Menopause and Insomnia

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Joyce Walsleben, RN, PhD

Joyce Walsleben, RN, PhD

How is sleep affected by perimenopause, menopause, and post-menopause?

Many female patients who come to my office in their late 30s and 40s with symptoms of insomnia are actually experiencing the beginning of their transition to menopause which is called perimenopause. Sleep can be impacted by many things, such as hormonal and lifestyle changes.

1. Hormonal changes . During the course of perimenopause through menopause, a woman's ovaries gradually decrease production of estrogen and progesterone, a sleep-promoting hormone. The shifting of ratios of hormones can be an unsettling process, sometimes contributing to the inability to fall asleep. Also, waning levels of estrogen may make you more susceptible to environmental and other factors/stressors which disrupt sleep.

2. Hot flashes . A hot flash is a surge of adrenaline, awakening your brain from sleep. It often produces sweat and a change of temperature that can often be disruptive to sleep and comfort levels. Unfortunately it may take time for your adrenaline to recede and let you settle down into sleep again.

3. Depression/Mood Swings . About 20% of women will experience depression during this time frame and some cases have been linked to estrogen loss. However, hormonal changes may not be the only cause. Precipitants such as life stress and a history of menopause are important causes as well.

4. Coincidental Social Issues . Aside from the hormonal changes you may be experiencing, this time in life can present many social changes. Whether your children and moving out of the house, retiring, moving to a smaller home or you are just feeling some of the "midlife crisis" stress of getting to a new phase in life, these issues can interfere with your ability to sleep.

Since hormonal and social issues are at play, it is important for you to be in touch with how your sleep is impacted by this transitional period. The perimenopaual period may last from 3-10 years. Some women ‘learn’ to have insomnia and adjust their life around it – and as their hormones settle down, they have built a lifestyle of insomnia.

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