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Why Menopause Causes Sleep Problems and What To Do About It

Menopause sleep problems include insomnia, hot flashes, and sleep apnea. Improve your sleep hygiene to get a good night’s rest.
Published
2023-01-27
Updated
2024-02-17
18 MINS
Written by
Jeff Kahn, M.S., Rise Science Co-Founder
Reviewed by
Chester Wu, MD, Rise Science Medical Reviewer
Our Editorial Standards
We bring sleep research out of the lab and into your life. Every post begins with peer-reviewed studies — not third-party sources — to make sure we only share advice that can be defended to a room full of sleep scientists.
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Updated Regularly
We regularly update our articles to explain the latest research and shifts in scientific consensus in a simple and actionable way.
woman cooling herself with folding fan to overcome menopause sleep problems

Menopause and sleep problems, unfortunately, go hand in hand with 65% of women reporting disrupted sleep during this time. In fact, sleep disturbance during menopause is so common it has been identified as a key symptom by the National Institutes of Health. 

But sleep doesn’t just feel good, it’s vital for everyday energy, performance, health, and quality of life. When your sleep suffers, everything else does, too.

Below, we’ll cover why menopause causes sleep problems and how you can use the RISE app to get better sleep before, during, and after the transition. 

Disclaimer: The scientific literature uses gendered language when talking about menopause. We have used the term “women” in this article, but this advice is for anyone who experiences menopause sleep problems. 

What is Menopause?

Menopause is when your menstrual periods stop and your ovaries stop producing estrogen and progesterone. This happens as a natural part of aging, or it can be due to surgery, chemotherapy, or radiation. Natural menopause usually happens around age 50 to 52

Perimenopause, or the transition period before menopause, can begin four to six years before your periods end, and postmenopause is the time after menopause. Many women now live for at least 30 years beyond their last period. 

What Are Menopause Sleep Problems?

Menopause sleep problems look different for everyone, but common issues include: 

  • Trouble falling asleep 
  • Trouble staying asleep 
  • Waking up too early
  • Shorter sleep duration 
  • Feeling tired during the day 
  • Narcolepsy
  • Hot flashes and night sweats 
  • Insomnia (and this may get worse as you go through the menopause transition, and be worse for those who experience menopause from surgery
  • Sleep-disordered breathing 
  • Sleep apnea 
  • Periodic limb movement disorder and restless leg syndrome 

You can experience these sleep problems during perimenopause, menopause itself, or postmenopause. 

And sleep problems during this time affect a lot of us: 25% of perimenopausal women and 30% of postmenopausal women say they only get a good night’s sleep a few nights or less a month. Insomnia is thought to affect 38% to 60% of peri- and postmenopausal women, and troubled sleep is reported by 54% to 58% of women aged 40 to 60.

If you’ve experienced sleep disturbances before menopause, the bad news is you’re more likely to experience them during menopause, too. 

These sleep problems can seriously impact your physical health, mental wellness, productivity, and day-to-day energy levels

Sleep loss can also make menopause symptoms worse. It can lead to brain fog and low libido, two key symptoms of menopause. 

Data from our RISE app shows that women have more sleep debt on average during the early postmenopausal years of ages 50-59 than at any other life stage, with the only exception being the age range of 18-23. From the age of 30 and onwards, women generally have more sleep debt than men, with the disparity peaking in the 50-59 age bracket. However, this gap begins to narrow from age 60 onwards. It's crucial to note we cannot infer causation from this data and our customers may not accurately represent the general population, as they use RISE to combat fatigue and increase energy levels while adopting healthier sleep habits to minimize sleep debt.

Age Who has more sleep debt? Percent difference
18-23 Men 2.8%
24-29 Same amount 0%
30-39 Women 2.5%
40-49 Women 1.3%
50-59 Women 3.5%
60+ Women 1%
Overall Women 1%

Why is it Hard to Sleep During Menopause?

