Our moms and grandmothers called it the “change of life” — that dreaded age of hot flashes and mood swings, and the unofficial start of middle age. Many women expect those unwelcome symptoms during menopause. But along with sweating and weight gain comes something many women don’t anticipate: disturbed sleep.
Poor sleep quality and sleep disturbance are lesser-known changes during this phase of life, says Grace Pien, M.D., M.S.C.E., an assistant professor of medicine at the Johns Hopkins Sleep Disorders Center, but they’re very common.
You might think that a good night’s sleep is nothing but a dream once you reach a certain age. Many women experience sleep problems during perimenopause, the period of time before menopause when hormone levels and menstrual periods become irregular. Often, poor sleep sticks around throughout the menopausal transition and after menopause. Fortunately, says Pien, there’s help.
What’s “good” sleep? Women should aim for between seven and eight hours of quality, uninterrupted sleep per night, Pien says. The rule isn’t hard and fast, though; some people need less sleep and others need more. “In general, if you're waking up regularly during the night and feel that your sleep isn't restful, those are signs that maybe you're not getting good sleep,” she says.
Hot Flashes and Sleep
Sleeplessness due to menopause is often associated with hot flashes. These unpleasant sensations of extreme heat can come on during the day or at night. Nighttime hot flashes are often paired with unexpected awakenings.
Pien says that though it’s common to feel like a hot flash has awakened you, research shows that many menopausal women actually wake just before a hot flash occurs.
“There are changes in the brain that lead to the hot flash itself, and those changes — not just the feeling of heat — may also be what triggers the awakening,” she says. “Even women who don’t report sleep disturbances from hot flashes often say that they just have more trouble sleeping than they did before menopause.”
Other Menopausal Sleep Disruptors
At this stage of life, women can also develop sleep disorders such as sleep apnea, which may come from a loss of reproductive hormones like estrogen and progesterone. These can go undiagnosed because women often attribute symptoms and effects of sleep disorders (like daytime fatigue) to menopause itself.
“Postmenopausal women are two to three times more likely to have sleep apnea compared with premenopausal women,” Pien says. “Before we become menopausal, we're fairly protected, but the protective effect of hormones seems to be lost with menopause. Furthermore, women often have more subtle symptoms of sleep apnea than men. Thus, they may be less likely to seek evaluation for sleep apnea. Their health care providers may also be less likely to recognize sleep apnea as a possibility, further delaying evaluation and diagnosis of sleep apnea.”
How to Get a Better Night’s Rest
The good news is that you don’t have to kiss a good night’s rest goodbye once you hit menopause. There are steps you can take to get better sleep.
Regular exercise can help menopausal women fall and stay asleep, Pien says. “We see that athletes, for example, tend to be highly efficient sleepers. But even for those of us who aren't professional athletes, exercise can help with sleep quality.”
Medication and Therapies
Some selective serotonin reuptake inhibitors (SSRIs) have been shown to help with sleep symptoms in menopausal women. Hormone replacement therapies can improve sleep quality, though few objective differences in sleep have been observed with their use, and the detrimental effects of hormone therapy can outweigh any benefit. Alternative therapies like acupuncture can also be helpful. Speak with your doctor about what might be right for you.
As for over-the-counter sleep aids? While occasional use isn’t harmful, it’s also important to make lifestyle changes that enhance sleep, like winding down an hour before bedtime, going to bed at the same time every night and not watching television or using an electronic device before dozing off.
“Just as we recommend that kids have a regular bedtime and wake time, trying to do that as an adult also helps your body know when it's time to go to bed,” Pien says.