Insomnia and Menopause

Those 40 Precious Winks

Woman lying in bed staring at ceiling
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You used to be a pretty good sleeper, right? Then you got near menopause, and suddenly you became the princess and the pea. (Or maybe “pee” since getting up in the night to use the bathroom is one more reason women lose sleep.) No, it’s not in your head: The menopausal years are prime time for complaints of insomnia. There are several reasons why this happens, and thankfully there are several things you can do about it, too.

Why You Don’t Sleep Well During Menopause

A number of factors gang up in menopause to disturb your sleep. Hormone levels, health issues, lifestyle, and situational stressors all play a role in whether you get to sleep and stay asleep. After the age of 40 (and sometimes before) you may have trouble getting or staying asleep because of:

  • Declining hormone levels, which impact your sleep/wake cycle
  • Hot flashes and night sweats that wake you up and may require you to stay awake to recover or change bedding
  • Health issues that wake you including thyroid problems, pain, breathing difficulties or other reasons for waking or discomfort
  • Sleep apnea, which is related to both changing levels of estrogen and to weight gain – both common in menopause
  • Life stressors -- everything from ailing parents to surly teenagers, divorce, job worries, money problems, and family issues can keep you awake once you are roused in the night
  • Depression and/or anxiety that may or may not be related to any of the above
  • Diet and use of substances such as caffeine, nicotine, alcohol or supplements
  • Medications, both prescription and over the counter, with side effects that keep you awake
  • Poor “sleep hygiene” that sets you up to be awake when you want to be asleep

    What Can You Do About Insomnia?

    What to do about sleepless nights depends on what is causing them. Here are some things to try if you want to improve your chances of restful sleep:

    • Cut out the stimulants. Stop, or greatly reduce, your intake of caffeine; quit smoking (there are so many good reasons for quitting); don’t drink alcohol; cut back on chocolate; check any supplements or diet medications to see if they have a side effect of sleep disturbance.
    • Treat your menopause symptoms. If anxiety or night sweats are waking you, treat your symptoms. Check with your medical provider and discuss what medications or supplements might be helpful for your symptoms. Whether you use black cohosh, flaxseed oil, antidepressants or a short course of hormone therapy, there are probably choices that will ease your symptoms enough to re-establish a good sleep pattern.
    • Keep your bedroom cool. You have a very sensitive hot flash threshold during menopause, so you want to keep your body as cool as you can without being uncomfortable. Anything that raises your body temperature can trip the switch, so keep your bedroom temperature a few degrees lower at night.
    • Keep your bedroom dark. You want to send your brain the message that nighttime is for sleep, and light cues you to wake up and stay up.
    • Moderate your body temperature to minimize night sweats. Wear light pajamas, and keep a cool rag or cold pack in a zip plastic bag next to the bed. Put the cool pack on your face and chest as soon as you notice a hot flash coming on, and do deep breathing until the flash passes. Try to stay relaxed while you do this.
    • Practice slow, deep breathing during the day so that when you wake with anxiety or a hot flash, you can use it immediately to calm and relax yourself.
    • Practice good sleep hygiene: Go to bed at a regular time, use your bed only for sleep and sex, relax before bed, don't have a television in the bedroom, and don't eat for at least two hours before bed.
    • Learn some relaxation techniques to “talk yourself down” during the night. Progressive relaxation, cognitive behavioral therapy, biofeedback or self-hypnosis are all techniques that will serve you during periods of insomnia, and also at other distressing moments in your life.
    • Take medications as prescribed. When you are experiencing insomnia, talk to your medical provider about the medications you are already taking. Side effects can keep you awake.
    • Exercise outside during the day. The combination of natural light, vitamin D and exercise is a recipe for better sleep. Be sure to do it early in the day, both for the daylight and so that it doesn’t rev you up before bedtime.
    • Consider sleep medications for brief periods. When you are experiencing insomnia, talk to your medical provider about the medications that might be prescribed for sleep. There are several types of prescriptions that help, including antidepressants, anti-anxiety medications, and sedative/hypnotic drugs. A short course might get you back into a natural sleep pattern.
    • Get help if you need it. A doctor, counselor, personal trainer, acupuncturist, massage therapist, or naturopath – either alone or in combination – may have words of wisdom and help for your body that will restore your sleep cycle.

    Don’t blame yourself if you can’t get shuteye. It sometimes comes with the menopause territory, and the more you despair about it, the less you will sleep. Sleeplessness is frustrating and spills out into all your daytime activities. You owe it to yourself to get the rest and recovery that can only happen with a good night’s sleep. Then, when life dishes up a new challenge, you can say, “Let me sleep on it.” And you will.


    North American Menopause Society, (NAMS), Menopause Guidebook: Helping Women Make Informed Healthcare Decisions Around Menopause and Beyond, 6th Edition , North American Menopause Society, 2006. 10 Oct. 2007.

    Murphy, P, “Altered Sex Hormone Levels, Higher Body Temp Affects Sleep Quality In Postmenopausal Women,” SLEEP, December, 2007. Associated Professional Sleep Societies, LLC, 21 Jan. 2008

    Morin, CM, Colecchi, C, Stone, J, Sood, R, Brink, D, “Behavioral and Pharmacological Therapies for Late-Life Insomnia:A Randomized Controlled Trial” JAMA, Vol. 281, No.11 991-999. 281: 991-999, Mar, 1999, 21 Jan, 2008

    Boston’s Women’s Health Book Collective, Our Bodies, Ourselves: Menopause, Touchstone/Simon and Schuster, New York. 2006.

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