Are you wide awake at 2 a.m., tossing and turning? Or maybe you’re reading this when you should be fast asleep, wondering why rest feels so elusive. You’re not alone. During perimenopause and menopause, sleep disturbances are common, with nearly 80% of menopausal women reporting difficulty sleeping. These issues include trouble falling asleep, staying asleep, and experiencing poor sleep quality.
Why is this happening?
Sleep is a complex process, and disturbances during this time are often multifactorial:
- Hormonal changes play a significant role in sleep disruptions. Declining levels of oestrogen, progesterone, and melatonin impact circadian rhythm and sleep quality.
- Lower levels of progesterone and estrogen are associated with an increased risk of sleep-disordered breathing and obstructive sleep apnoea, both of which can severely disrupt sleep.
- The decrease in oestrogen also contributes to other menopausal symptoms, such as hot flushes, night sweats, nighttime urinary frequency, anxiety, and depression—all of which can exacerbate insomnia or lead to frequent nighttime awakenings.
When sleep is disrupted, other aspects of health are often affected. Sleep deprivation can negatively impact nutrition and exercise, leading to a cascade of consequences for overall well-being. Additionally, poor sleep can worsen menopause-related symptoms, including irritability, mood swings, low energy, and fatigue.
Management options to discuss with your doctor:
- Assessment and screening for sleep disorders: While obstructive sleep apnoea is commonly thought of as a condition affecting men that presents with snoring and breathing pauses, it can also affect women although it presents differently- Women may experience symptoms such as fatigue, lack of energy, insomnia, and mood disturbances. Some evidence suggests that Menopausal Hormone Therapy (MHT) may improve sleep-disordered breathing, but other interventions—such as CPAP masks—should also be considered.
- MHT (Menopausal Hormone Therapy): This treatment can help control vasomotor symptoms (like hot flushes) and mood changes, which may be interfering with sleep, as well as directly address underlying hormonal changes that may be causing disrupted sleep.
- Topical vaginal oestrogen: This can be helpful if genitourinary symptoms, such as urinary frequency, are causing frequent nighttime awakenings.
- Cognitive Behavioural Therapy for Insomnia (CBT-I): CBT-I is an effective, non-pharmacological treatment that can help improve sleep quality by addressing the underlying thoughts and behaviours that disrupt sleep.
- Lifestyle modifications and optimising sleep hygiene: Simple changes to your sleep environment and habits—such as a regular sleep schedule, reducing caffeine intake, and creating a relaxing bedtime routine—can significantly improve sleep quality.
- Melatonin: This supplement may be beneficial in regulating sleep patterns and improving sleep onset.
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