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How To Treat Menopause & Postmenopausal Sleep Issues

Sara Coughlin

Menopause and insomnia can unfortunately go hand-in-hand. Between hormone fluctuations, night sweats, and mood changes, you might be finding it harder to get some shut-eye post-menopause. But you can take control of your sleep schedule. Here’s what you need to know about dealing with — and avoiding — postmenopausal sleep issues.

How the Onset of Menopause Affects Your Sleep

Shamsah Amersi, MD, ACOG, an OB/GYN based in Santa Monica, CA, explains that sleep issues are extremely common among women entering menopause. What you’re most likely to experience, she explains, is postmenopausal insomnia, in which you fall asleep easily but wake up in the middle of the night and struggle to fall back to sleep.

Dr. Amersi says this restlessness is often due to night sweats, but those uncomfortable sensations are hardly the sole cause of sleep issues during and after menopause. In fact, it’s more often than not a combination of factors related to menopause that can result in poor sleep. Here, we’ll take a closer look at the main symptoms of menopause that can affect your sleep quality and may be causing your postmenopause sleep problems.

Hot Flashes While Sleeping

It makes sense that these flares, in which you feel excessively hot, flushed, damp, and sticky, are so often blamed for menopausal sleeplessness. They’re also the root cause of night sweats, which hardly make for a peaceful evening. It’s also important to note that hot flashes are one of the most common symptoms of menopause — Dr. Amersi says that between 75 and 85 percent of menopausal women will experience hot flashes, which further explains why they’re considered public enemy number one for sleep.

Hormonal Changes

You can also notice perimenopausal sleep problems and insomnia. The first hormone that declines during the onset of menopause is progesterone, Dr. Amersi explains. “That can translate into insomnia,” she adds. Estrogen will also decrease as you enter menopause, which could contribute to new issues with sleep. Not only do these hormonal changes cause hot flashes, they can also fuel the development of sleep apnea, or sleep disordered breathing, in some menopausal women.1 Regardless of how these hormonal fluctuations manifest themselves, the end result is often the same: disrupted sleep.

Changes in Mood

During menopause, you might feel less confident and experience more anxiety and depressed moods, due to the aforementioned physical and hormonal changes you’re experiencing, and notice that your quality of sleep suffers, in turn.2 Specifically, research claims that declining estrogen levels can contribute to depression.3 And depressed moods have a cyclical relationship with insomnia, in which they can exacerbate each other if left unaddressed.

Postmenopause Sleep Problems

Some women may see improvements to their sleep as they enter post-menopause, Dr. Amersi notes. This could be due to some abatement in the symptoms outlined above — for example, some research suggests that feelings of depression may decrease with post-menopause.4

However, others might not find much relief upon making this transition. According to a 2012 review, 35 to 60 percent of postmenopausal women deal with sleep disturbances,5 and this is usually due to the symptoms listed above. Luckily, whether you’re in the midst of menopause or preparing for postmenopause, you can address these issues and get your sleep back on track.

How to Cope with Sleep Issues During and After Menopause — and When to See Your Healthcare Provider

Treatment for perimenopausal insomnia and menopausal and postmenopausal sleeplessness can range from simple, at-home changes to medications prescribed by your healthcare provider. If problems with your sleep schedule start to crop up, the best first steps are to start small. Then, if you don’t notice any improvements after making those minor tweaks, Dr. Amersi says to get in touch with your healthcare provider.

If you’re interested in watching a quick clip from Bonafide Chief Medical Officer, Dr. Alyssa Dweck, on how to manage sleeplessness, check out the below:

Lifestyle Changes

A good night starts with a good day, one in which you plan your activities and meals with sleep in mind. That means avoiding caffeine, alcohol, spicy foods, or warm beverages close to bedtime, Dr. Amersi says, adding that it’s also wise to skip your midday nap. Aside from omitting certain things from your day, you should consider adding regular exercise and a simple meditation practice to your schedule. Both of these activities will help relieve stress and help you unwind when it’s time for bed. Just don’t exercise too close to when you go to sleep, as it can have a stimulating effect, Dr. Amersi warns.

Bedtime Routines

In addition to setting a regular bedtime (and sticking to it) and stopping screen use an hour before bed, you can make small changes to your bedtime routine that specifically help to remedy those dreaded hot flashes. Dr. Amersi recommends wearing loose-fitting, cotton clothes and keeping your bedroom cool and well-ventilated. For the record, cooler temperatures are better for sleep in general, not just for people dealing with hot flashes.6

Over-the-Counter Insomnia Remedies

You can find a wide range of natural and over-the-counter (OTC) remedies that may help address sleeplessness, but some are particularly well-suited for aiding with sleep issues related to menopause. If hot flashes are the main cause of your sleeplessness, Swedish pollen extract could be a good option for you. This naturally occurring ingredient is hormone-free, plant-derived, and may help alleviate some symptoms related to menopause, including hot flashes and night sweats.7

Dr. Amersi points to black cohosh, a natural supplement, as another option for treatment. Proceed with caution, however, since black cohosh is also what’s known as a phytoestrogen and can act like estrogen in the body. It’s important to check with your healthcare provider first before starting anything new, but especially when it comes to phytoestrogens, and if you have a history of breast cancer.

Other OTC options that may help you get to sleep include the dietary supplement melatonin or progesterone cream, a topical form of progesterone that Dr. Amersi recommends dabbing on your wrists or lower back. Again, be sure to check with your healthcare provider first to determine if products containing hormones are right for you.

Prescription Treatments

Finally, if you’re dealing with constant sleeplessness during or post-menopause and haven’t seen any improvements, Dr. Amersi says to talk to your healthcare provider. They may recommend a prescription-level hormone therapy regimen or refer you to a sleep specialist, depending on the exact cause of your sleep issues.

Why You Should Make Sleep a Priority During Menopause and Beyond

Every woman at every life stage needs to get a good night’s sleep — that means an uninterrupted seven to nine hours, Dr. Amersi says. Without this sustained period of rest every night, your health as a whole will decline. Poor sleep can increase your risk of heart disease, cognitive decline, and diabetes, Dr. Amersi explains, adding that a lack of sleep (six hours a night or fewer) increases the level of cortisol, a hormone associated with stress, in the body. And chronic stress can present its own set of adverse health effects, including weight gain, increased anxiety, digestive problems, and, in yet another instance of a vicious cycle, problems falling asleep.8

Lying awake night after night can be endlessly frustrating, but you don’t have to feel powerless when it comes to addressing your sleep issues. By making sleep a priority and addressing the symptoms that are keeping you up at night, you can get the Zzzs you deserve.



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