Hot flushes disturbing your sleep? Not sleeping as well as you used to? How does menopause impact on sleep?
Sleep changes for a lot of women around the start of menopause and after menopause. For some it can be hot flushes which cause sleep disturbance whereas for others, sleep throughout and then after the menopause sleep feels lighter and more readily disturbed. I often see women who
had trouble with sleep prior to menopause but were managing, but the changes to sleep with menopause make enough of a difference that they find they are having trouble.
What is menopause?
Menopause is defined as the permanent cessation of menstrual periods, and women are said to have reached post-menopause when they haven’t had a period for 12 months. It occurs at a median age of 51 years in normal women, and if it occurs before the age of 40 is felt to be pre-mature. There is a transition, where periods are irregular, before menopause, which is called perimenopause. It’s often during this time that women experience symptoms such as hormonal changes and hot flushes.
During reproductive years, women have varying levels of oestrogen and progesterone throughout the menstrual cycle. (For more details on the menstrual cycle and it’s impact on sleep see this post.) With the onset of perimenopause, oestrogen levels gradually reduce and follicle stimulating hormone (FSH) increase. These changes in hormone levels can bring about a number of symptoms:
- Hot flushes – also called ‘hot flashes’ or ‘vasomotor symptoms’ are the most common symptoms of the menopausal transition. In the US SWAN study, 60% to 80% of women had them at some point during the menopausal transition (Thurston and Joffe, 2011), and in more than half of women with frequent hot flushes they lasted more than 7 years (Avis et al, 2015). When hot flushes occur at night, women typically describe them as ‘night sweats’.
- Depression – in a US cohort study, women were about 2.5 times more likely to be diagnosed with depression during the menopausal transition than before it (Freeman et al, 2006). This is an association; many other things also affect mood at this time of life.
- Sleep disturbance – About 4 in 10 women report trouble sleeping around the menopause (see below).
- Breast pain and tenderness – these symptoms are more common in early perimenopause
How does menopause affect sleep?
Women in perimenopause and post-menopause report more sleep disturbance than pre-menopausal women. In the US Study of Women’s Health Across the Nation (SWAN), 38% of more than 12,000 women aged 40 to 55 reported trouble sleeping. This rose to about 45% in late perimenopause and 48% after surgical menopause, and waking during the night was the main complaint (Kravitz et al, 2003). A later SWAN study of more than 3,000 women found similar results (Kravitz et al, 2008). These are surveys, so they show what women report, not what causes it.
When sleep is measured overnight with a sleep study, it does not look worse after menopause, even though women report being less satisfied with their sleep (Young et al, 2003). How sleep feels and how it measures often differ.
There are a number of contributing factors to disturbed sleep, but hot flushes are reported as being the major cause of sleep disturbance during perimenopause. Most women with severe hot flushes report disturbed sleep. (Archives of Internal Medicine 2006)
Other factors associated with disturbed sleep and the menopause are:
- depression and anxiety symptoms – as noted above, women are at higher risk of depression during the perimenopause, and can also have an increase in anxiety symptoms
- sleep disorders – are more common in women during perimenopause and post-menopause. In a small study of 102 women referred with sleep complaints, 53% had sleep apnoea, restless legs syndrome or both.
What can be done to help with sleep?
With sleep being lighter and more readily disturbed, together with the sleep disturbance from hot flushes and sleep disorders, it’s important to give yourself the best chance of sleeping well, as well as minimise the impact of poor sleep.
- Managing hot flushes – most women with hot flushes don’t need medication as there are some simple strategies than can help reduce night sweats. Reducing the room temperature, using a fan in the bedroom and dressing in layers of bed clothing that can be shed can help. If hot flushes are more severe, treatment can be discussed with your health professional. Menopausal hormone therapy (MHT) is the most effective treatment. Non-hormonal options such as low-dose venlafaxine, escitalopram or gabapentin also reduce hot flushes, though less than MHT; in a randomised trial, venlafaxine was less effective than oestrogen (Joffe et al, 2014). These medicines are used off-label for hot flushes in Australia. Fezolinetant (Veoza) is a newer non-hormonal medicine approved in Australia for moderate to severe hot flushes. It is not currently subsidised on the PBS, and it needs liver blood tests before and during treatment. The Australasian Menopause Society has more on non-hormonal options.
- After breast cancer – menopausal hormone therapy is generally not recommended after breast cancer. Treatments such as tamoxifen, aromatase inhibitors and ovarian suppression often bring on or worsen hot flushes and disturbed sleep. Cognitive behavioural therapy for insomnia (CBT-I) helps sleep whether or not hot flushes are present, and does not interact with cancer treatment; randomised trials support this, including in breast cancer survivors. See the Westmead Breast Cancer Institute guide, Menopause after breast cancer (2025), and Cancer Australia’s clinical guideline (2016).
- Minimise the impact of disturbed sleep – looking after yourself, by ensuring you have time for yourself (see this post on prioritising ‘me’ time) are maintaining good general health can help you feel better throughout the day. If you’re feeling better during the day, even if sleep is disturbed, it won’t have as much of an impact.
- Look out for sleep disorders – recognise that you are at higher risk for sleep disorders such as sleep apnoea or insomnia. So if you are having trouble with sleep despite doing what you can, talk to your health professional about getting a referral to a sleep specialist.
- Treat insomnia directly – cognitive behavioural therapy for insomnia (CBT-I) is the most effective treatment for insomnia. The free This Way Up Insomnia Program is a good place to start.
- Worth knowing – waking during the night is normal. Poor sleep has not been shown to bring breast cancer back or to cause dementia; studies show associations, not cause and effect. More time in bed does not fix fatigue, and trying hard to sleep usually makes it harder. The Sleepiness and Fatigue Profile can help you see what is affecting your energy.
Related posts & links:
- Jean Hailes Foundation
- Menopause – The Basics – Up to Date
- Minimising the impact of sleep disorders
- Sleep Talk: Episode 39 – Menopause
- Sleep Talk: Episode 28 – Sleep and Cancer
Need more information about how you can sleep better?
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