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. They can occur in up to 80% of women, with 20-30% of women seeking medical attention for treatment. When hot flushes occur at night, women typically describe them as ‘night sweats’.
- Depression – women have a 2.5 times increased risk of developing symptoms of depression in the menopausal transition compared to when they are premenopausal.
- Sleep disturbance – Around 40% of women develop sleep disturbance associated with menopause.
- Breast pain and tenderness – these symptoms are more common in early perimenopause
How does menopause affect sleep?
Women in perimenopause and post-menopause have more sleep disturbance than pre-menopausal women. Research on over 3,000 women published in 2008, showed that 40% of women post-menopause reported problems staying asleep or waking frequently at night. 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. In women with severe hot flushes, around 80% have chronic insomnia during perimenopause. (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 study of 102 women reporting sleep disturbances, 53% had sleep apnea, 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 flush symptoms are more severe, hormonal or drug treatment could be considered in discussion with your health professional. There has been recent research on treating hot flushes with a low dose of venlafaxine (a medication also used for depression and anxiety) showing a similar effectiveness to oestrogen or other hormone replacement therapy.
- 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 apnea 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.
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