The changes that occur during menopause can affect everything from mood to sex drive. Though for some women classic symptoms — like hot flashes — are mild, for others, symptoms can be severe. What’s more, the majority of women experience at least some sleep disruption — which can have far-reaching effects.
A lack of restful sleep can undermine health and safety in a wide range of ways, from raising the risk of chronic conditions like cardiovascular disease to putting a person in greater danger of a car accident. Not getting adequate rest raises levels of the stress hormone cortisol, which can contribute to weight gain. “Many menopausal women have an issue with weight gain anyway, so not getting enough sleep can make that worse,” says Dr. JoAnn Pinkerton, executive director of the North American Menopause Society, and a gynecologist and a professor of gynecology at the University of Virginia Health System. “Also it turns out that sleep is important for us to maintain our antibody level.” Not getting enough rest can predispose a person to having more health issues like the flu. “It affects work performance. Your brain actually does some consolidation when you sleep,” Pinkerton points out. “So if you don’t get enough sleep, you’re not going to be able to make as good a decision as you would have been otherwise.”
It can lead to other problems in the bedroom as well. “There’s a link between menopause and sleep disruption, which affects sexual satisfaction for women,” Pinkerton says. One study found that even after adjusting for other causes of sleep problems, such as depression or chronic disease, women who have less sleep are less likely to be sexually active or satisfied with it — particularly if they were over age 70, she notes.
[See: 11 Changes Women Go Through in Menopause.]
And lots of women who are going through menopause — or perimenopausal — are having sleep difficulties; and the same goes for postmenopausal women, who have gone without a menstrual cycle for more than one year or who are in menopause after surgical removal of their ovaries. In fact, 2015 survey data released by the Centers for Disease Control and Prevention this September found that more than half — or 56 percent of perimenopausal women — and 40.5 percent of postmenopausal women report getting less than seven hours of sleep, on average, in a 24-hour period. That compares to about one-third (32.5 percent) of premenopausal women, who haven’t gone through menopause. Perimenopausal and postmenopausal women also reported more trouble falling asleep and staying asleep, and were more likely to say they didn’t wake up feeling rested four days or more in the previous week.
Menopause is also linked with a higher rate of insomnia and other sleep disorders like obstructive sleep apnea and restless legs syndrome that should be treated but often are overlooked. “The diagnosis of OSA in postmenopausal women can be more challenging because their symptoms are different from the more obvious ones that men experience, such as loud snoring and may include insomnia, headaches, fatigue, depression and anxiety,” Pinkerton says.
With age, women and men often experience increased sleep issues. For women going through menopause, certainly hot flashes — sudden feelings of heat that are particularly intense for some women — can disrupt sleep. Hormonal changes can play a role in difficulty getting adequate shuteye; and anxiety frequently increases around the time of menopause, which can disrupt sleep. But often the cause for sleep issues like insomnia is not more deeply understood — beyond the fact it can be linked with menopause. “You can just see insomnia as an isolated symptom,” says Dr. Dale Mitchell, chairman of the obstetrics and gynecology department at Scripps Clinic, which is part of Scripps Health, based in San Diego.
Improving sleep frequently requires prioritizing good sleep hygiene practices — like having a routine and set bedtime, keeping the TV out of the bedroom and not drinking caffeine or alcohol before bed — along with addressing symptoms, including sleep issues, associated with menopause. “For women with insomnia, some approaches which may help include improved sleep regimens each night (so-called sleep hygiene), over-the-counter melatonin, sleep aids or antianxiety medications for short-term use or medications like trazodone which improve sleep without having addictive qualities,” Pinkerton says.
Keeping the bedroom not only dark but cool is important for anyone, but a special point of emphasis for women going through menopause. Pinkerton recommends keeping it between 60 and 67 degrees. “If [you] are warm going to bed, try a cool shower, a cold drink or a cool pillow or an iced washcloth on the back of the neck,” she says.
[See: What Only Your Partner Knows About Your Health.]
“A cool bedroom environment is essential for good sleep, and this can become problematic when you’re experiencing the hot flashes,” echoes Natalie Dautovich, an assistant professor of counseling psychology at Virginia Commonwealth University and Environmental Fellow at the National Sleep Foundation; in her fellowship role, Dautovich focuses on the aspects of the bedroom environment that can be modified or optimized to promote healthy sleep. She suggests using moisture-wicking sheets and clothing to help with cooling following the hot flash.
Experts also recommend keeping a journal to jot down worries before bed. “Engaging in relaxation, deep breathing or other ways of coping — such as keeping a worry log — can help to decrease and try to manage the feelings of anxiety and depression that can be disruptive to sleep,” Dautovich says. Adds Mitchell: “If there’s a component of any kind of mood issues as well as insomnia, we have found that low doses of antidepressant medications — in particular, agents like Paxil — can be helpful in alleviating symptoms.”
Persistent sleeping difficulties should be discussed with a doctor. “I think a general physical and checkup with their doctor is a good idea,” Mitchell says — to ensure a woman is in good health. “Make sure there aren’t other things or medical conditions that are causing some of their sleep problems.”
For some women going through menopause, hormone replacement therapy may be recommended. “For symptomatic menopausal women who are under age 60 and within 10 years of menopause, hormone therapy improves sleep in women with bothersome hot flashes or night sweats by reducing nighttime awakenings,” Pinkerton says. She notes that women on hormone therapy have fewer sleep disruptions, improved rapid eye movement, or REM, sleep and longer sleep duration.
As with any treatment, experts advise discussing the risks as well as benefits. “With the use of hormone therapy … there’s been a lot of conflicting studies [indicating] there may or may not be a slight increase in breast cancer. It’s not really clear whether there’s any causative effect here, or in some cases, might there be some protective benefit to hormone therapy,” Mitchell says. “Certainly, if they’ve had a personal history of breast cancer, you would not want to use estrogen therapy in general. For older women, especially if they’ve developed cardiovascular disease or are at risk for risk for blood clots — these are probably women in particular you don’t want to use hormone therapies for.”
[See: 8 Steps to Fall Asleep Fast.]
The key, say health providers who treat menopause and sleep-related issues, is to raise sleep concerns, just as you’d discuss other symptoms or health issues.
“There are a lot of options for women who are having trouble sleeping, and they shouldn’t suffer in silence,” Pinkerton says. Experts say much good can come from improving sleep hygiene and treating menopause symptoms, when those efforts ultimately make it easier to rest — from improved well-being and work performance to a better sex life.
More from U.S. News
Is it Healthy to Sleep With Your Pets?
10 Reasons You May Be Feeling Fatigued
17 Ways Heart Health Varies in Women and Men
What to Do When Menopause Sabotages Your Sleep originally appeared on usnews.com
