If you’re a middle-aged woman, the days of “sleeping like a baby” may feel long gone. You might wake in a cold sweat. Or you might wake up several times throughout the night — or before your alarm goes off. It may feel like you’re always struggling to get a good night’s rest.
Welcome to menopause.
While hot flashes are the most common, well-known menopause symptom, they are not the most disruptive — sleep issues are.
To discuss how menopause can interfere with sleep, we turned to Erin Habecker, MD, who works in Adult, Consult, and Reproductive Psychiatry at the Kaiser Permanente Delta Fair Medical Offices in Antioch and Diem Truong, MD, ob-gyn at the Kaiser Permanente Santa Clara Medical Center. Dr. Truong is also certified as a menopause practitioner by the nationally recognized Menopause Society.
Let’s start with the basics. What is menopause?
Dr. Truong: Menopause is when periods stop for good. You are officially in menopause when you have gone 12 months without a menstrual period. Menopause mostly happens when women enter their 40s or 50s. The average menopause age in the United States is 51, and this transition may last years. Driven by hormonal shifts, menopause includes a wide range of physical and emotional changes. These symptoms are interconnected and can vary from person to person.
Before we get into sleep issues, explain the impact menopause has on mental health.
Dr. Habecker: There is a physiological mechanism behind mood changes. The fluctuation of estrogen and progesterone affects the levels of “feel good” hormones, such as serotonin and dopamine, in your brain.
Many women will experience depression or anxiety for the first time in their life during menopause. They are one and a half times more likely to develop anxiety, and between 15% and 30% of all women will have symptoms severe enough to be considered a depressive disorder. The depression risk increases if someone has had depression before.
How does mood affect sleep or sleep affect mood?
Dr. Truong: About 40 to 60% of menopausal women experience significant sleep issues — trouble falling asleep, waking up frequently, or too soon. Sometimes, hot flashes at night, or night sweats, disrupt sleep. Mood can improve when sleep improves and becomes more restorative.
Dr. Habecker: Essentially, sleep and mood are a self-reinforcing cycle. Poor sleep lowers emotional resilience. Disrupted sleep reduces the brain’s capacity to regulate stress and mood.
But poor moods also make it difficult to get good sleep. Worry and emotional distress make it harder to fall asleep and to stay asleep. Improving sleep is one of the most powerful steps to improving mood.
How can we improve sleep?
Dr. Truong: There are many things you can do to improve sleep. First, it’s important to start by ruling out any underlying conditions like sleep apnea or restless leg syndrome. They tend to emerge in midlife and are easy to test for. Hot flashes, night sweats, and thyroid conditions, as well as certain medications, can also affect sleep negatively. It’s important to address all of these. Lifestyle medicine is the foundation for managing and treating sleep issues. That means making lifestyle changes, including diet, mindfulness, and regular exercise. If that doesn’t work, medications, such as antidepressants and hormone replacement therapy, can help.
Dr. Habecker: Cognitive therapy can also help. The core idea is that your thoughts, feelings, behaviors, and physical symptoms influence each other. We use cognitive therapy to identify the thoughts and anxiety driving physical and emotional disturbances. Then to break the cycle, we learn to react differently to stressors. It may seem counterintuitive, but it works, and there’s research to back it up. Some of the approaches to better sleep are also what we recommend for improving moods and reducing depression.
