Sleep Problems During Menopause: Here’s What Actually Helps

Physical symptoms may be only mildly bothersome for some, but for others, they can significantly interfere with daily activities1. According to studies, 60–86% of women seek medical help due to the severity of their symptoms2, 3.

Among the most frustrating are sleep problems during menopause, which can leave you exhausted, irritable, and searching for answers. The good news? There are effective strategies backed by science that can help manage the symptoms.

What causes sleep problems during menopause?
Sleep problems during menopause are often triggered by hormonal changes, hot flashes, mood shifts, and disrupted body temperature regulation. Lower estrogen and progesterone levels, along with lifestyle factors, contribute to difficulties falling asleep, staying asleep, and getting restful, restorative sleep.

I cover most significant symptoms and management tools in detail in separate articles under Healthy Body & Mind and Exercise & Nutrition.

Understanding Sleep Disturbances 

Sleep disturbances are very common among women going through the menopausal transition and come in different forms. Between 33% and 57% of us are affected4.

Insomnia is frequent and characterized by difficulty falling asleep or staying asleep. Chronic insomnia is defined as occurring at least three times a week for three months. Many women experience frequent awakenings, which disrupt deep rest5, 6, 7.

Breathing-related issues also play a role. Restless legs syndrome (RLS) causes an uncomfortable urge to move the legs, which can interrupt sleep. Obstructive sleep apnea (OSA) involves temporary pauses in breathing due to relaxed throat muscles8, 9, 10.

In addition, menopausal women often spend less time in restorative sleep stages. These include stage 2, slow-wave sleep, and REM sleep, which are essential for mental and physical recovery. Together, these challenges make restful sleep difficult during our menopause transition11.

It’s not enough that we work hard during the day, we also don’t get enough rest at night!

Why is Sleep Disrupted?

Studies show that lower estrogen and higher follicle-stimulating hormone (FSH) levels increase sleep disturbances, including frequent awakenings and poorer sleep quality. Decreased estrogen and progesterone play a role here as well. They normally help regulate sleep and body temperature, promote relaxation, and even reduce wakefulness by blocking certain neurotransmitters in the brain. 

Menopausal symptoms like hot flashes, night sweats, and mood changes also disrupt sleep. Hot flashes, for example, wake nearly 70% of women who experience them12. Mood disorders, such as anxiety or depression, are strongly linked to sleep problems as well13, 14.

Not all sleep disturbances are caused by menopause alone. Everyday factors like stress, weight, overall health, and even alcohol play a big role in sleep quality. Add to that frequent nighttime trips to the bathroom (nocturia) and the natural drop in melatonin as we age, and it’s clear that these can be just as impactful as the hormonal shifts of menopause15, 16.

Management Strategies

Managing sleep problems during menopause often requires a combination of approaches. From medical treatments to lifestyle adjustments, the good news is that you have several options to improve your sleep quality and feel more rested.

Below, we’ll explore some of the most effective strategies, starting with medical therapies and moving into holistic methods you can integrate into your daily routine.

Hormone Replacement Therapy (HRT)

Low-dose HRT, like 0.5 mg oral estradiol and low-dose venlafaxine, has shown promising results in reducing insomnia and improving sleep quality17. Studies also suggest that combined estrogen-progesterone therapy can make a difference for those dealing with menopausal sleep disruptions18.

Both estradiol and conjugated estrogens (CEE) can improve sleep, with the skin patch working better than the pill. Adding micronized progesterone to your bedtime routine may help even more, as it has calming effects on the brain and reduces sleep disturbances better than other progesterone options. Together, these therapies are more effective than estrogen alone for improving sleep32.

Melatonin

Melatonin’s effects on sleep during menopause are still up for debate. While a meta-analysis found no clear benefits, recent studies suggest that melatonin might improve sleep, mood, and quality of life for some perimenopausal women without significant side effects.

The advice? Try a low dose (1-5 mg) about 2 hours before bedtime and see if it works for you19, 20, 21.

Supplements

Taking whey protein isolate and omega-3 fatty acids together may help improve sleep quality and mood in postmenopausal women, although the results haven’t always been strong enough to confirm a significant effect22, 23.

Isoflavones (25 mg daily) and black cohosh show potential for improving sleep, though more research is needed24, 25.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

Consider CBT-I, a well-supported approach to improving sleep. It’s not specific to menopause transitions but has been proven to be effective. CBT-I focuses on identifying and changing thoughts and behaviors that contribute to sleep problems. You learn to develop healthier sleep habits, manage stress, and create a bedtime routine that promotes relaxation. It’s even been shown to be more effective than sleep hygiene education alone26, 27.

Sleep Hygiene Practices

Establishing a consistent routine can make a real difference in sleep quality, so try to go to bed and wake up at the same time every day.

• Set up your bedroom to be sleep-friendly: keep it dark, cool, and quiet.
• To wind down before bed, consider gentle stretching, reading, or taking a warm bath to relax.
• Try to avoid screens at least an hour before bedtime to reduce blue light exposure, which can interfere with sleep28, 29.
• Recent research shows that using a mattress designed to manage body temperature, like one with high heat capacity, can help postmenopausal women get more deep sleep. This approach lowers core body temperature and heart rate, which may lead to better overall sleep quality33, 34.

Curious Facts

During menopause, the risk of obstructive sleep apnea (OSA) rises, but it’s often overlooked because women’s symptoms can differ from men’s. While men with OSA usually have loud snoring and noticeable pauses in breathing, menopausal women are more likely to experience insomnia, fatigue, morning headaches, mood swings, or restless sleep instead of classic snoring.

This increased risk is partly due to the drop in hormones like progesterone, which helps support normal breathing. Recognizing sleep apnea as a hidden cause of sleep issues during menopause is key. Treating it not only improves your sleep but also reduces the risk of high blood pressure, heart disease, and other health problems. Addressing OSA can significantly enhance your overall health and quality of life during this transition30, 31.