Why Does Sleep Become Elusive in Perimenopause?

Women in perimenopause and menopause very often report problems with sleep.

Sleep disturbances are one of the most common symptoms of the midlife transition, second only to vasomotor symptoms like hot flashes and night sweats. When asked to elaborate, I have heard women say they have trouble falling asleep or, more commonly, staying asleep, sometimes waking up every two to three hours throughout the night. Sometimes they even give up and stay awake until morning.

They then spend the day dealing with fatigue and exhaustion.

Sleep complaints affect about half of women going through the menopausal transition and can often be a cause of daytime fatigue. Poor sleep often has multiple causes.

Sleep Stages

Sleep is a repeating cycle of different stages that the brain and body move through during the night:

1. First, there is light sleep (stage 1: 90–120 minutes). The body's muscles are starting to relax, and heart rate and breathing slow down. Some people may experience a sensation of falling as they drift off to sleep. Here, good sleep hygiene is essential. As with putting a baby to sleep, the room should be dark and quiet, with no distractions. It should be at a moderate temperature, with no stimulation right before bed.

   There should be a calming sleep routine, and bedtime should be approximately the same time every night to trigger the body to get ready for sleep. There should be an intentional set of calming activities designed to train the body and brain that it is time to wind down and go to sleep.

2. Next is stage 2 (25 minutes or more), which is light to moderate sleep during which there are some short bursts of brain activity. Muscles begin to relax and body temperature drops. This is an important stage for memory processing and learning.
3. Next comes deep sleep (stage 3). This is the time associated with slower brain waves. It is considered restorative sleep and is the hardest stage to wake up from. This is when tissue repair, immune system strengthening, memory consolidation, and energy restoration occur. It is essential for feeling well and refreshed when waking up in the morning.

However, in perimenopause or menopause, you may be just about falling into that deep sleep stage when your body starts sensing that it is way too hot. Sweating begins in an effort to turn down the heat, and when the sweat starts to evaporate, there's a chill that wakes you, leaving you sweating and tired. Sometimes this same scenario happens over and over throughout the night, resulting in morning anxiety, daytime fatigue, and general exhaustion. Soon, a lack of sleep at night is ruining your days.

Finding the Root Cause

If this is happening to you, it would be wise to try to figure out the root cause. If sweating and chills are waking you, and you are a safe candidate for menopausal hormone therapy, that would be the recommended place to start. There are also nonhormonal medications that work on the brain's thermoregulatory center to help relieve hot flashes and night sweats.

If a partner or family member tells you that you are snoring at night, or if you wake up gasping or trying to catch your breath, you may have obstructive sleep apnea (OSA). Ten to fifteen percent of women have sleep apnea, according to the National Sleep Foundation, and this number increases with age and weight. It requires a sleep study to see if this condition is contributing to waking, poor sleep, and daytime fatigue.

Some women find that certain supplements help them sleep. Magnesium or melatonin may help with muscle relaxation or the timing of sleep cycles. Melatonin has been used to reduce jet lag when traveling through time zones. Often, getting onto a medical therapy plan, usually a combination of estrogen and progesterone, will help improve sleep, especially in conjunction with a healthy sleep routine.

If poor sleep or insomnia seem to be connected to other health issues, like anxiety, depression, a racing heartbeat, or headaches, this should be evaluated by your physician, as it may not be hormonally related.

The Bottom Line

Good sleep during the menopausal transition and in menopause often requires a layered approach. This includes building strong sleep hygiene habits, considering whether any safe supplements may be helpful, using medical therapies when appropriate, and addressing any underlying health issues.

Restful and restorative sleep is critical for overall health, especially at this important time of midlife transition.

Better days may start with better nights!