How Does Menopause Affect My Sleep?

Our moms and grandmothers called it the “change of life” — that age of hot flashes and mood swings. Many expect those symptoms during menopause. But along with sweating and weight gain comes something many people don’t anticipate: disturbed sleep.

woman awake in bed

Poor sleep quality and sleep disturbance are lesser-known changes during this phase of life, say the experts, but they’re very common.

Sleep problems can start 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, there’s help.

For “good” sleep, people should aim for between seven and eight hours of quality, uninterrupted sleep per night. 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 may be signs you're not getting good sleep.

Hot Flashes and Sleep

Sleeplessness due to menopause is often associated with hot flashes. These sensations of extreme heat can come on during the day or at night. Nighttime hot flashes are often paired with unexpected awakenings.

Though it’s common to feel like a hot flash has awakened you, research shows that many menopausal women actually awaken 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. Research shows that 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, people 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 the symptoms and effects of sleep disorders (like daytime fatigue) are easy to confuse with symptoms of menopause itself.

Experts note that postmenopausal women are two to three times more likely to have sleep apnea compared with premenopausal women. Before menopause, people are fairly protected, but the protective effect of hormones seems to be lost with menopause. Furthermore, people assigned female at birth may have more subtle symptoms of sleep apnea than those assigned male at birth. 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, diagnosis and treatment.

Depressive symptoms and anxiety may also be risk factors for poor sleep during menopause.

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 people experiencing menopause fall and stay asleep. Studies show 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 people. 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 pediatricians recommend a regular bedtime and wake time for children, keeping regular sleep hours as an adult helps your body know when it's time to go to bed.

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