There are many reasons menopause makes getting a good night’s sleep harder. Unfortunately, there isn’t enough research into sleep problems in women, and it’s only recently that some funding bodies require women to be included in sleep studies. 

But here’s what we know about how menopause and its symptoms affect sleep.

Fluctuating Hormone Levels 

Your hormones have the power to disrupt your sleep throughout your whole lifespan — that’s why sleeping on your period and sleeping when pregnant can be so difficult. And hormones are to blame for a lot of menopause sleep problems, too. 

The hormones estrogen and progesterone begin fluctuating in perimenopause and start falling. These hormonal changes have been linked to many menopause symptoms.

Progesterone has a sedative and anti-anxiety effect and estrogen regulates your body temperature and can decrease sleep latency (how long it takes to fall asleep) and how often you wake up during the night, and increase total sleep time. 

Declining estrogen has been linked to hot flashes and the changes in both hormones can cause sleep-disordered breathing.  

When progesterone levels fall, feelings of anxiety can increase, which can easily keep you up at night. Menopausal women report high levels of anxiety, stress, depression, and poor mood — all of which make it harder to get the sleep you need. 

Testosterone, even though it’s mainly associated with men, also decreases in women as they age. And low testosterone has been linked to everything from insomnia to sleep-disordered breathing to needing to use the bathroom more during the night. 

You can learn more about testosterone and sleep here.

Hot Flashes 

Hot flashes — also called hot flushes, vasomotor symptoms, and night sweats, when they happen at night — may wake you up during the night. You may feel a sudden wave of heat and excessive sweating, or simply wake up drenched in sweat. 

They’re a common symptom with 12.5% of perimenopausal women, 79% of menopausal, and 39.3% of postmenopausal women experiencing them. 

Hot flashes are linked with chronic insomnia. They can wake you up during the night and, once you’re awake, it can be hard to fall back to sleep as you’re hot, sweaty, and uncomfortable. 

You may also experience anxiety around hot flashes — or anxiety about the poor sleep they cause in general — but this anxiety can contribute to sleep problems, making it harder to drift off. 

Increased Need to Use the Bathroom 

A change in hormones during and after menopause can trigger the need to use the bathroom more often during the night. This obviously cuts into your sleep time as you wake up, but you may also find it harder to fall back to sleep once you’ve gotten out of bed and turned on the bathroom light. 

Weight Gain 

Weight gain is common during menopause. This comes down to lifestyle changes, sleep loss, and — yet again — hormones. The drop in progesterone can cause weight gain and estrogen may change how your body fat is distributed. 

Hormonal changes are also linked to belly fat gain during menopause, and sleep loss only adds to this. We’ve covered how to lose belly fat naturally here.

Plus, medications — like antidepressants or hormone therapy — used to treat menopause symptoms can cause weight gain.

But, being overweight or obese has been linked to trouble sleeping and sleep disorders like insomnia. It’s also a risk factor for sleep apnea

Sleep loss experienced through menopause can also cause weight gain, causing a vicious circle. 

You can learn more about how to lose weight during menopause here. 

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Sleep Apnea 

Obstructive sleep apnea is a condition that causes you to stop breathing temporarily throughout the night. This causes you to wake up regularly, making it harder to get the amount of sleep you need.

Your risk of developing sleep apnea goes up as you age, but it also increases as you become perimenopausal and it’s thought 47% to 67% of postmenopausal women suffer from sleep apnea. 

You can blame your hormones for this one, too, as this increased risk is due in part to how hormonal fluctuations change your fat distribution. Lowered progesterone may also cause your airways to become more relaxed, therefore making them more likely to collapse during the night.

Sleep apnea may also go undiagnosed in menopausal women as many of the symptoms of sleep apnea — like difficulty concentrating, memory problems, waking up often to use the bathroom, and fatigue — are the same as menopause symptoms. 

It’s important to get diagnosed and seek treatment for sleep apnea, however, as it can lead to serious health conditions like obesity, diabetes, and cardiovascular disease.

You can find out how to know if you have sleep apnea and how to get rid of sleep apnea here. 

