Navigating Sleep Disorders During Menopause

There are a lot of reasons for sleepless nights during menopause: racing repetitive thoughts, a cocktail too close to bedtime, late-night demands from your bladder–seems like your body can come up with endless ways to avoid sleeping peacefully. While the occasional restless night isn’t usually something to worry about, sleep disorders and chronic sleep issues like insomnia, night sweats, and sleep apnea can show up or worsen during menopause. If you find yourself waking up too early or sleeping fitfully lately, you're not alone. We’ll take a closer look at some of these sleep disturbances, the causes behind them, and what you can do about them.

Quality sleep is essential for supporting aspects of healthy brain function, such as cognition and memory, and physical health, like metabolism. When we don’t sleep enough, our mood suffers: we might feel cranky, impatient, short-tempered, sad, or generally unable to cope. Getting more (and deeper) sleep can help us feel more resilient, energized, and better able to tackle our days, whatever they might bring.  

How hormonal changes contribute to sleep disruption

The primary culprit behind sleep problems during menopause is the fluctuating levels of hormones, particularly estrogen and progesterone, which play a critical role in regulating the sleep-wake cycle. As levels of these hormones shift and decline, it affects the signals your brain sends to your body, making it harder to fall asleep, stay asleep, or both. Here’s a closer look at the functions of each hormone:

• Estrogen influences the production of serotonin, a neurotransmitter that promotes relaxation and sleep. Lower estrogen levels can lead to decreased serotonin and an inability to fall asleep. "Estrogen also plays a role in muscle tone; this includes the throat muscles," says Mary Best, NP, Nurse Practitioner at Complete Sleep. As estrogen levels decline during menopause, she explains, "there is a marked decrease in muscle tone that can contribute to an increased risk for obstructive sleep apnea in postmenopausal women."

• Progesterone, known for its calming effects, helps regulate sleep. Declining levels can contribute to anxiety, irritability, and difficulty initiating sleep.

Existing research indicates that these hormones may even help protect women against sleep apnea—but unfortunately, menopause can cancel out that benefit. Menopause influences the prevalence of sleep apnea, with postmenopausal women experiencing sleep apnea severity comparable to that of men.

Understanding sleep apnea during menopause

While fatigue is a common menopause symptom, many people don’t realize that their sleep disturbances may be due to an underlying sleep disorder like sleep apnea. Sleep apnea is a condition in which breathing repeatedly stops and starts during sleep, and if left untreated, it can lead to serious health complications such as high blood pressure, heart disease, and cognitive impairment.

What raises the risk of sleep apnea during menopause?

The hormonal changes that occur during menopause—particularly the decline in estrogen and progesterone—can contribute to airway instability, making women more susceptible to sleep apnea. Additional risk factors include:

• Weight gain, which is common during menopause and can increase airway obstruction

• Increased soft tissue collapse in the throat due to decreased muscle tone

• Nighttime hot flashes and awakenings that disrupt deep sleep cycles

Signs of sleep apnea

Women with sleep apnea may not have the same symptoms as men. While men often experience loud snoring and gasping for air, women tend to report more subtle symptoms, such as:

• Persistent fatigue and excessive daytime sleepiness

• Morning headaches

• Difficulty concentrating or memory problems

• Mood changes, such as irritability and anxiety

• Waking up frequently at night to urinate

Ugh, sounds a lot like menopause too, right? Because these symptoms overlap with common menopause complaints, sleep apnea often goes undiagnosed in women. But since you can’t diagnose yourself with sleep apnea, it's important to get tested. If you suspect you may have sleep apnea, consider a home sleep test to determine if further evaluation is needed.

Types of sleep apnea

There are three main types of sleep apnea:

1. Obstructive Sleep Apnea (OSA): The most common type, caused by the collapse of soft tissue in the throat that blocks airflow.

2. Central Sleep Apnea (CSA): A less common form where the brain fails to send proper signals to the muscles that control breathing.

3. Complex Sleep Apnea Syndrome: A combination of both OSA and CSA.

The good news is that sleep apnea is treatable. Some use CPAP therapy, which relies on a machine that uses air pressure to keep airways open and facilitate breathing during sleep, while others prefer oral appliances such as custom-fitted night guards that help by gently repositioning the jaw and tongue.

Other sleep disorders that can worsen during menopause

In addition to sleep apnea, menopause can also increase the likelihood of experiencing other sleep disorders, such as insomnia, frequent night wakings, and restless leg syndrome.

Insomnia

Many women experience menopause-related insomnia, which differs from chronic clinical insomnia. While chronic insomnia is often linked to psychological factors, menopause-related insomnia is largely driven by hormonal changes. Symptoms include:

• Difficulty falling asleep or staying asleep

• Waking up too early

• Feeling unrefreshed in the morning

Cognitive behavioral therapy for insomnia (CBT-I) is considered the first-line treatment, with menopausal hormone therapy (MHT) as an option for some women. Some melatonin and serotonin-based medications may also provide relief to help regulate the sleep-wake cycle, but always check with your physician to see if these options are compatible with your needs and any other medications you may take.

