Menopause and Sleep

This is a fact sheet about Menopause and Sleep. Menopause is associated with a number of hormonal changes which can have various effects on the body, including sleep patterns.

Middle-aged woman laying on grass. Photo by Centre for Ageing Better
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January 12, 2024
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Things you should know:

  • Hormonal changes affect the quality of sleep of many women.
  • There is a link between hot flushes, night sweats, and not sleeping well.
  • Other issues may also affect sleep quality at this time of life (e.g., sleep apnoea and depression).
  • There is no proof that hormone treatment helps sleep.

How does sleep change during the menopause?

Many women report that it is more difficult to sleep well during the menopause. They say that it is not as easy to get to sleep or to stay asleep and they also tend to wake up earlier than planned. This may be due to less oestrogen in the body. After the menopause, sleep will improve.

What about hot flushes, cold sweats and night sweats?

During the menopause, the levels of hormones in the body change. This means that the body temperature is less stable and sometimes there are surges of adrenaline. When this happens, a hot flush is felt. All of these can happen during the day or at night. Women tend to wake up just before a hot flush occurs. Experts think that both the waking up and the hot flushes are caused by the same thing.

Does this happen to all women as they go through menopause?

Before menopause, about 30% of women say they have some type of problem sleeping more than three times a week. But for women in menopausal transition, this percentage goes up by two to three times. It can take a long time for sleep to settle down again for women after the menopause. We do know that women in menopausal transition who find it the hardest to get to sleep and stay asleep are also the ones who tend to have other problems, particularly hot flushes and sweats.

Is poor sleep at this time of life always due to hormonal changes?

It can be hard to know how much sleep difficulties are linked to hormonal changes rather than just getting older (see Ageing and Sleep). We also know that women's risk of depression is higher in menopause. Hormonal changes may not be the only reason for this (see Depression and Sleep). Menopausal hormonal changes may be linked with Obstructive Sleep Apnoea (OSA). This leads to trouble breathing which can get in the way of your sleep and be bad for your health. Oestrogen loss around the time of menopause makes body fat move more to the stomach area. This increases the chances of snoring and having sleep apnoea. For some women Restless Legs may affect their sleep. However, it is not certain that this is linked with menopausal symptoms.

What can help?

There is a view that Hormone Therapy (HT) may help with sleep during menopause, but there is no proof for this yet and the issue needs more study. Some studies have found HT is slightly helpful for sleep, but others have shown no consistent benefit. If you are thinking of HT it is best to discuss this with your doctor and weigh up the pros and cons.

It can help if you sleep in a cool room where air can flow through freely (e.g., using a fan). Avoid heavy bed clothes or tight bedspreads. If you can put your feet outside the blankets, it will help cool down from a hot flush. Sleep in light sleep wear. Cotton is best.

Make sure that you have good sleep routines. This will help you get the best sleep that you can (see Sleep Hygiene: Good Sleep Habits).

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