How does the menopause affect sleep?

The menopause is the name given to the point in a woman’s life when periods come to an end. It is marked by a decrease in female hormones, mainly oestrogen and progesterone, which are made in the ovaries. Menopause itself is defined as when periods have ceased for 12 consecutive months and the average age for this to occur is 51 years old. The transitional time leading up to the menopause is called the perimenopause, and this can begin 4-5 years before the menopause itself takes place.

The change in hormone levels in both the perimenopause and menopause can lead to a variety of symptoms including hot flushes and night sweats, brain fog, depression and anxiety, irritability and joint pains as well as bladder and vaginal symptoms.

There is a significant range in the type and severity of symptoms experienced during the menopause, but an extremely common symptom affecting 1 in 4 women is poor sleep.

Why should we worry about poor sleep during the menopause?

We all know how one night of poor sleep can make us feel – tired, irritable, unable to concentrate, unable to remember things and low in mood. These symptoms are very similar to those experienced by many women due to the perimenopause and menopause itself. In this way, poor sleep can magnify the symptoms of the menopause. 

In addition to this, good evidence shows us that poor sleep affects many other aspects of our physical health, especially the cardiovascular system. Oestrogen has a protective effect on the cardiovascular system by reducing the rate at which blood vessels narrow and fur up. During the menopause, this hormone level decreases dramatically, and so together with poor sleep, the risk to your cardiovascular system can increase.

What causes poor sleep during the menopause?

Poor sleep can occur during menopause for several different reasons and this article will look at three of the top ones – insomnia, obstructive sleep apnea and restless legs syndrome.

Insomnia

Insomnia is the difficulty in falling asleep, staying asleep, or early morning waking. It is defined as short-term if it occurs for less than three months and chronic if it persists for longer than this.

Anxiety around menopause may make it very difficult to fall asleep. You may wake up multiple times during the night due to hot flushes or needing to go to the toilet. Depression associated with menopause often causes early morning waking.

With short-term insomnia, people often develop coping strategies to deal with excessive daytime sleepiness, such as napping, or drinking lots of caffeine. Over time, the original reasons for insomnia to start may have settled down but it is the coping strategies, originally designed to help you through the day, that now propagate your insomnia and make it chronic.

You can read more about insomnia here.

Obstructive Sleep Apnea

Obstructive sleep apnea, or OSA, is a condition where your airway repeatedly closes as you sleep, causing your breathing to stop. It is more common following the menopause.

Parts of your upper airway, such as the back of the throat and the base of the tongue, are held in position by muscles. When you fall asleep, these muscles relax and your airway becomes narrow, which can cause snoring. In some people, the airway gets so narrow that the airway eventually closes entirely. This causes a pause in breathing, called an apnea, and during this time your oxygen levels fall. Your body can only tolerate this for so long before it gets so concerned it has to pull you back from this deep state of sleep to a shallower state (or even completely awake) so that your airway muscles regain their tone and pull open your airway so your breathing can restart, often with a loud snort. 

This gives rise to the three main nighttime symptoms of OSA – loud snoring, stopping breathing and snorting or gasping.

This means that even if you sleep for eight hours, you never fall into the deep restorative state of sleep that is needed to feel refreshed in the morning because whenever they do, your airway closes, you stop breathing and your body has to wake you up. 

With such poor quality sleep, you wake feeling unrefreshed, are tired all day, can’t concentrate, have poor memory and are irritable. There is a significant crossover with the symptoms caused by menopause itself.

OSA is associated with significant physical health conditions including heart disease, high blood pressure and strokes, and mental health conditions including depression and anxiety. 

You can read more about OSA in our in-depth article, here.

Restless Legs Syndrome

Restless legs syndrome is a condition causing an uncomfortable, restless feeling in the legs and an irresistible urge to move. It is estimated to affect 10% of the population and is another sleep disorder more common after the menopause

The feelings in the legs are typically very difficult to describe. People often say their legs are ‘itchy on the inside, ‘squirmy’, ‘antsy’, ‘achey’ or have feelings ‘like the urge to yawn, but in the legs’

These uncomfortable feelings are accompanied by a strong urge to move, shake or stretch the legs, which reduces the unpleasant sensation. The feeling is most commonly felt in the legs, but can also be felt in the arms. The symptoms are usually much worse at night and may stop you from falling asleep.

We discuss restless legs syndrome in more detail here.

What can be done to improve my sleep during menopause and perimenopause?

The good news is that all of these conditions are treatable. The most important first step is to get a clear understanding of your sleep disorder, and from this point, a treatment plan can be made.

Insomnia can respond to good sleep hygiene, which are the routines and practices that encourage quality sleep. You may find that starting hormone replacement therapy may help by controlling night sweats, hot flushes, anxiety and depression. Cognitive behavioural therapy for insomnia is an extremely effective treatment for insomnia which is discussed in more detail here.

Obstructive sleep apnea needs to be diagnosed with an overnight sleep test. Our home sleep tests are dispatched the same day and can be booked here. OSA itself may improve with lifestyle changes, such as reducing alcohol intake, stopping smoking and weight loss, if appropriate. Dental devices can be used to hold the lower jaw slightly further forwards when you sleep, which opens up the airway. The gold standard treatment for OSA is CPAP, which stands for continuous positive airway pressure. This is a small device that sits on your bedside table and blows air at low pressure through a tube to a mask held over either your nose, or mouth and nose, and holds your airway open from the inside. This is an extremely effective treatment for OSA and can improve your sleep and symptoms in as little as two weeks. 

Restless legs syndrome often improves with lifestyle changes such as stopping smoking and reducing caffeine and alcohol. There are also a number of medical treatments that are discussed in more detail here.

If you are suffering from poor sleep, you don’t have to just put up with it. Book a sleep test and consultation with one of our expert sleep doctors today.