Menopausal insomnia: more than just night sweats

This article is brought to you by Evergreen Women’s Health. Navigating the menopause transition can be challenging for many women, especially when their concerns are dismissed as a natural part of aging. However, it’s important to recognize that declining estrogen levels can lead to uncomfortable symptoms and serious health risks. As an advocate for women’s health, I will provide educational information and research-based practices to help women navigate this transition with confidence and support their overall health and well-being. My goal is to empower women with resilience and vitality through all stages and seasons of life.

Of all the changes associated with menopause, one of the most disruptive can be the associated sleep issues, especially insomnia and night sweats. Poor sleep at night can have profound effects on how we feel throughout the day. It can affect our mood, energy levels, memory, concentration, and even our ability to heal from injury and fight illness. Fortunately, there are many effective strategies to help menopausal insomnia.

So, why do sleep issues occur during perimenopause and menopause? As a physician specializing in menopause care, Dr. Rebecca Adams explains, “Often beginning years before a woman’s final menstrual period, hormone levels (particularly estrogen and progesterone) can wildly fluctuate. Estrogen and progesterone are hormones, or chemical messengers, that play a key role in regulating many processes in our body, including sleep.”

Studies show that over 60% of menopausal women experience insomnia. However, many women experience issues with sleep well before the menopause transition. It is common to struggle with insomnia in the days before starting your period. This is due to the natural drop in progesterone during the menstrual cycle. Because progesterone is a hormone that supports sleep, bioidentical progesterone therapy can often help with menopausal insomnia.

Hormone fluctuations can also alter your body’s ability to regulate temperature. Sudden, intense episodes of flushing and sweating can interrupt sleep and often make it difficult to fall back to sleep easily. Even brief disruptions in sleep can result in fatigue or not feeling rested the next day.

“The good news is that bioidentical estrogen is FDA approved for treatment of hot flashes and night sweats. There are also several non-hormonal treatments that are effective,” explains Dr. Adams. Because stress, medications, alcohol, spicy foods, and other triggers can worsen hot flashes, lifestyle modification is also helpful.

Another issue that can affect sleep during the menopause transition is an overactive bladder. Fortunately, this can be treated with proper pelvic floor therapy, behavioral interventions, appropriate timing of hydration, and non-systemic estrogen therapy to protect the bladder and pelvic tissues.

If you are struggling with sleep during perimenopause or menopause, there are several non-medication options to manage insomnia:

1. Establish a consistent sleep routine. Sleep hygiene involves not only going to bed and getting up at the same time, but a routine for preparing your body to successfully fall asleep and awaken feeling refreshed.
2. Create a comfortable environment for sleep. Keep your bedroom dark, calm, and cool. Mattress cooling pads, cooling pillows, fans, and breathable bedding can be helpful.
3. Exercise during the day can improve sleep at night. Just be careful not to exercise too close to bedtime, which can interrupt the normal circadian rhythm.
4. As with exercise, avoid stressful activities before bedtime. Unfortunately, this may be the time your child announces they need help with their math homework. Remember, the goal is to do the best you can with the things you can control.
5. Be thoughtful about what you eat and drink. Hydrate well during the day but consider tapering off fluids before bedtime. Avoid caffeine and alcohol close to bedtime. Alcohol can increase cortisol, worsening anxiety and insomnia.
6. Incorporate relaxation techniques. Yoga, meditation, mindfulness, stretching and deep breathing can help you feel calmer and improve sleep at night.
7. Seek professional support. If sleep issues interfere with your quality of life, they are likely also affecting your overall health. Cognitive behavioral therapy, hormone therapy, and other treatments may provide significant relief. Because each woman’s menopause transition is unique, compassionate menopause care using evidence-based treatments can make a substantial difference.

Dr. Rebecca Adams, MD, is a Menopause Society Certified Practitioner. She provides personalized, evidence-based care for perimenopause, menopause, and associated issues at Evergreen Women’s Health in Idaho Falls.