Your Burning Questions About Menopause and Sleep Answered

Having trouble falling asleep? Waking up several times during the night? Feeling foggy-headed all day? Hormonal changes associated with perimenopause and menopause may be the culprit.

Menopause brings radical changes to your life—the most talked about being hot flashes and weight gain. But you may not realize how much menopause can affect your sleep patterns.

To help you get the rest you need, we've compiled answers to many of the questions asked by the 40 percent to 60 percent of menopausal women who report experiencing sleep disturbances.

How does menopause affect sleep?

It's all about estrogen, the "women's hormone." Produced in the ovaries, estrogen plays a vital role in regulating a woman's metabolism and body weight and in processes at every stage of sexual development and childbearing. During perimenopause and menopause, estrogen production steadily diminishes, causing myriad symptoms—many of which directly or indirectly cause sleep disturbances.

Common symptoms of menopause include:

Hot flashes and night sweats: Affecting 8 out of 10 women and those assigned female at birth, hot flashes and night sweats (both names for the same condition) are often associated with sleep disturbance. They're more common at night and they can have you waking up from sleep, sometimes drenched in sweat—hence the term night sweats. Once awake, it's harder to go back to sleep, and when this happens repeatedly, it can lead to chronic sleep deprivation.

Anxiety and depression: This phase of life can be a difficult and stressful time for many women who are raising teenagers, watching their children leave home for college, caring for elderly parents or just generally dealing with the rapid hormonal changes associated with menopause.

Other sleep disorders: Sleep apnea and restless leg syndrome, for example, are seen more commonly in this age group.

Because these symptoms and other hormonal changes can negatively impact your sleep—and therefore your health—it's crucial you find a way to address the underlying issues so you can rest easy once again. Getting a good night's sleep is about much more than just getting your "beauty sleep." It's actually critical to your health:

• Sleep improves mood and lowers stress levels.
• It's needed for DNA cell repair and to normalize cortisol and other hormone levels.
• Poor sleep is also a risk factor for strokes, cardiovascular disease, diabetes, obesity and certain types of cancer.
• Because fatigue slows response times and makes you less alert, it can increase the likelihood of car accidents.
• By stressing your immune system, poor sleep patterns can also increase your susceptibility to infections.

Do sleep aids work?

There's no shortage of prescription and over-the-counter sleep aids on the market, but do they work? Yes, they can help, but it's important they're only used occasionally and for a short period of time.

Over-the-counter sleep aids include:

• Melatonin: This is a hormone naturally released in the brain about four hours before we feel sleepy. It's triggered by the body's response to the growing darkness. But buyer beware: If a melatonin supplement is taken every night, it will impact your body's ability to produce it naturally. Side effects of melatonin include headache, dizziness and nausea.
• Elemental magnesium: Some research indicates magnesium may help improve insomnia symptoms by increasing the concentration of melatonin and decreasing levels of the stress hormone serum cortisol. Side effects of magnesium include nausea, cramping and diarrhea.

As always, talk to your doctor before starting any new over-the-counter supplement to ensure it's safe and won't interact with any other medications you're taking.

Some menopausal women have turned to prescription medications to help them sleep, which may help when used for a short time. The National Institute on Aging cautions that these are not a cure for sleep disturbances and should not be used long term.

Will MHT help me sleep better?

Menopausal hormone therapy (MHT) helps some women whose menopausal symptoms cause sleep disturbances.

The North American Menopause Society, the American Society for Reproductive Medicine and the Endocrine Society agree that most healthy, recently menopausal women (up to age 59 or within 10 years of menopause onset) can use MHT for relief of symptoms such as hot flashes.

When considering the use of MHT, you and your healthcare practitioner should take into account your age, time since menopause and your risk of blood clots, heart disease, stroke and breast cancer.

Are there any lifestyle changes that could help me sleep better?

"I advise women to start preparing for menopause, which can be an enjoyable time in life, early," said Nitu Bajekal, M.D., a gynecologist and women's health specialist. "But it's never too late to make lifestyle changes that will help you get a restful night's sleep."

Changes can be as simple as establishing a calming bedtime routine or taking a walk after dinner. Or bigger steps, such as switching to an anti-inflammatory diet. Other tips for better sleep include following a regular sleep schedule, avoiding late naps, keeping your bedroom at a cool temperature and exercising regularly.

How will an anti-inflammatory diet help me sleep?

An anti-inflammatory diet can help relieve some symptoms of menopause, including those pesky symptoms that can keep you from getting a good night's sleep.

While the diet reduces disease-causing inflammation in your body, it boosts your energy and mood, and alleviates aches and pains—enabling you to be more active and get back to a more balanced way of life.

"Every woman has different inflammation-trigger foods," said Suzie Welsh Devine, a nurse and founder of Binto. "Triggers for you might be gluten, dairy, sugar or even certain fruits or vegetables. If you experience brain fog, fatigue, balance issues, excess gas, irregular bowel movements or mood swings after eating certain foods, your body is having an inflammatory reaction."

Generally speaking, plant diversity is especially important during menopause. You should strive to consume protein, complex carbohydrates and fiber-rich plants, including fruits, vegetables, beans, soy, whole grains, nuts, seeds, herbs and spices. If you eat meat, make sure it's lean, organic and grass-fed.

How do alcohol, caffeine and screen time affect sleep?

Alcohol, caffeine and an overabundance of screen time are all notorious for ruining sleep, but you don't need to avoid them entirely. Knowing exactly how they disturb sleep can help you manage them more effectively.

Alcohol (especially before bedtime): Alcohol can make you feel relaxed and even sleepy, but it will disrupt your natural sleep cycle and reduce the REM phase—that magical place where dreams and memory consolidation take place. That glass of wine with dinner won't hurt, but drinking close to bedtime will negatively impact sleep.

Caffeine (especially in the second half of the day): Caffeine blocks receptors for adenosine, a sleep-promoting chemical in the brain. Foods and drinks that contain the highest levels of caffeine include coffee, tea, certain carbonated drinks and chocolate. Instead of consuming caffeine, try warm milk, chamomile tea or tart cherry juice, which is loaded with sleep-inducing tryptophan and melatonin.

Screen time (for 2 to 3 hours before bed): Blue light emitted by LED devices disrupts the circadian rhythms that regulate sleep. If you need to work late or you just can't resist watching that movie on your tablet in the evening, you can reduce the amount of blue light you're receiving. Some people recommend wearing blue-light-blocking glasses, although experts disagree on whether there is enough evidence that they help. Probably a better, cheaper solution would be switching to Night (or Dark) mode on your device.

Stress: The silent sleep thief

If your job is getting you down, your teenager is about to leave the nest, you can't get everything done each day or you're worried about your relationship—you're likely under stress and it's probably keeping you up at night.

"Women are always 'on'—never releasing stress," said Abi Adams, a professional movement coach. "And it's stress that creates the symptoms that can rob us of sleep."

Finding a community of women for support and understanding can also help alleviate stress. Because of the stigma associated with openly talking about menopause, the experience can feel isolating. Joining a support group, internet forum or other community of like-minded people can help.

Sweet dreams, sweet time of life

Taking a holistic approach to your menopausal symptoms will help you get back on track to sleeping well, feeling better and regaining a sense of control in your life.

If you're like many women, you've been putting others' needs before your own for a long time and it might feel strange to focus on your own well-being. But by putting guilt aside, enlisting the help of your healthcare provider and making some lifestyle changes now, you'll free yourself up to enjoy what could be an incredibly empowering and fulfilling time of life.