When you’re making your journey through menopause, sleeping through the night may seem like an impossible dream. Insomnia and sleep disturbances caused by hot flashes leave many menopausal women tossing and turning or waking up drenched in sweat. The next day, irritability, anxiousness, fatigue, and trouble concentrating are common. If menopause symptoms continually keep you up at night, make an appointment to see your doctor. And in the meantime, try these lifestyle changes and smart sleep strategies to rest easy.
The Insomnia and Menopause Link
Sleep disturbances are extremely prevalent and a challenging problem for midlife women, says Steven Goldstein, MD, professor of obstetrics and gynecology at New York University School of Medicine and president of the board of the North American Menopause Society. In fact, according to the National Sleep Foundation, 61 percent of perimenopausal and postmenopausal women report frequent bouts of insomnia.
Dr. Goldstein says it’s important to figure out why your sleep is disturbed. He explains that sometimes the cause is hormonal changes related to menopause, and sometimes the problem is another age-related health condition such as incontinence or joint pain. Midlife stresses such as anxiety over work and family can also interfere with sleep. And if you weren’t a great sleeper to begin with, entering menopause can make insomnia even worse.
Hot Flashes and Sleep Problems
One cause of menopause-related sleeplessness is hot flashes. Fluctuating levels of estrogen and progesterone that occur during perimenopause and menopause can cause hot flashes in about 85 percent of American women. When they strike during the night, they can wreak havoc on sleep, explains Michael Decker, PhD, RN, an associate professor of nursing and a sleep disorder specialist at Georgia State University in Atlanta. “Typically, hot flashes that occur during the night can be associated with drenching night sweats that lead to awakening from sleep.” Some women even have to change clothes or bed linens. “This amount of activity occurring in the middle of the night makes it difficult to resume sleep, resulting in insomnia,” Decker adds.
If menopause symptoms such as hot flashes are waking you up night after night, turning down the heat can restore your sleep, Goldstein says. Hormone replacement therapy (HRT) remains the gold standard in treating moderate to severe hot flashes and other menopause symptoms, but not everyone is a candidate for it. Women who are at high risk for breast cancer or have a history of blood clots and certain other medical conditions should not take HRT. There are alternatives, though. Low-dose antidepressants such as fluoxetine (Prozac) may be effective, and for perimenopausal women, low-dose combination birth control pills may control hot flashes and even out irregular periods.
According to a study from Northwestern University, regular aerobic exercise can improve the quality of your sleep, mood, and vitality. The study included 23 sedentary people; most were women age 55 and older with insomnia. Half the group began doing moderate aerobic exercise four times a week. At the end of the study, those who exercised reported significant improvements in sleep . Timing of exercise is important, however. Don’t exercise two to three hours before bedtime, as that can also interfere with rest.
Caffeine — found in coffee, colas, tea, and chocolate — is a stimulant that can take as long as eight hours to leave your system. Besides keeping you awake, it may also trigger hot flashes in some women. It’s best to avoid it altogether if you are struggling with insomnia or night sweats that repeatedly wake you up, but if you must have it, have it early in the day. Skip the alcohol before bed, too. It’s another possible hot flash trigger, and while it may initially relax you and help you fall asleep, it will likely make it hard for you to stay asleep. It also keeps you from the deep, restorative stages of shut-eye that you need.
To ward off hot flashes and night sweats, make sure the temperature in your bedroom is comfortable and low. Wear breathable cotton sleepwear, whether you prefer pajamas or a nightgown, and choose cotton sheets over synthetic materials. Before bed, consider taking a cool shower. If you wake up because of hot flashes (or for another reason), don’t torture yourself by lying awake in bed. After 20 minutes, get up and do something relaxing until you start to feel sleepy. Worrying about not sleeping can actually keep you from sleeping!
If anxiety during menopause is keeping you awake at night, try a relaxation technique such as meditation, yoga, or deep breathing to de-stress. Make it a nightly ritual, just like brushing your teeth. Soothing sounds or pleasurable reading may also lull you to sleep. If hot flashes aren’t a problem, take a warm bath — the water is soothing and can set the stage for sleep.
Stick to a Schedule
You may be tempted to stay up late during the week and then catch up on rest over the weekend, but sticking to the same schedule every night is more conducive to getting quality sleep. That means going to bed and waking up at about the same time every day. If you’re a fan of taking an afternoon siesta, indulge before 3 p.m. so that it won’t interfere with nighttime shut-eye. And try to get outside to soak up some sun for about 30 minutes a day (with sun protection) — exposure to daylight translates to better sleep patterns.
See a Specialist
Chronic insomnia can contribute to heart disease, high blood pressure, and other lasting medical conditions. It also impacts job performance, your safety, and your overall quality of life. Fortunately, you don’t have to just lie back and live with it. “Perhaps the most important issue is that women should feel empowered to see a sleep specialist if their menopause symptoms negatively impact sleep,” Decker says.
- Last Updated: 11/20/12