t look the same for everyone. Maybe you have hot flashes so intense you keep a change of clothes in your car, or perhaps you can’t go an hour without having to hit the bathroom. But sleep issues, be they trouble falling asleep or staying asleep, are as universal as it gets — because a bad night’s sleep is the collateral damage of many other menopause symptoms.

“There are a lot of sleep interruptions that happen in midlife,” says Dr. Camille Moreno, D.O., the medical director of the Midlife Women’s Health and Menopausal Medicine program at the University of Utah. “They don’t necessarily have to be related to night sweats waking you up. You can really just wake up for unknown reasons.”

Research has found that sleep disorders are both common and significant during the menopausal transition, and it gets worse once you've hit menopause (which is defined as once you've gone 12 months without a period). The good news, sort of? Getting to the bottom of the source of your sleep problems can lead you to a solution.

Why sleep is so important — especially during menopause

Sleep is critical no matter where you are in life. It’s the time when your body does important repair work, which is key for pretty much every system and function, including your hormone regulation. So during menopause, if you aren’t getting enough sleep, it can throw everything off and trap you in a vicious cycle, says Dr. Sally MacPhedran, M.D., the director of the Midlife Women's Center at University Hospitals Cleveland Medical Center and a professor of reproductive biology at Case Western Reserve University School of Medicine. “For example, a lack of sleep can worsen hot flashes. And night sweats can cause sleep disruptions.”

It’s also important if you’re on a weight journey. “When sleep is disrupted, everything kind of falls apart,” says MacPhedran. Why? Whether you’re tossing and turning all night or wake up at 2 a.m. feeling wired, it leads to an increase in cortisol, your stress hormone. And when your cortisol is high, your “metabolism decreases to preserve energy for the vital functions of your body,” she adds.

Then there’s the very universal reality that if you wake up feeling like you need to go back to bed, you might not have the energy to make it to the gym or prep a healthy lunch. So it can trigger a domino effect that leads to unhealthy habits — which can, in turn, get in the way of your weight-loss efforts.

Why menopause disrupts sleep

“As we get older, there’s this physical effect of aging that disrupts our circadian rhythm,” says Moreno, referring to the body’s built-in sleep-wake cycle. But part of the reason sleep can be so tough during menopause is because there are a ton of other things going on that can also disrupt your sleep. Here’s a closer look at some of them.

• Lower levels of progesterone: While estrogen gets top billing as the hormone that drops during the menopausal transition, progesterone plays a role too — since it has a calming effect that can usually help you fall asleep. “Once we start losing progesterone in perimenopause, that can cause the nighttime awakenings, but also anxious thoughts that are more noticeable at night,” says Moreno. Some of her patients share that their anxiety is more heightened at night — and their effects, whether it’s their heart racing anxious thoughts, prevent them from falling asleep.
  
  
• Night sweats: Essentially hot flashes that occur overnight, night sweats can do a number on sleep. “When you start losing both estrogen and progesterone, that can actually also impact the way our body regulates temperature,” says Moreno. So you might wake up sweaty, with a damp pillow, or with your clothes completely drenched—and then have trouble getting back to sleep afterwards.
  
  
• Sleep apnea: Even if you’ve never had it before, sleep apnea — which is when you stop breathing for short bursts during sleep — becomes more common in midlife. Your risk of sleep apnea goes up by 4% with each year in the menopausal transition, one study found. Experts aren’t really sure why. “It could be an indirect association between the hormonal changes that happen in midlife,” says Moreno. And while menopause is associated with weight gain — which is in turn linked to higher rates of sleep apnea — that doesn’t totally explain it. “There’s a subset of women, who do not have overweight or obesity, who have obstructive sleep apnea that increases with menopause,” says MacPhedran.
  
  
• Urinary issues: ”A lot of times, women have urinary issues that wake them up,” says MacPhedran. “They have to pee more often, and that wakes them up.” In fact, waking up to pee is so typical during menopause that it has a name: nocturia. Nocturia is among the most common genitourinary symptoms related to menopause, and it's mostly due to lower estrogen levels, which affect how much urine your bladder can hold and can also increase urine production.
  
  
• Depression: Mental health can take a hit during the menopause transition for a variety of reasons, including hormonal shifts. Depression is on par with night sweats as being a major factor for poor sleep. And, in turn, poor sleep can worsen your depression.

