Why sleep breaks down
Night sweats wake you, sometimes before you notice the heat. Falling progesterone removes a natural calming effect. Oestrogen changes affect body temperature and the timing of sleep. Anxiety, bladder symptoms, joint pain and life stress add to it.
Insomnia
Insomnia means trouble falling or staying asleep at least three nights a week for three months, with daytime effects. Cognitive behavioural therapy for insomnia is the first choice treatment. It is available in person and through structured online programmes. It works in six to eight weeks for most people, and the benefit lasts.
Sleeping tablets are a short term option only. They lose effect and carry risks of falls and dependence.
Sleep apnoea
Obstructive sleep apnoea rises sharply after menopause and is often missed in women. Women more often report tiredness, headaches on waking and insomnia than loud snoring. A sleep study confirms it. Treatment improves energy, mood and heart health.
Restless legs
An urge to move the legs in the evening becomes more common in midlife. Low iron is a common cause and is easily checked.
Habits that help
Set a fixed wake time, seven days a week. Leave bed if you are awake more than 20 minutes and return when sleepy. Keep the bedroom cool, around 18 degrees. No alcohol in the three hours before bed. Morning daylight and daytime exercise strengthen your body clock.
See a practitioner if
- You wake unrefreshed for more than three weeks
- Someone sees you stop breathing in your sleep
- You fall asleep while driving or in meetings
- Legs twitch or ache at night
Common questions
Does hormone therapy help sleep?
Yes, mainly by stopping night sweats. Micronised progesterone taken at night also has a mild sleep promoting effect.
Is melatonin worth trying?
Evidence for melatonin in menopausal insomnia is weak. It may help with jet lag or shift work. Discuss it with your practitioner.
Why do I wake at the same time every night?
Early morning waking is common in perimenopause and in low mood. Cognitive behavioural therapy for insomnia targets it directly.
Sources
- American Academy of Sleep Medicine, clinical practice guideline for chronic insomnia
- The Menopause Society, 2022 Hormone Therapy Position Statement
- Study of Women's Health Across the Nation, sleep findings
This page is education, not medical advice. Talk to your doctor or menopause practitioner about your own care. In an emergency, call your local emergency number.