Many women in midlife have difficulty sleeping and for those with moderate or severe sleeping problems it is likely that this will increase as they go through the menopause*. Women told us how menopausal symptoms affected their sleep, how they coped with less sleep, and what they did to get more sleep.
Menopausal symptoms and sleep disruption
Not everyone had a sleep problem. Some women didn’t worry about the occasional sleepless night or could function effectively on fewer than eight hours sleep. Others said they were good sleepers, who either slept through the night or got back to sleep even if they had hot sweats.
Marcia manages to sleep even though she has night sweats
Many women, however, found it impossible to get a good night’s sleep during the menopause. Hot flushes and sweats are a major cause of sleep disruption (see Hot flushes and night sweats). Women talked about the “horrendous” effect of hot sweats on their sleep, of sleeping fitfully and being woken up to a “dozen times a night”. Waking up feeling hot one minute, cooling down, dozing off to sleep only to be woken up again by a hot sweat can be a vicious sleep-wake-sleep-wake cycle. And after finally getting to sleep, women were woken all too soon by their alarm.
Rachels night sweats affected her sleep
For women experiencing hot sweats, the night can be very active rather than a time of rest. Tossing and turning, throwing the covers off and on, looking for cool spots in the bed, changing night clothes and bedding, getting up to open the window or turn the heating down, putting the fan on, walking around, having a shower to cool off can all replace sleep. Some women slept in another room to get cooler or to protect their partner’s sleep.
Maureen describes a typical nights sleep with hot flushes
Other symptoms can also influence sleep during the menopause. Heavy bleeding, heart palpitations, restless legs (a condition that causes uncomfortable sensations in the legs); getting up to pee, anxiety and emotional turmoil are also disruptive (see section on Symptoms). Some women slept poorly just before a period was due. In others their sleep was affected most nights, even after the periods had stopped and symptoms eased.
Inner turmoil as well as night sweats affected Margarets sleep for many years
It’s often hard to say what disrupts sleep. The menopause is not always to blame. Sleep may also be disturbed by worries and concerns about family and work; by illness, pain and medication; by partners and children; and by the environment (see Family, health and life events and Relationships, sex and contraception). Poor sleep patterns which start earlier in life, for example while bringing up children, may continue through the menopause. Ageing can also influence the quality and quantity of sleep; many people feel they need less sleep as they get older (see ‘Getting older‘).
Denise wakes at 3am and cannot get back to sleep, partly because she worries about her teenage sons
Effects of poor sleep
Women who suffered from lack of sleep said it affected almost everything. They felt tired, “comatosed”, irritable, snappy, and tearful. Unable to concentrate, focus or think clearly, some struggled to cope with the demands of a busy job and family life. Energy can be further sapped as women try to prioritise tasks and keep on good terms with staff, colleagues, partners and children (see Work). Unsurprisingly by the end of the day they feel stressed and worn out. For some women, tiredness becomes part of life.
Carole feels absolutely shattered after waking up 5-6 times a night
Sandras poor sleep affects her daily life
Ways of getting more sleep
As well as trying to minimise the effects of hot sweats (see Hot flushes and night sweats), women had used a range of approaches to improve their sleep, with varying success. These included going to bed early, having an afternoon nap, catching up with sleep at the weekend, sleeping in the spare bedroom, having separate duvets, taking regular exercise, and cutting down on coffee, alcohol and spicy foods (see Non-HRT and lifestyle options). Relaxation and visualisation techniques also helped. But everyone’s circumstances are different, and what works for some women may not work for others.
Visualisation helped Rhonda to calm her hot flushes so she could get back to sleep
Roses sleep improved when she went to bed early and drank less red wine
Joyce tried breathing and relaxation techniques
Some women bought herbal remedies and over-the-counter products such as valerian, Kalms and Nytol to try to improve sleep. Though at first encouraging, they did not always work long-term (see Complementary therapies).
Anne tried various products to improve her sleep. She found Menopause Plus the most helpful
Other women, desperate to relieve symptoms and get a good night’s sleep, turned to prescription medication, including antidepressants to reduce depression and anxiety, HRT to ease hot flushes, and sleeping pills such as temazepam (see Hormone replacement therapy (HRT)). When used short-term, these medications may help restore sleeping patterns. However, women are advised to seek advice from their GP about the risks and possible side effects before taking any medication.
Maggie uses sleeping pills sparingly to relieve her insomnia
Some women continue to be troubled by poor sleep throughout the menopause and into later life (see our Healthtalk website on Sleep problems in later life). For others, disruption is short-lived with sleep patterns returning to normal once symptoms ease. The importance of good sleep cannot be underestimated. As one woman observes, “Sleep is highly underrated in my book. As soon as you sleep you just feel human again.”
*Ellen W. Freeman, PhD, research professor in the department of Obstetrics and Gynecology at the Perelman School of Medicine at the University of Pennsylvania.