Symptoms of menopause sleep disturbance

So…how do you know if you’re having a capital-S sleep issue? You might have dealt with feeling tired in the morning long before menopause and have always been the type to hit snooze, so it can be tough to know what makes this different — and serious.

If you’re waking up to pee multiple times a night or can’t fall asleep for hours, then you might know you have a sleep issue. But for something like sleep apnea, it helps to start with people close to you. If you have a partner sleeping next to you, have they “noticed you snoring yourself awake, or perhaps actually experienced an apnea episode?” says Moreno.

You might be able to identify it on your own, too: Sleep apnea is described as waking up in the middle of the night gasping for air; it might feel similar to choking. You also may wake up with a headache, since “there was this upper airway obstruction that was happening throughout the night and you're not getting enough blood flow or circulation to the brain,” she says.

But there are other symptoms as well, “like waking up already tired or feeling worsening fatigue as the day goes on,” says Moreno. If you need to take a nap in the middle of the day to combat your fatigue, then it’s worth addressing.

How to sleep better during menopause

Lifestyle interventions can go a long way in alleviating sleep issues. “Make sure the room is dark and quiet,” says MacPhedran. “If you do have a snoring partner, try to sleep in a different area just to see if that does help improve your sleep, or use either noise-canceling earphones or earplugs and see if that helps.”

Also, power down your devices well before you plan to go to bed. The blue-wave light emitted from electronic devices can interfere with your ability to fall asleep, for one. And if you’ve been falling asleep to your comfort TV show for years, it might be doing more harm than good. “The light flickering, even if there's no volume, may also interfere with your ability to have deep sleep,” says MacPhedran.

If you’re up because you have to go to the bathroom, she recommends not drinking any fluids for up to four hours before you go to bed. “Two hours is usually a good cut-off,” she says. (You can experiment to see what works best for you.) She also advises skipping any spicy food before bed, since it can cause heartburn that keeps you awake.

How to treat sleep issues during menopause

There are a few ways to treat sleep issues when you’re in the midst of menopause. They include:

• Menopause hormone therapy (MHT): The beauty of MHT, more commonly known as hormone replacement therapy (HRT) is that it can address both the menopause symptoms that contribute to poor sleep (like night sweats) as well as the drop in progesterone that makes it hard to fall back asleep during the night. For that, both experts pair estrogen with a micronized progesterone, “because once it's in the body and metabolized, it's the metabolites that help women feel sleepy,” says MacPhedran.
  
  
• Sleep apnea interventions: If you’re dealing with sleep apnea, it’s a little more complicated. “Typically, getting a sleep study done to diagnose the sleep apnea or to rule it out would be the first step,” says Moreno. For that, you would need to see a sleep medicine specialist. Once it’s confirmed, you might need to use a CPAP machine at night or see a dentist for a mouthpiece that prevents the upper airway from getting obstructed, she says. If you’re struggling with sleep apnea and weight, however, a clinician may prescribe a GLP-1 like Zepbound, which is FDA-approved to treat both conditions.
  
  
• Non-hormonal medications: While gabapentin is an anti-seizure medication, it’s often used off-label “for night sweats, because it does have some sedating side effects,” says Moreno. “For women coming to me just with nighttime symptoms, since sleep is the major issue, gabapentin is an option.” There are also antidepressants, which are commonly prescribed to treat hot flashes and night sweats and can help you get some rest. One study found that paroxetine (sold as Brisdelle) significantly reduced the number of nighttime awakenings due to night sweats and increased sleep duration.
  
  
• Over-the-counter sleep aids: As a stopgap, MacPhedran sometimes recommends magnesium or melatonin supplements. However, they don’t address the root of the issues, and won’t help if you’re waking up as a result of night sweats or anxiety. Plus, “melatonin is a short-term option,” she says. So you can try them (with your doctor’s sign-off), but you might end up needing an Rx instead.
  
  Get help with your menopause-related sleep issues by talking with a clinician at WeightWatchers Clinic for Menopause. They’ll be able to go over your symptoms and lifestyle with you, offer recommendations, and prescribe medications like MHT if appropriate.

The bottom line

Sleep problems during menopause aren’t just common — they’re complicated. They can stem from a drop in certain hormones, night sweats, bladder issues, or all of the above; on top of that, sleep disorders like sleep apnea become much more common at this age. But that just means that finding a solution can take a little strategy, not to mention trial and error. Pairing good sleep habits, like unplugging an hour before bed and sleeping in a cool, dark space, with proven medications can go a long way in helping you get some rest.