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How do perimenopause and menopause affect sleep quality?

Ben Kaminsky
Dermatologist (Skin Specialist)
In perimenopause, hormone fluctuations are blamed for disturbed sleep. Many women report difficulty in falling asleep, difficulty staying asleep, and fatigue and fogginess upon arising. At this stage in the lifecycle, many women experience distressing hot flashes and attribute their sleep arousals to increased body temperature and night sweats. Some women report that hot flashes occur for several months; in others, these disruptions last for 10 years or longer, if they start at the beginning of perimenopause. Adding to the stresses, at this life stage many women are juggling raising teenagers, careers, and caregiving to aging parents, all of which can increase anxiety, resulting in feelings of overload and poor sleep. 
Dr. Michael Breus, PhD
Psychology Specialist

Women face challenges to sleep throughout their lives, but menopause often brings with it particularly difficult obstacles to sleep. According to the National Sleep Foundation, 61% of postmenopausal women report experiencing some degree of insomnia. What happens during menopause that wreaks such havoc with sleep? There are several factors:

  • Hormone shifts. Starting in perimenopause, the hormones estrogen and progesterone begin to fluctuate, and these short-term shifts can be disruptive to sleep. Over the course of menopause, the body’s levels of estrogen and progesterone decrease. Both estrogen and progesterone have effects on sleep, and the new, decreased, postmenopausal levels of these critical hormones can make sleep more difficult.
  • Physical symptoms. Menopause brings about a number of physical symptoms that can be very uncomfortable and also challenging to sleep. Hot flashes in particular can pose frequent interruptions to a woman’s nightly sleep, leaving her feeling fatigued and sleep deprived. Over time, interrupted sleep can take on a life of it’s own—insomnia and disrupted sleep can persist even after the hot flashes have disappeared.
  • Mood changes. The process of menopause has not only significant physical changes, but also emotional ones. Some women will experience depression, anxiety and other mood disorders in greater frequency during menopause. These mood-related shifts can be a cause of sleep deficiency—they can also be a consequence of insufficient sleep.

The years stretching from perimenopause to post-menopause are when sleep problems are most abundant, accounting for 61 percent of reported insomnia, according to the National Sleep Foundation. In fact, it's fairly common for women who visit their healthcare providers complaining of insomnia to learn the reason for their sleeplessness is that they're beginning the transition into menopause. Known as perimenopause, its average length is four years.

During perimenopause and continuing onto menopause, the decline in the production of estrogen and progesterone (a hormone that promotes sleep) ushers in a sharp decline in the quality—and quantity—of sleep. It can be perturbing and disturbing to be stuck in a rut of sleeplessness—but it will get better.

Hot flashes and night sweats—much like a pesky snoring or restless bedmate—can suddenly rouse women out of a deep sleep, filling them with anguish and anxiety.

But hormones aren't the only culprits in midlife sleep issues. Other "garden-variety" things can also make sleep difficult around this age, like:

  • the need to get up to urinate in the middle of the night
  • sleep-related disorders like sleep apnea or chronic pain
  • restless legs syndrome or leg cramps
  • stress, anxiety or depression

This content originally appeared on HealthyWomen.org.

Dr. Carol Ash, DO
Pulmonary Disease Specialist
Perimenopause and menopause can create poor sleep quality; women's hormones are erratic, which creates symptoms that disrupt sleep. In this video, internist and sleep expert Carol Ash, DO, explains how this stage of women's lives impacts sleep.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.