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Sleep Struggles During Menopause and What You Can Do About It

If you are perimenopausal or menopausal and struggling with getting a good night's sleep, you are not alone.

Though many women can fall asleep just fine, staying asleep is a challenge for many women during this time of life. Women will usually develop more fragmented sleep; so you may be good for a few hours, but then struggle to get back to sleep after waking. 

Hormones obviously play a major role in sleep disturbances – like night sweats – during the menopause transition, but there are other factors that get overlooked and may be underdiagnosed. Sleep apnea for example doesn’t show up with the same symptoms in women as it does in men, and it is a common cause of poor sleep. 

To get good sleep – and you deserve to get good sleep – you need to get to the heart of what’s causing the issues.


Common Causes of Fragmented Sleep in Menopause

First, let's be sure you’re practicing all the basics for good sleep. That means winding down in the 30 to 60 minutes before bedtime, turning off the electronics, dimming the lights, and performing a little bedtime ritual so you’re signaling to your brain that it’s time to relax and get some sleep. Avoid eating a big meal two hours before bedtime; avoid alcohol before bed, and don’t perform intense exercise right before you plan to go to sleep.

All that said, many women have the basics down and are still waking up in the middle of the night. As your hormones shift during menopause, a number of sleep-wrecking issues can arise. Some are obvious…others, less so. The following are some common factors that might be keeping you up at night:


Hot Flashes & Night Sweats

Obviously, if you start pouring sweat in the middle of the night, you’re going to wake up. But nighttime hot flashes can be more subtle than that and you may have disrupted sleep without ever breaking a sweat.

Your hot flashes may be causing just enough of a disruption in your body temperature regulation to wake you up and mess with your sleep. So, you feel like you’re suffering from insomnia, but what you’re really suffering from is nighttime hot flashes related to your hormones.

Whether you wake up on soaked sheets or suspect hot flashes are causing your sleep disturbances, do not suffer in silence. Hormone therapy is an excellent option for treating hot flashes. There are also other medications, such as gabapentin, which can help with hot flashes and improve your sleep. Discuss with your doctor for the best course of treatment for you.


Sleep Apnea

The risk for sleep apnea goes up and becomes similar to men’s once you’re postmenopausal. Hormones may be the reason. Estrogen and progesterone may protect airway patency before menopause. Women, however, may not show the same “classic” symptoms of sleep apnea, such as snoring, waking up gasping, or having someone witness them stop breathing in their sleep. So, when they go to the doctor because they’re not sleeping well, their doctor doesn’t register that they may have sleep apnea. 

Women more commonly have REM-related sleep apnea, so they fall asleep pretty easily, but then they start waking up and have fragmented sleep in the second half of the night. What’s happening is they have breathing disturbances that wake them up during this period when their muscles are most relaxed. 

Though women present differently than men, the treatment is the same: getting more air through your airway. One way is a continuous positive airway pressure (CPAP) device, which provides a continuous flow of air into a mask that fits over your nose and/or mouth and provides just enough pressure to keep your airway open while you sleep.


Restless Leg Syndrome

Restless leg syndrome (RLS) is a condition that causes a desperate urge to move your legs, usually in the evening or nighttime. It creates a creepy crawly, throbbing, and/or aching feeling in your legs (though it can occur in other parts of the body) that creates an urge to move, which temporarily relieves the uncomfortable feeling.

There’s a strong genetic component to RLS and it is more common in women who have had children (it is also common during pregnancy), and the more children a woman has had, the higher the likelihood that she’ll have RLS. Though the exact underlying mechanisms are still not fully understood, iron levels appear to play a role. Some anti-depressants, particularly SSRIs, can exacerbate it, as can caffeine, alcohol, and smoking.

Also, work with your doctor to dial in your iron levels. People with RSL have lower than normal iron stores in some regions of the brain, but may not be anemic or show up as having an iron deficiency in standard blood panels. You want to have your ferritin checked. Your doctor may recommend iron therapy as part of the treatment. 

There are also prescription medications for restless leg syndrome. Whatever course ends up working for you, know that there are options to help you get the sleep you deserve. 


Anxiety, Stress & Hypervigilance

Anxiety and stress can make it nearly impossible to stay soundly asleep. Some women swear by CBD for sleep because of the anti-anxiety effects (which can be particularly useful for menopausal women). We still need more research there, but it could be helpful. If you want to try it, give it a month, and see if it improves your sleep quality.

Also consider trying a sleep app like Calm. Bedtime stories work for kids for a reason: they’re relaxing, and they help the child feel safe and sound before drifting off to sleep. Using a sleep app, which is designed to promote relaxation and lull you to slumber can have a similar effect.

If you’re suffering from chronic insomnia, which by definition is the inability to get to sleep and or stay asleep at least three times a week for at least three months, the best course of action is cognitive behavioral therapy for insomnia. It is an evidence-based form of behavioral therapy that addresses the behaviors that are causing you to be stimulated in your sleep and retrains your brain to associate bedtime with sleep.



Source: Selene Yeager,

R Ellen Eye, M.D., F.A.C.O.G. R Ellen Eye, MD, FACOG Rita Ellen Eye, MD is a board-certified OB/GYN physician who joined Premier OB-Gyn in 2014. Dr. Eye is originally from Potosi, Missouri, a small town near St. Louis (and she remains a loyal fan of the St. Louis Cardinals!). She graduated from her high school as Valedictorian. She attended Missouri University of Science and Technology, earning her Biological Sciences degree while graduating with Magna Cum Laude honors. She received her doctoral degree from the University of Missouri-Columbia in 2006. Dr. Eye went on to complete her residency in Obstetrics and Gynecology and was honored by being elected Chief Resident at the University of Oklahoma in Tulsa. She began her successful private practice in Texas where she lived and worked for four years before moving to Florida. She is married to husband Chet and a proud mom to a sweet daughter named Faith. Dr. Eye is board certified by the American Board of Obstetrics and Gynecology.

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