The Connection Between Sleep and Menopause Symptoms

It’s no secret that the menopausal transition can affect sleep — with sleep disorders impacting 39% to 47% of perimenopausal women and 35% to 60% of postmenopausal women, according to the National Sleep Foundation.¹ But what’s less commonly known is that menopause sleep problems can also exacerbate other menopause symptoms.

Brain fog, anxiety, mood swings, decreased libido, headaches - all of these are symptoms a woman may experience during menopause that could be made worse by a lack of quality sleep. Understanding the effects poor sleep can have on menopause symptoms and why— along with some ways to get better sleep — may help you feel more rested while potentially mitigating the severity of other menopause symptoms.

What Causes Menopause Sleep Problems?

As with almost all of the symptoms that affect women during this transitional time, hormones are primarily to blame for difficulty sleeping during menopause. Decreasing levels of estrogen, progesterone and melatonin — along with an increase in the stress hormone cortisol — all contribute to menopause sleep problems.²

Melatonin helps regulate the body’s sleep-wake cycle, while cortisol plays a role in the body’s fight-or-flight response to stress³, loss of estrogen and progesterone, meanwhile, can trigger symptoms like hot flashes and night sweats that can disrupt sleep.⁴

In one study looking at the connection between hot flashes and sleep disruption, 69% of hot flashes were associated with women awakening in the night.⁵ Another study found that 66% of hot flashes occurred within five minutes after waking, with 80% of women experiencing hot flashes just before or during the process of waking up.⁶

How Does Poor Sleep Impact Other Menopause Symptoms?

When you’re dealing with multiple menopause symptoms, you may be tempted to chalk everything you’re feeling up to hormones. But lack of sleep can affect every system of the body — and it can make many menopause symptoms worse.

“We really need to recognize that sleep is not optional,” says Dr. Jaime Tartar, PhD, a professor in the Department of Psychology and Neuroscience at Nova Southeastern University who studies the neurobiology of sleep. “Just like breathing, just like eating, you have to do it.”

Sleep is when the brain is focused on repair and restoration, Dr. Tartar explains. Without adequate time to perform this important restoration process, any health issues you’re dealing with (including menopause symptoms) will be exacerbated.

“Sometimes people talk about sleep as the Swiss Army knife of health, and I completely agree with that,” Dr. Tartar says. Anything that's wrong with you, if you don't sleep, it's going to make it a little bit worse.” So, sleep problems during menopause may very well exacerbate symptoms.

When speaking about menopause specifically, Dr. Tartar points to several specific symptoms that can be worsened by lack of sleep.

Brain Fog and Other Cognitive Problems

According to Dr. Tartar, cognitive concerns, like difficulty focusing and memory problems, are among the first symptoms to appear when we don’t sleep well.⁷ “We think about attention as really being the most expensive resource our brain is running at any time,” Dr. Tartar says. “It's difficult for us to maintain attention, so with lack of sleep, that’s the first thing that goes.”

For women who are already struggling with brain fog related to menopause, Dr. Tartar goes on to explain that, lack of sleep can make the problem worse — especially since women in general tend to carry a heavy cognitive load.⁸

“Sometimes the effects of sleep deprivation on cognition are worse for women who are already maintaining their attention on so many different aspects of their lives and their kids’ lives,” Dr. Tartar says. “It's hard enough to track all of these ‘tabs’ that we have open. Once you lose sleep, cognition goes down — especially working memory and attention.”

Anxiety and Depression

There appears to be a chicken-and-egg relationship between mental health issues like anxiety and depression and lack of sleep, especially when considering sleep problems during menopause. For example, menopause-induced anxiety may keep you awake at night, causing you to be sleep deprived the next day, Dr. Tartar explains. This in turn can cause you to feel more anxious, since lack of sleep has been shown to trigger anxiety.⁹

Hormone changes during menopause can also leave women feeling depressed; the incidence of depression doubles during this time, according to Harvard Health.¹⁰ Since sleep deprivation is also linked to depression, poor sleep caused by menopause can have a compounding effect on depressive symptoms during this time.¹¹

