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Insomnia and sleep disruptions from hot flashes are common in women going through menopause. Here's what you need to know to get the rest you need. By Ashley Welch Medically Reviewed by Kara Leigh Smythe, MD Medically Reviewed Midlife stresses such as a demanding work schedule, children, and caring for aging parents make getting a good night's sleep a challenge.Getty Images When you’re making your journey through menopause, a good night’s sleep can feel impossible. Sleep disturbances are often a challenging problem for midlife women, according to Mary Rosser, MD, PhD, an assistant professor of women's health in obstetrics and gynecology and the director of Integrated Women's Health Columbia University Irving Medical Center. In fact, the incidence of sleep disorders ranges from 16 to 47 percent at perimenopause (the transition to menopause)
and 35 to 60 percent at post-menopause, according to research published in January 2022 in the Journal of Mid-Life Health. Dr. Rosser says it’s important to figure out why your sleep is disturbed. Sometimes the cause may be hormonal changes related to menopause, or it could be midlife stresses such as anxiety over work, children, aging parents, or relationship issues. “In addition to hormonal changes, stress is a major driver of sleep disturbance,” Rosser says. Hot flashes can also be the reason behind sleepless nights. Fluctuating levels of estrogen and progesterone that occur during perimenopause and menopause can cause hot flashes in more than 80 percent of women, according to research published in January 2019 also in the Journal of Mid-Life Health. When these occur, they can cause night sweats, which can disrupt sleep. Some women even have to change their clothes or bed linens. “This causes an inability to obtain adequate deep or REM sleep,” Rosser explains. Other health conditions, such as loss of bladder control, joint pain, and depression, as well as alcohol and certain medications can contribute to inadequate sleep, she notes. If you already struggle with insomnia, the menopause transition can make it even worse. If menopause symptoms continually keep you up at night, make an appointment to see your doctor. In the meantime, try these lifestyle changes and smart sleep strategies to rest easy. 1. Consider Hormone Replacement Therapy (HRT) Hormone replacement therapy (HRT) remains the gold standard in treating moderate to severe hot flashes and other menopause symptoms, which can lead to more restful sleep, according to a research review published in Endocrine in 2017. While there has been some concern about the safety of HRT in the past, the North American Menopause Society released a position paper in 2022 stating that the “benefits of hormone therapy use generally outweigh risks for healthy women with bothersome menopause symptoms who are aged younger than 60 years or [are] within 10 years of menopause onset.” But HRT may not be for everyone. Women who are at high risk for breast cancer or have a history of heart disease, stroke, and blood clots should talk to their doctor about whether HRT is right for them. Alternatives, such as low-dose antidepressants, can reduce the severity of hot flashes, per the Cleveland Clinic. 2. Move Your Body During the Day “There are so many studies that indicate that people who have a regular exercise routine tend to be better sleepers,” says Deirdre Conroy, PhD, a clinical sleep psychologist at Michigan Medicine in Ann Arbor. “So if you're not elevating your heart rate during the day, that may be another contributing factor to your difficulty sleeping.” A research review published in Frontiers in Medicine in 2023 analyzed 17 clinical trials and determined that exercise interventions, such as walking, yoga, and aerobic exercise, significantly reduces severity of insomnia and alleviates sleep problems in menopausal women. In a study published in Frontiers in Medicine in 2022 of 289 perimenopausal women with anxiety, depression, or insomnia, twice weekly hourlong sessions of aerobic exercise for eight weeks led to significant decreases in symptoms across all three disorders. Timing of exercise is important, however. Don’t exercise two to three hours before bedtime, as that can also interfere with rest, Rosser warns. 3. Sip Selectively Caffeine — found in coffee, colas, tea, and chocolate — is a stimulant that can take as long as 10 hours to completely leave your system, according to the Cleveland Clinic. Besides keeping you awake, some research suggests caffeine may trigger hot flashes in some women. It’s best to avoid it altogether if you are struggling with insomnia or night sweats that repeatedly wake you up, but if you must have it, have it early in the day. Dr. Conroy notes that tea can be a soothing drink before bed, but it’s important to pay attention to which varieties contain caffeine. “Green tea is very good for your health, but it does have some natural caffeine in it,” she says. “I encourage people to have herbal teas with no caffeine and make sure that the label says herbal and not just ‘caffeine free,’ because there might be trace amounts of caffeine that your system may be very sensitive to.” Skip the alcohol before bed, too. It’s another possible hot flash trigger, and while it may initially relax you and help you fall asleep, it will likely make it hard for you to stay asleep, Conroy cautions. 4. Keep Cool To ward off hot flashes and night sweats, make sure the temperature in your bedroom is comfortable and low. Aim for 66 to 68 degrees F, Rosser recommends. Wear breathable cotton sleepwear, whether you prefer pajamas or a nightgown, and choose cotton sheets over synthetic materials. Before bed, consider taking a cool shower. If you wake up because of hot flashes (or for another reason), don’t torture yourself by lying awake in bed. “Give it about 20 minutes, then get out of bed and do something relaxing,” Conroy advises. “Move into another room, get a change of scenery, and read a book or do something quietly until you start feeling sleepy, then go back to bed.” 5. Try Relaxation Techniques If anxiety during menopause is keeping you awake at night, relaxation techniques such as meditation, yoga, or deep breathing can help you to de-stress. “The good news is there are so many apps available now that make practicing these techniques very accessible,” Conroy says. A study published in January 2021 in PLoS One examined the effectiveness of one such app on sleep. It included 263 adults with insomnia, half of whom were asked to meditate using the Calm app for at least 10 minutes a day for eight weeks, while the other half were asked to go about their normal routine and not use any meditation apps. At the end of the study period, those who meditated reported significantly less daytime fatigue, daytime sleepiness, and pre-sleep arousal, which included both physical and mental symptoms like sweating and intrusive thoughts, than the control group. 6. Stick to a Schedule You may be tempted to stay up late during the week and then catch up on rest over the weekend, but sticking to the same schedule every night is more conducive to getting quality sleep, Conroy says. That means going to bed and waking up at about the same time every day. It’s also helpful to develop sleep rituals, such as reading, meditating, or listening to soft music before bed, Rosser suggests. She advises eliminating screen time one to two hours prior to sleep. 7. See a Specialist Chronic insomnia can contribute to heart disease, high blood pressure, and other lasting medical conditions. It also impacts job performance, your safety, and your overall quality of life. Fortunately, you don’t have to just lie back and live with it. “If you've been struggling with insomnia for three months or more, it's probably time to talk to your doctor about it,” Conroy says. “Then hopefully you can get a referral for a qualified sleep medicine professional to figure out why that might be happening.”
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