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Menopause can cause more than hot flashes, mood swings, and irregular periods. It can also disrupt sleep. The good news is that better rest is possible. With strategies and support from a healthcare provider who understands menopause, many women are able to get more restful sleep.
Maariya Bassa — medical director for quality at Unity Health Care in Washington, D.C. and a certified nurse midwife and women’s health nurse practitioner — shared practical tips with ThisIsMenopause to help women sleep better before, during, and after menopause.
More than 40 percent of women report sleep problems during perimenopause.
Up to 64 percent of postmenopausal women may struggle to get a good night’s sleep.
Hormone shifts, night sweats, anxiety, and even joint pain can make it harder to fall asleep or stay asleep in perimenopause. If you’re having trouble sleeping, you’re not alone. More than 40 percent of women report sleep problems during perimenopause, and up to 64 percent of postmenopausal women may struggle to get a good night’s sleep.
“I’ve lost so much sleep due to hot flashes, night sweats, and achy joints,” one woman told ThisIsMenopause.
Another shared, “It’s horrible. I might sleep three or four hours at a time.”
The first step toward better sleep is figuring out what might be keeping you awake.
Sleep problems during perimenopause and menopause don’t always have just one cause. Before your healthcare provider can suggest treatment, you’ll need to figure out what’s keeping you awake.
“When someone is struggling with insomnia during the menopause transition, we look at whether symptoms like hot flashes are waking them up, or whether other factors such as sleep habits, medical conditions, or sleep disorders may be involved,” Bassa explained. “Aging, stress, and psychological factors can also contribute to poor sleep health.”
Common causes of menopause-related sleep problems include:
Keeping a sleep diary can help you track symptoms and sleep patterns so you can describe them to your doctor. If you have space for a notebook and pen next to your bed, write down when you struggle to fall asleep and what you were doing before you went to bed.
Many women are used to caring for others, so it can be tempting to push through fatigue caused by restless nights. But getting to the root of sleep problems is important for long-term health.
“Poor sleep health can increase the risk of Alzheimer’s disease and dementia,” Bassa said. It can also raise the risk of developing high blood pressure, obesity, diabetes, stroke, heart disease, daytime fatigue, mood changes, and depression.
Once you and your healthcare provider identify the cause of your sleep problems, you can work together to find solutions.
Your treatment plan for sleep disruption will depend on what’s causing your sleepless nights.
If you have a sleep disorder, such as sleep apnea, your healthcare provider may recommend a continuous positive airway pressure (CPAP) machine to keep your airway open while you sleep. If your sleep disturbances are related to daily habits, like staying up late to watch movies, your provider might suggest relaxation techniques and reducing screen time before bed.
For sleep problems linked to the hormonal changes associated with menopause, treatment may include medication or hormone therapy. But what works for one person may not work for someone else.
“Progesterone has been shown to help improve sleep,” Bassa said. “But some folks have difficulty tolerating it because of the adverse effects it can have on mood, while others feel like progesterone really helps to improve sleep and mental clarity.”
Menopause hormone therapy, also called hormone replacement therapy (HRT), replaces some of the estrogen and progesterone the body loses during the menopause transition. HRT is a common treatment for menopause symptoms, but it’s not without risks. Your healthcare provider can help determine whether hormone therapy is right for you.
Other medications may include certain antidepressants and medications specifically approved for insomnia.
Some sleep aids are available without a prescription, but talk to your doctor before trying them. They may not provide the deep, restorative sleep you need, and some may cause unwanted side effects or interfere with medications.
Lifestyle changes at home can make a big difference in sleep quality during menopause.
“Sleep hygiene involves establishing a daily routine,” Bassa explained. “It’s making sure you're setting up a pattern of when you shower, when you stop using electronics, when you get in bed, and maybe start reading a book. Having regular rituals is helpful.”
What you do during the day affects how well you sleep at night. Try to reduce your caffeine and alcohol intake, especially in the evening, and avoid heavy meals before bed. While regular physical activity improves sleep, vigorous exercise right before bedtime may keep you awake. Try not to nap in the afternoon.
Exposure to bright natural light during the day, minimizing light at night, and reducing screen time before bed all support your body’s natural sleep cycles. Keeping a consistent sleep schedule, even on weekends, reinforces a healthy sleep routine.
Creating a bedroom that encourages rest is key. Keep the room cool, dark, and quiet, and remove any electronics that might distract you. If you work from home, try to avoid using your bed and bedroom for work. Your brain should associate the space with rest rather than stress.
If night sweats keep you awake, try cooling sheets, a cooling mattress pad, or a moisture-wicking blanket. Choose comfortable sleepwear to help regulate your body temperature.
Relaxing before bed signals to your brain that it’s time to sleep. A warm bath or light stretching routine may help you relax. Some women find meditation, deep breathing, yoga, or tai chi helpful. Experiment to see what works for you.
Research shows that cognitive behavioral therapy for insomnia can help improve sleep habits and support better sleep over time. Working with a therapist over six to eight sessions, you can learn strategies to try at home, like getting out of bed if you can’t sleep, limiting the amount of time you spend in bed, and relaxation techniques.
Some people try supplements, such as melatonin, valerian root, or chamomile, to improve sleep. However, evidence is limited, and some supplements may have side effects or interact with medications. Always talk to your doctor before trying any new product, even over-the-counter options.
You’re probably not the only person you know struggling with sleep during perimenopause or menopause. Talking to friends or joining a support group is a great way to exchange tips and ideas. Hearing what others are experiencing can also help you feel less alone. While this stage of life may bring uncomfortable and unexpected changes, help is available, and you can take steps to improve your sleep and quality of life.
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