Age-Related Sleep Problems

As if menopause-related sleep problems weren’t enough, midlife and later-life women can also experience sleep problems due to aging. 

The ailments that come with aging — think lower back pain, stiff joints, or sleep apnea — may keep you up. And any medication you’re taking for age-related health issues like high blood pressure can also disrupt your sleep. 

Even healthy older adults have been shown to spend twice as long awake during the night than younger adults. 

As we get older, our circadian rhythm is “flattened,” meaning the natural biological cues to go to sleep and wake up aren’t as strong. This makes it harder to maintain a regular sleep-wake cycle, and you may feel sleepy during the day, wake up more often during the night, and struggle to get enough sleep overall.  

Your circadian rhythm is your body’s internal clock, which runs on a roughly 24-hour cycle. Your “circadian arousal signal,” or the signal to be awake, weakens with age, meaning older people end up sleeping significantly more during the “wake maintenance zone,” or your second peak in energy, typically in the early evening. 

The secretion of melatonin — the hormone that primes your body for sleep — can also be diminished in older people if they have a medical condition that causes melatonin to be lower. 

The number of light-sensing cones in our eyes decreases with age, too, meaning it’s harder to get the light we need to keep our circadian rhythms in check. 

Our sleep architecture — or the timing and length of sleep cycles like REM and deep sleep — is also affected, meaning we’re not getting the healthy natural sleep we need to feel our best. 

And women of any age usually report more sleep disturbances than men, and this becomes more apparent as we age. You can learn more about sleep problems and female fatigue here. 

Period-Related Sleep Problems 

During perimenopause, you’ll still get your period, but they may become irregular, heavier, and the length of your cycle can get shorter or longer. 

This means your sleep can still be disrupted by your periods the same way it can for premenopausal women. And as perimenopause can last four to six years, this disruption can be significant. 

Fluctuating hormones and period cramps can make it harder to fall and stay asleep, and period-related fatigue can leave you feeling drained during the day. 

We’ve covered how to sleep on your period and insomnia before your period here.

How to Improve Sleep During Menopause?

Sleep is vital to everyday function and overall health. Meeting your sleep need, the genetically determined amount of sleep you need, can boost your mood, productivity, energy levels, how well you manage pain, and can even prevent wrinkles and accelerated aging.

Use the RISE app to find out your individual sleep need and how close you are to getting it each night. Menopause symptoms making it hard to get enough sleep? Here’s how to change that. 

1. Improve Your Sleep Hygiene 

RISE app screenshot showing when to get and avoid bright light
The RISE app can guide you through 20+ sleep hygiene habits.

Sleep hygiene is the name for the set of healthy sleep habits you can do each day to help you fall asleep faster and wake up less often during the night. 

If menopause symptoms are cutting into your sleep, you want to ensure nothing else keeps you awake and the sleep you do get is as restorative as possible. 

Here’s what to do: 

  • Keep a consistent sleep schedule: Going to bed and waking up at the same time each day will help regulate your circadian rhythm. So, keep a consistent schedule, even if you no longer have set wake times due to being retired and kids being out of the house. 
  • Avoid caffeine, large meals, intense exercise, and alcohol close to bedtime: All four can keep you up or wake you up during the night. Caffeine and alcohol can also trigger hot flashes, so it’s even more important to drink them wisely. (We cover ways to get energy without caffeine here.) 
  • Get light in the early morning and avoid it close to bedtime: Light early in the day will reset your circadian rhythm, helping you feel sleepy at the right time that evening. But too much light in the evening can make it hard to drift off. Dim the lights and put on blue-light blocking glasses 90 minutes before bed, and use a low-powered red light night light if you wake up during the night to use the bathroom to avoid waking yourself up too much.  
  • Do a relaxing bedtime routine: This will help slow your brain and body down for sleep and reduce anxiety, which can keep you up. Read more about how to relax before bed here. 

