Menopause is a time of significant change for women, so much so that it has been called the “change of life”.
Insomnia can often go hand in hand with menopause, although it may be difficult to recognize it for what it is. Some suffering from menopause-induced insomnia may have trouble falling asleep, while others may find their sleep interrupted as they wake repeatedly throughout the night for seemingly no reason.
What causes insomnia during menopause?
During the onset of menopause, there are gradual decreases in the production of estrogen and progesterone, hormones produced by the ovaries. Both hormones play a role in regulating a number of bodily functions and are primary in governing reproduction and the menstrual cycle. What may be less well known is the impact they have on energy levels, mood, and sleep. Both estrogen and progesterone promote quality sleep in different ways, and when levels of these hormones decline, women often experience insomnia.
Several studies assessing how many women report insomnia during menopause have found that 25-50% suffer from difficulty sleeping in general, compared to approximately 15% of the general population. These sleep difficulties are not limited to just postmenopausal women. Women in perimenopause (menopause transition) often experience similar problems with sleep because hormone levels fluctuate greatly during this time leading to the overall decline of estrogen and progesterone production.
Progesterone, in particular, has sleep-inducing effects. It seems to have a calming or relaxing effect which makes it more likely that you will fall asleep when you go you bed or are quiet and still. During pregnancy, progesterone levels normally rise, which partly accounts for the daytime sleepiness that many women experience. As the level of progesterone decreases, many women have difficulty falling asleep in a reasonable period of time. Estrogen also contributes to menopausal insomnia because estrogen has an effect on how the body uses magnesium, which helps the muscles relax and contributes to quality sleep.
Estrogen is also largely responsible for hot flashes. Hot flashes are in large part a surge of adrenaline. When they occur during sleep, they can cause you to wake up and have trouble getting back to sleep. Often, hot flashes happen together with night sweats, which are associated with an increase in body temperature. During normal sleep, our core body temperature may drop as much as 1 ½ degrees and anything that interferes with that drop makes it harder to get to sleep and stay asleep.
Mood Swings and More
Mood swings and depression are also part of the “change of life” for many women and can be directly related to changing hormone levels. In one study, it was found that 20% of women suffer from depression during the perimenopausal/menopausal period of their life, which is sometimes linked to lower estrogen levels. This depression can be compounded by other life changes or stressors, such as problems at work, interpersonal relationships, or other developing changes in health. It can become a vicious cycle, as untreated insomnia predisposes women— and men—to depression.
Anxiety may also be part of the insomnia picture during menopause for some women. This can also be a major contributor to difficulties in falling asleep and staying asleep. Menopausal symptoms can make you anxious about whether you will be able to get a good night’s sleep, which becomes a self-fulfilling prophecy when you have a lousy night as a result.
Women who experience insomnia related to menopause need not accept their fate, nor grin and bear it. There are a number of simple but important habits you can develop to reclaim your sleep. First of all, create a routine. Avoid engrossing activities such as watching television or using the internet before bed. Anything which can stir up thoughts or trigger feelings of stress right before bedtime should be avoided, as this time should be reserved for relaxation. A journal can also be a useful tool when feelings of anxiety threaten your ability to sleep through the night. Try writing down the things that are bothering you or make a to-do lists. Taking problems out of your head and putting them onto paper can help calm and empty your mind in preparation for bed.
Reclaiming your sleep
Of course, the first place to start is with your primary care physician/gynecologist. A thorough evaluation can provide informed choices for treating insomnia that may include medications such as hormone replacement therapy or other medication for menopausal symptoms, including depression and anxiety. There are also new drug-free treatment approaches that have been shown to be effective in treating insomnia available. Talk to your doctor. Help is available.