Sleep Studies: How Perimenopause Sabotages Sleep (and What You Can Do About It)

If you’re struggling to fall asleep or waking up several times a night, you aren’t alone. Perimenopausal people consistently report poor sleep as one of the most common and bothersome symptoms they experience.

Let’s discuss how the menopausal transition changes sleep and, more importantly, what you can do about it.

What happens to sleep in perimenopause?

If you follow menopause newsletters or social media accounts, you’ll hear about poor sleep—a lot. This is probably because it’s such a common struggle during this time: one-third to half of those aged 40-64 report sleep trouble.

What is “disturbed sleep”?

Here are some of the key characteristics of peri- and postmenopausal sleep disruption:

It can include difficulty falling asleep and trouble staying asleep. Many people find they wake up very early in the morning and can’t get back to sleep.
The type(s) of sleep disturbances appear to be connected to other perimenopausal symptoms. For example, nighttime hot flashes are associated with frequent awakenings during the night; depression is associated with difficulty falling asleep and waking very early.
Sleep troubles tend to get worse later in perimenopause and persist into the postmenopausal years.
Certain sleep disorders, such as obstructive sleep apnea, are more common in postmenopausal people than in those who haven’t yet completed the transition.

Interestingly, sleep studies haven’t consistently shown a change in sleep architecture during perimenopause: the ratios and lengths of REM and non-REM cycles during sleep don’t appear substantially different from those of people who aren’t in perimenopause. However, these studies have been small and variable, so more research is warranted.

What causes sleep disturbances during the menopause transition?

Until recently, researchers weren’t sure about how much menopause itself drives these sleep changes. Some hypothesized that age-related changes may be responsible for worsening sleep during perimenopause. It’s a reasonable hypothesis: certain sleep problems, such as sleep apnea, do indeed become more common with age.

However, new data suggest that perimenopausal hormone changes play an important role. Declining levels of estrogen and progesterone likely contribute to disturbed sleep during the peri- and postmenopausal years.

In addition to shifting hormones, other elements of the perimenopause experience may contribute to sleep difficulties. A few to consider:

Anxiety and depression can mess with your sleep quality. Depression, for example, can make it more difficult to fall asleep. This can lead to a vicious cycle in which mood symptoms worsen your sleep quality, and poor sleep makes it harder to manage the symptoms of depression and anxiety.
Nighttime hot flashes can make it harder to fall and stay asleep. Hot flashes are also associated with mood problems such as depression, which also have negative effects on sleep.
Race and ethnicity can influence your experience of sleep troubles, too. For example, perimenopausal Caucasian women report more sleep difficulties than Japanese women in the same stage.
People who transition through menopause early because of surgery or other medical treatment report higher rates of sleep disturbances than those who transition naturally. This may be related to the fact that early transitioners experience more severe hot flashes and night sweats that disrupt their sleep.

How poor sleep affects your whole life

You’ve probably experienced this before: when you don’t sleep well, your whole next day feels “off." You’re tired and a little grouchy, and your brain feels like it’s firing on two of its six cylinders.

In addition to making individual days drag out, poor sleep can add up over time and create bigger problems. Sleep problems and mood disorders exist on a two-way street: sleep disorders predict the development of depression, and depression increases the risk of developing sleep problems. Poor sleep can also undermine your cognitive function and increase the risk of dementia later in life.

Over time, insomnia and decreased sleep duration also increase the risk of developing metabolic syndrome—a constellation of conditions such as high blood pressure and cholesterol that increase one’s risk of heart disease, stroke, and type II diabetes.

Sleep struggles are more than a drain on your daily energy and productivity: they’re a real threat to your long-term health, too. You’re probably wondering what you can do to stop the threat in its tracks—so let’s discuss.

Maximizing sleep in menopause

Time for some good news: if you’re struggling with sleep during the menopausal transition, there’s a lot you can do to improve it. Several research-backed interventions have shown promise in helping peri- and postmenopausal people tackle sleep trouble.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

CBT-I is a specialized form of cognitive behavioral therapy focused on—you guessed it—insomnia and disturbed sleep. A CBT-I therapist can help you:

Learn proper sleep hygiene and establish healthy bedtime behaviors.
Address and modify habits that might be sabotaging your sleep.
Identify and take control of thought patterns that interrupt sleep.

In a study of over 100 peri- or postmenopausal women with moderate-to-severe insomnia, researchers delivered six sessions of CBT-I via telephone.

Compared to women who received only general menopause education, those who received CBT-I reported more efficient sleep, decreases in the time it took to fall asleep, and less time spent awake at night. Best of all, it wasn’t just a short-term fix: these women maintained their sleep improvements for at least six months after treatment.

Sleep Medications

For people who’ve tried CBT-I and are still struggling to sleep, medication may be the next step. There are several prescription medications designed to reduce how long it takes to fall asleep and help you sleep longer. Talk with your healthcare provider to determine if medication is an appropriate next step for you.

Menopausal Hormone Therapy (MHT)

High-quality research has established that declining levels of estrogen and progesterone during perimenopause contribute to increasing sleep disturbance and decreasing sleep quality.

Menopausal hormone therapy, which replaces both estrogen and progesterone, improves multiple elements of sleep in perimenopausal people. While it’s not the first-line option for treating sleep troubles, providers often recommend it for people struggling with sleep alongside other perimenopausal symptoms.

People receiving MHT demonstrate more efficient sleep, take less time to fall asleep, and have fewer nighttime awakenings. They also report greater satisfaction with their sleep.

Taking back control with sleep tracking

Tracking can be a powerful tool in the quest to understand and improve your sleep quality. Sleep is a complex process with both subjective and objective elements, and your smartwatch can help you quantify the objective ones.

Recall that traditional sleep studies don’t always demonstrate negative effects on the sleep structure of perimenopausal people. Wearable tracking tools such as smartwatches aren’t perfect either: some can incorrectly label nighttime awakenings as sleep, for example.

These limitations don’t mean that sleep troubles are “all in your head."

Remember: The data from your smartwatch is a tool to help you understand your sleep patterns over time, but your personal experience of sleep and restfulness is equally important.

Questions to ask your doctor

If sleep disturbance is a significant struggle for you, don’t brush it under the rug! For your next medical appointment, here are some questions to help you start the conversation about sleep with your provider:

I’ve been having more trouble falling/staying asleep lately, even though I haven’t changed my bedtime routine or daily habits. Is it possible that hormonal changes are driving some of these sleep problems?
For the past [X] months, I’ve been tracking my sleep with my smartwatch, and I’ve noticed some changes. Can I show you a summary of my sleep patterns and get your opinion on it?
I’ve adjusted my sleep routine and bedtime behaviors to improve my sleep hygiene, but I’m still having a lot of trouble sleeping. Are there any sleep medications we can consider trying as an add-on?

DISCLAIMER

This article is intended for educational purposes only, using publicly available information. It is not medical advice, and it should not be used for the diagnosis, treatment, or prevention of disease. Please consult your licensed medical provider regarding health questions or concerns.