RISE can remind you to do 20+ sleep hygiene habits each day and tell you the ideal time to do them to make them more effective. 

RISE users on iOS 1.202 and above can click here to set up their 20+ in-app habit notifications.

2. Consider Cognitive Behavioral Therapy 

Cognitive Behavioral Therapy for Insomnia (CBT-I) aims to change your thoughts and behaviors around sleep to cure insomnia. It’s been shown to be effective for older adults with chronic insomnia and for midlife women. Even CBT-I delivered over the phone (digital CBT-I or D-CBT-I) has been shown to help peri- and postmenopausal women with insomnia symptoms and hot flashes. 

Research has also compared CBT-I with sleep restriction and sleep hygiene improvements, and while all three helped improve insomnia symptoms in postmenopausal women, CBT-I had the greatest impact. 

CBT may also help reduce the number of hot flashes you have. Feeling more in control and less stressed and distressed about your hot flashes has been linked to having fewer of them. 

3. Try Hormone Replacement Therapy 

Hormone replacement therapy (HRT) can increase levels of estrogen and progesterone, alleviating some of the symptoms low levels of the hormones cause.

Research shows estrogen therapy can treat hot flashes, help you fall asleep, and decrease nighttime awakenings. It may also help you lose weight.

HRT started a decade or more after menopause has been linked to heart attacks and breath cancer, but a 2020 paper states when initiated within 10 years of menopause, HRT may reduce all-cause mortality and risks of heart disease, osteoporosis, and dementia. 

HRT may not be right for everyone, though. Some experts believe HRT isn’t safe for those with a high risk of breast cancer. But recent research disagrees.

A 2022 review states when started in women younger than 60 and/or close to menopause, HRT “significantly reduces all-cause mortality and cardiovascular disease.” It adds that the risks of health issues like breast cancer and stroke are rare and comparable to other medications.

Speak to your healthcare provider to see if it’s a suitable treatment option. 

Your doctor may also recommend low-dose birth control pills, which contain estrogen and progesterone, or selective serotonin reuptake inhibitors (SSRIs). 

4. Manage Nighttime Hot Flashes 

You may not be able to avoid hot flashes altogether, but there are things you can do to minimize how much they disrupt your sleep. 

  • Invest in a cooling pad or mattress: This can help keep your body temperature lower during the night. 
  • Cut back on triggers like caffeine and alcohol: This will also help to improve your sleep overall. The RISE app can tell you the best time to have your last coffee and alcoholic drink each day.
  • Keep your bedroom cool: Aim for 65 to 68 degrees Fahrenheit. This will also help you fall asleep in general. 
  • Keep nighttime anxiety and light low: If you wake up sweaty in the night, keep calm (remember anxiety is the enemy of sleep) and change your pajamas in low light (bright light will wake you up). Keeping a change of nightwear nearby can help you get back into bed quicker. 
  • Practice yoga, tai chi, and meditation: Research shows they can improve hot flashes and overall menopause symptoms. 
  • Try omega-3 supplements: Omega-3 fatty acid supplements have been found to reduce how many hot flashes you have. 

For some, hot flashes are a passing symptom and go away when you’re postmenopausal. However, hot flashes may not stop until 4.5 years after your final period, so it’s still worth finding a way to manage them to limit how disruptive they are to your sleep.  

We’ve covered more ways to stop night sweats here.

5. Try Acupuncture

A 2016 study found one course of acupuncture treatments decreased hot flash symptoms and this improvement lasted at least six months after the treatment ended. 

Another 2016 study found acupuncture was associated with an increase in estrogen levels and a significant reduction in sleep disturbances in women going through menopause. 

6. Get a Foot Massage 

If there was ever an excuse to get a foot massage, this is it.

A 2022 study looked at postmenopausal women who got a foot massage once a day for seven days and a control group who didn’t. The results showed the women who got foot massages slept for an hour longer each night, and they had lower levels of anxiety and fatigue. 

7. Practice Yoga 

Yoga isn’t just great for weight management and anxiety reduction — both of which can help with sleep — it may also specifically reduce menopause symptoms. 