Weight Changes

Up to 90% of women deal with weight-related challenges during menopause; women gain 12 to 15 pounds on average between the ages of 45 and 55, when menopause typically occurs.¹²

Unfortunately, menopausal sleep deprivation may make maintaining a healthy weight during menopause even more difficult. Many clinical studies have shown increased hunger and calorie intake among sleep-deprived adults, and that people tend to crave carb-heavy, fatty comfort foods after a night of poor sleep.¹³

Mood Swings

According to the North American Menopause Society (NAMS), studies show 23% of peri and postmenopausal women experience mood changes.¹⁴ Throw sleep deprivation into the mix, and unstable emotions may become even more volatile. This may suggest that menopause sleeplessness can increase symptoms like mood swings and even hot flashes.

“Even with just one night of sleep loss, a lot of people experience emotional instability,” Dr. Tartar says. You may not be consciously aware of it, but lack of sleep affects your brain’s ability to process emotions, which can lead to mood issues. Research indicates a strong connection between sleep deprivation and negative emotions such as anger, irritability and frustration.¹⁵

How to Sleep Better During Menopause and Beyond

For some quick tips on how to sleep better during menopause and beyond, hear from Bonafide Chief Medical Officer, Dr. Alyssa Dweck, below: 

Dr. Tartar explains that the first step toward getting more and better rest during menopause is to acknowledge the important role sleep plays in supporting overall health — and prioritizing it accordingly. She suggests women think about sleep as basic hygiene, like brushing their teeth or exercising, since it’s just as crucial to wellbeing.

“We can't wake up early because we want to do a bunch of things and expect everything else to be wonderful in our life,” Dr. Tartar says. Here are some of her tips for getting a better night’s sleep.

• Create a sleep oasis. Dr. Tartar recommends investing in a comfy mattress and cozy bedding. “Think about how much money we spend on our cars, and we’re only in them for around an hour a day,” she points out. Creating a calm, comforting space can be a great way to combat sleep problems during menopause.
• Stick to a bedtime routine. When we have babies, we recognize that a routine helps them go to sleep, Dr. Tartar explains, and adults can benefit in the same way by training their brains that it’s time to rest. This can include things like avoiding screen time after a certain time and setting a consistent “bedtime.”
• Turn to technology. There are many apps available that can help you slow down your racing mind at bedtime and help fight menopause sleeplessness, Dr. Tartar advises.
• Consider separate rooms. If a partner’s snoring or restlessness is keeping you up at night, think about sleeping separately. You’ll enjoy your time together during the day much more if you’re both well-rested!
• Guard your rest time. “Absolutely be selfish about your sleep,” Dr. Tartar says. “It’s for everybody’s benefit.”

If you’re struggling with interrupted or poor quality of sleep during menopause, it’s not a bad idea to revisit your bedtime routine and see where any of the above recommendations may help. And if you’re finding that lifestyle changes alone are not helping, be sure to speak with your healthcare provider to determine what treatment options may be right for you.

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Resources:

1. https://www.sleepfoundation.org/women-sleep/menopause-and-sleep
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611767/#:~:text=Insomnia%20is%20a%20major%20complaint,in%20a%20more%20gradual%20course
3. https://www.psychologytoday.com/us/blog/sleep-newzzz/202004/the-effects-cortisol-your-sleep
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551537/
5. https://pubmed.ncbi.nlm.nih.gov/25256933/
6. https://pubmed.ncbi.nlm.nih.gov/26951410/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656292/
8. https://www.bbc.com/worklife/article/20210518-the-hidden-load-how-thinking-of-everything-holds-mums-back
9. https://www.nature.com/articles/s41562-019-0754-8
10. https://www.health.harvard.edu/womens-health/menopause-and-mental-health
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318605/
12. https://www.menopausenow.com/weight-gain 
13. https://www.hsph.harvard.edu/nutritionsource/sleep/#:~:text=Sleep%20Deficiency%20and%20Eating%20Behaviors,allowed%20free%20access%20to%20food
14. https://www.menopause.org/for-women/sexual-health-menopause-online/causes-of-sexual-problems/depression-mood-swings-anxiety
15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122651/