Sleep Well: The Relationship Between Sleep and Menopause

We know that sleep is essential for allowing our bodies time to rest and recharge. In many ways, sleep is the foundation for a healthy lifestyle. But with all the distractions and stressors coming at us each day, achieving a restful night’s sleep isn’t always easy. In fact, according to the Center for Disease Control and Prevention, one in three Americans aren’t getting enough sleep.

Our multi-part series, Sleep Well, examines the power of sleep and how it relates to our health throughout our lifespan – from our menstrual cycles to fertility, and menopause – and offers advice on how to get better sleep tonight. In this issue, we dig into the connection between menopause and sleep. Dr. Jeanette McDonald of Axia Women’s Health – OB/GYN of Indiana shares her insight.

The Science Between Menopause and Sleep

“Many factors can affect the sleep/wake cycle of midlife women,” says Dr. McDonald, “It’s common to feel tired earlier and wake earlier as we age. However, during menopause, certain conditions can develop that can further disrupt our sleep.” In fact, according to the National Sleep Foundation, 61% of perimenopausal and postmenopausal women experience frequent insomnia.  Fortunately, there are treatments that can help you to rest easier. The first step is understanding what exactly is keeping you up at night.

Before we explore the potential causes of sleep disturbances, it’s important to understand what’s happening inside our bodies during menopause. During menopause, women experience a gradual loss of the hormones estrogen and progesterone.

“When hormone levels are low, women can experience some of the troubling vasomotor symptoms associated with menopause including hot flashes or night sweats. Besides hot flashes and night sweats, another cause of sleep disturbance that can occur during menopause is sleep apnea. While heavy body weight is a significant cause of sleep apnea, declining ovarian hormones, particularly progesterone, also play a role in sleep apnea.”

Potential Causes of Sleep Disturbance During Menopause

Hot flashes and night sweats

Hot flashes are a common occurrence during menopause, affecting up to 75% of women during the menopausal period, according to the North American Menopause Society. Hot flashes are defined as a sudden rush of increased body heat followed by a cool sweat, typically lasting a couple of minutes.

“Nighttime hot flashes, also called night sweats, can trigger arousal and awakening, especially during the first half of sleep,” adds Dr. McDonald.

Experts believe that decreased estrogen levels may cause your hypothalamus in your brain, which regulates your body temperature, to become more sensitive. When your body senses that it’s too hot, it tries to cool itself down, causing you to experience a hot flash. So, what’s there to do about it?

• Experts recommend setting your thermostat between 60 to 67 degrees Fahrenheit at night, as a cooler room can be more conducive to sleep.
• Avoid diet related triggers like alcohol, caffeine, or spicy foods close to bedtime.
• Try sleeping in breathable clothing made with natural fabrics like cotton.

If your hot flashes can’t be managed by lifestyle adjustments, treatments may be able to help.

“Hormone replacement therapy with estrogen and progesterone can improve sleep disturbances due to hot flashes. There are many routes including oral, transdermal (through the skin), and vaginal.” As with any treatment, it’s important to discuss the risks/benefits with your provider.

According to a study published in Menopause, women taking hormone therapy sustained significant improvement with hot flashes and night sweats (both frequency and duration) over a four-year treatment period.

“For women with sleep disruption due to hot flashes who cannot take estrogen, there are other vitamins and herbal supplements that can help such as estroven, black cohash, valerian root, and melatonin.”

Sleep Apnea

According to a study published in the medical journal Pulmonology, postmenopausal women are three times more likely to experience obstructive sleep apnea (OSA) compared to premenopausal women. Obstructive sleep apnea, the most common subtype of sleep apnea, is defined by pauses of reduced breathing during sleep due to complete or partial blockages in your airway.

These pauses can occur anywhere between 5 to more than 60 times in one hour before regular breathing resumes. One of the most obvious symptoms associated with sleep apnea is snoring. Experts believe that a decrease in estrogen and progesterone could again be responsible for the correlation between menopause and sleep apnea, as they support the airway muscle and keep it from weakening or collapsing. The good news: there are multiple treatments that can help:

• In some cases, weight loss can be an excellent first step in addressing sleep apnea

• There are also non-surgical treatments that come in the form of supportive devices like the continuous positive airway pressure (CPAP) machine. This machine is an effective treatment that blows air into the airway to make it less likely to close during sleep
• If your OSA is more severe, your provider may recommend a surgical procedure such as a uvulopalatoppharyngoplasty (UPPP) that removes excess tissue from your mouth and throat to help clear the passageway

Other Tips to Sleep Well, Tonight

In addition to treatment, there are several lifestyle changes that may help you to rest easier at night, such as:

• Exercising regularly
• Engaging in a relaxing activity before bed like reading, journaling, or taking a bath
• Limiting blue light from your phone or other electronic devices before bed
• Practicing meditation
• Sticking to a schedule of going to bed at the same time each night and getting up at the same time each morning

Other conditions that can be keeping you up at night could include incontinence, joint pain, or mood disorders. It’s important to understand the root cause in order to properly treat it.

Further exploration with a sleep study or mental health evaluation may be appropriate and may indicate other condition specific treatments that can improve sleep.

Menopause can be a challenging transition to navigate, but you don’t have to go it alone.  If you have concerns, speak with your Axia Women’s Health provider who can help you develop a plan to achieve a better night’s sleep.