A 2018 meta-analysis found yoga helped to reduce total menopause symptoms, hot flashes, and mental and physical symptoms. 

More research needs to be done, however, as an earlier study from 2014 found 12 weeks of yoga didn’t improve the frequency of hot flashes. But it did help with insomnia and no serious adverse effects were found, so it may still be worth trying. 

Exercise in general can help you fall asleep faster, wake up less often during the night, and improve insomnia. Just be sure to avoid intense exercise within an hour of bedtime, and this can keep you up. 

We’ve covered more on the best time to work out here.

8. Speak to a Medical Professional  

A doctor may be able to recommend treatments to help improve your menopause sleep problems. They can also look at any medication you’re taking to see if this is causing sleep issues. 

Speak to a sleep specialist if you think you’re suffering from sleep apnea and speak to a therapist to get help managing nighttime anxiety and depressive symptoms associated with menopause. You can also learn more about how to sleep with anxiety here. 

9. Consider Taking Melatonin Supplements 

RISE  app screenshot showing you when to take melatonin supplements
The RISE app can tell you the best time to take melatonin supplements.

It’s tempting to reach for over-the-counter sleep aids when your sleep starts to suffer, but these products can come with many dangerous side effects and they’re designed for short-term use.

We recommend harnessing the power of the most natural, risk-free sleep aid: sleep hygiene. If your sleep needs an extra helping hand, however, melatonin supplements may help. 

Melatonin supplements can change the timing of your circadian rhythm, helping you fall asleep when you naturally wouldn’t. To boost your melatonin naturally, focus on avoiding bright light and alcohol before bed — both can suppress melatonin production. This is even more important to do as you get older as natural levels decline. 

You can learn more about what melatonin does here, and if you do decide to try melatonin, RISE can tell you the best time to take your supplements each day to feel sleepy at the ideal time. 

RISE users on iOS 1.202 and above can click here to set up their take melatonin supplements reminder.

Get the Sleep You Need Later in Life 

Sleep is vital at every stage of life, but it gets harder to fall and stay asleep as we get older. And it seems peri- post- and menopausal women have drawn the short straw when it comes to sleep difficulties, with everything from fluctuating hormones to hot flashes to sleep apnea getting in the way of a good night’s sleep. 

To help, try improving your sleep hygiene to avoid hot flash triggers, boost your melatonin, and make sure nothing else gets in the way of your sleep. The RISE app can guide you through 20+ sleep hygiene habits and tell you when exactly to do them each day, helping you drift off and stay asleep, even through menopause. 

FAQs

Menopause and sleep problems

Menopause sleep problems include trouble falling asleep and staying asleep, waking up too early, hot flashes, sleep apnea, insomnia, and an increased need to use the bathroom during the night.

Why is it hard to sleep during menopause?

It’s hard to sleep during menopause because of fluctuating hormones, which affect your body temperature, breathing during sleep, and mood. Hot flashes can also wake you up in the night and menopause can cause sleep disorders like insomnia and sleep apnea.

How can I sleep better with menopause?

You can sleep better with menopause by improving your sleep hygiene, including getting light first thing and avoiding light, caffeine, and alcohol too late in the day. Hormone replacement therapy may also help you fall asleep faster and wake up less often during the night.

Does menopause insomnia go away?

Menopause insomnia can go away, but it may also last for months or years depending on what’s causing it. Hot flashes, for example, may end about 4.5 years after your last period, eliminating this common sleep disruption.

How long does insomnia last in menopause?

Menopause insomnia can last for months or years depending on what’s causing it. Hot flashes, for example, may end about 4.5 years after your last period, eliminating this common sleep disruption.

Menopause sleep problems natural remedies

Natural remedies for menopause sleep problems include yoga, acupuncture, and improving your sleep hygiene, which includes keeping a consistent sleep schedule, getting light first thing, and avoiding light, caffeine, and alcohol too close to bedtime.

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