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Sleep issues are common and are often a result of ageing. Poor sleep may be linked to hormone changes, but physical symptoms, like hot flushes, mood changes, and stress can contribute too.
Women often talk to us about how difficult they’re finding it to get a decent night’s sleep. The effects of sleep issues can be debilitating and can take their toll on your daily life, affecting your mood, behaviour and even your long-term health.
Studies have also shown that lack of sleep can affect mood, making your brain focus on negative thinking, and also leading to a tendency for your brain to remember unhappy events rather than happy ones.
Your judgement and concentration can be impaired, which doesn’t help the experience of menopausal brain fog. Inadequate sleep can also affect your behaviour, so that you may take more risks. Reaction time decreases, and you can become more accident-prone and clumsy.
If you’re struggling with sleep, we hope this information will encourage you to ask for help if you need it.
There are many reasons why sleep can be affected by the menopause. To understand why and how let’s first look at the whole process of sleep.
When you’re asleep, your brain cycles through two different types of sleep – REM (rapid eye movement) and non-REM sleep.
Non-REM sleep comes in four stages:
Non-REM sleep is essential for learning and memory and is more restful and restorative.
Here’s how a typical sleep pattern looks:
You’re more likely to wake with hot or cold sweats during REM sleep because it’s the lightest. Stage 3 and 4 non-REM sleep is the deepest sleep and is the most restorative.
There are many reasons that the menopause affects your sleep. Broken sleep can be directly connected to some of the physical symptoms of the menopause – for example, being woken up in the night by hot flushes and night sweats, or joint pains.
You may also need to get up in the night to go to the loo to pass urine – something you didn’t do before the menopause transition.
Psychological symptoms, such as anxiety and increased stress, can leave you tossing and turning. We know that sleep is affected by low mood and depression too.
Sleep apnoea is when your breathing stops and starts while you sleep, causing snoring and snorting due to the partial obstruction of the upper airways. It’s typically found in women who are overweight – but not always. It can increase after the menopause because of a direct effect of changing hormones, and is not just a factor of weight.
Sleep apnoea can cause headaches, anxiety, low mood, and tiredness. If you think you may have sleep apnoea, you should speak to your GP who can refer you to a specialist.
Many women ask us about melatonin and sleep. Melatonin is a hormone that’s important for our sleep/wake cycle. Melatonin levels decrease in both men and women as we get older. It could be a factor affecting your sleep during the perimenopause and menopause. Melatonin seems to be important in sleep timing (reminding your body that it’s time to sleep) and promoting sleep – but it’s not a sedative.
Although the changes in hormones are thought to play an important part in causing sleep problems, it’s probably not the complete picture, as sleep quality declines with age in men and women.
Other factors that are important in affecting sleep:
In research conducted by the British Menopause Society, up to 60% of the women interviewed mentioned sleep problems .
Sleep issues can occur during any stage of the menopause transition. Ageing can also be a factor, so sleep may continue to be a challenge in postmenopausal life.
There are many things that can help with sleep issues, and here are a few tips. Always seek help from your doctor or a healthcare professional if sleep issues are really affecting your life.
Stress and worry about sleep can be a problem for some. Tackling these negative thoughts can help.
Knowing that you’ve had the most restorative sleep (during the first part of the night) can help some people. If you wake in the middle of the night, knowing that your body has had a chance to repair may take away some of the worries about not sleeping, and you may even go back to sleep again. It’s normal to wake several times a night and most people do not need eight hours of sleep.
Avoid limiting your daytime activities because of poor sleep. Instead, pace yourself and try to carry on as normal so that your life doesn’t shrink because of lack of sleep. You may be surprised at how much you can do in manageable chunks – and this means that you are more likely to go to bed tired at the end of the day, as well as being able to live your life.
Making sure your sleep environment is geared up for a good night’s sleep is important:
You might think HRT is best placed to tackle the physical menopause symptoms (like hot flushes) that can cause sleep issues. It’s true, HRT can help with physical symptoms, but it can also have a direct effect on your overall quality of life, energy levels, and sleep.
You may feel anxious about taking HRT because of the well-publicised small risks, particularly of breast cancer. In reality, these risks are tiny for most. Lifestyle factors, like how much you weigh and how much alcohol you drink, can have a greater impact on your risk of breast cancer than HRT.
You can find out more about HRT here.
Cognitive behavioural therapy (CBT) can help some women. The process works by challenging the negative thought processes surrounding lack of sleep and teaches strategies for turning around your negative thinking. You can find out more about our CBT partners Sue Makin and Claire Lloyd.
If you’re troubled by sleep issues, talk to your GP, or book an appointment with our menopause clinic, to talk about your symptoms in the context of the menopause.
If you think you may be experiencing symptoms of the menopause transition, you can learn more with our symptom checker or by taking our Menopause Questionnaire.
You can also find more information about the menopause transition at the British Menopause Society and the National Institute for Health and Care Excellence.
Dr Spencer, Clare
Registered menopause specialist, GP and co-founder
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Source: Krause AJ, Simon EB, Mander BA, Greer SM, Saletin JM, Goldstein-Piekarski AN, Walker MP. The sleep-deprived human brain. Nat Rev Neurosci. 2017 Jul;18(7):404-418.
Source: Currie H, Moger SJ. Menopause – Understanding the impact on women and their partners. Post Reproductive Health. 2019;25(4):183-190.
Source: Newson, LR. Best practice for HRT: unpicking the evidence.Br J Gen Pract 2016; 66: 597–598.