Frequent Night Wakings

A common complaint among menopausal women is waking up between 3-4 AM and struggling to fall back asleep. While this can be classified as insomnia, it can also be a result of:

• A drop in melatonin production

• Stress and increased cortisol levels

• Blood sugar fluctuations during the night

• Hot flashes, which can trigger awakenings even before the sensation of heat is felt

To manage these wake-ups, try practicing relaxation techniques before bed, keeping your room cool, and avoiding heavy meals or alcohol before sleep. If these disturbances happen often, Gennev Registered Dietitian Nutritionist Melissa Burton suggests that it could be a good time to have your Hemoglobin A1c (which measures your average blood glucose levels over the previous 2-3 months) tested to see if blood sugar regulation issues could be the culprit. Blood sugar levels are supposed to fluctuate throughout the day as your body carries out digestion and metabolism, but wild spikes and downswings at night can both affect hormones and contribute to night awakenings. While medications and/or menopause hormone therapy may be helpful in those cases, simple dietary changes can also help stabilize blood sugar overnight.

Restless Leg Syndrome (RLS)

Restless leg syndrome is a neurological condition that causes an uncontrollable urge to move the legs, particularly at night. Women going through menopause may notice their symptoms worsening due to:

• Changes in dopamine levels

• Iron deficiency, which is more common in menopausal women

• Increased stress or anxiety

Simple strategies like stretching before bed, taking iron supplements (if deficient), and practicing relaxation techniques may help alleviate these symptoms. Burton notes that while there is limited research into dietary supplementation for restless leg syndrome, some vitamins and minerals do show promise. Some of her patients have found relief for RLS and other sleep issues with magnesium, a key mineral that supports muscle, nerve, bone, and heart health in addition to helping with mood and sleep. If you’re tempted to try it, a few tips: there are different forms of magnesium, some of which can cause vivid dreams or digestive discomfort, so Burton advises first-timers to look for magnesium glycinate, since it can be gentler on the GI system. It’s also a good idea to take your first dose when you’re not facing a busy day, just to minimize the chance of an upset stomach disrupting your plans.

And of course, before trying any new vitamin or mineral supplement, check with your healthcare provider or a pharmacist to make sure there’s no risk of interaction with other supplements or medications you're taking or contraindications with other health conditions you may have.

The impact of disrupted sleep on overall health and quality of life

Time and time again, research shows that not getting enough sleep over a long period of time impairs our mental and physical health. Being sleep-deficient can interfere with our ability to work, drive, focus, remember things, make decisions, get tasks done, regulate our emotions, and be fully present for our children, family members, and friends. Our overall well-being suffers.

Sleep deprivation also increases the risk of chronic diseases such as diabetes and heart disease and serves as a kind of “warning sign” for other medical and neurological issues, such as congestive heart failure, osteoarthritis, and Parkinson’s disease. While sleep duration needs vary from person to person and do decrease a little bit as we age, sleep quality is still extremely important for short-term and long-term health–so know that you don’t have to just power through poor sleep if you’re not getting the rest you need.

Strategies for better sleep during menopause

While sleep disturbances during menopause are common, there are steps you can take to improve your sleep quality:

• Maintain a regular sleep schedule to support your body’s internal clock.

• Create a relaxing bedtime routine to signal to your body that it’s time for sleep.

• Optimize your sleep environment by keeping your bedroom cool, dark, and quiet.

• Limit caffeine and alcohol in the evening to prevent disruptions to your sleep cycle.

• Exercise regularly but avoid intense workouts too close to bedtime.

• Incorporate relaxation techniques such as deep breathing, meditation, or gentle yoga.

When to seek professional help

If your sleep problems are severe or persistent, it might be time to consult a healthcare professional. They can help identify any underlying medical conditions, recommend appropriate treatment options, and rule out other possible causes of sleep disturbances. Potential solutions may include:

• Hormone Replacement Therapy (HRT)

• Cognitive Behavioral Therapy for Insomnia (CBT-I)

• Medical evaluation for sleep apnea or restless leg syndrome

• Diet, lifestyle, and physical activity changes overseen by a Registered Dietitian Nutritionist

Some final thoughts

Sleep disorders during menopause are a common—but manageable—challenge, so it’s important not to give up hope. By understanding the underlying causes and building healthy sleep habits, you can start to reclaim your nights and enjoy more rejuvenating sleep. If you’re struggling to get deeper sleep no matter what you try, be sure to reach out to your healthcare provider for personal advice and support. "If you suspect your sleep is being affected by your hormones, take a home sleep test and talk to your physician regarding treatment," says Mary Best, NP, Nurse Practitioner at Complete Sleep.

When it comes to treatment, there are a variety of options available depending on the cause of sleep disturbances. “Treatment options include hormone replacement therapy (HRT), SSRIs, and acupuncture, in addition to cognitive behavioral therapy," Best says. And if sleep apnea is a factor, she explains, "manual devices to assist in airway support are also a viable and reasonable option without the risks of medication side effects."

If you’re dealing with sleep apnea (or worried that you might be), Complete Sleep can help you get tested with easy, accurate testing right from the comfort of home. Even better, if you find out that you have sleep apnea, Complete Sleep offers a helpful, effective treatment with custom-fitted night guards.

You can also find support for sleep issues through Gennev. Our menopause-trained MDs and Registered Dietitian Nutritionists can help identify the root causes of your sleep concerns and address fatigue, night sweats, insomnia, racing thoughts, anxiety, and more via personalized care plans designed to help you find relief.

No matter what stage of menopause you’re in, know that support is available and that getting better sleep is absolutely possible.