Symptom Guide: Menopausal Insomnia and Sleeplessness

Getting good sleep on a regular basis is already hard enough. During your menopausal years, the same hormonal dips that can cause night sweats and hijack your libido can also disrupt your sleep at night. Some menopausal folks even experience full-blown insomnia, a sleep disorder that involves extreme difficulty falling and staying asleep and can lead to daytime exhaustion and even anxiety or depression.

“It’s clear that women with hormonal changes within the two years of perimenopause and menopause don’t sleep as soundly or as long,” says Lizellen La Follette, a board-certified OB-GYN in Marin County, California.

According to Dr. La Follette, this lack of sleep isn’t just miserable the next morning. Lack of restorative sleep can lead to a host of short-term and long-term health problems. On the flip side, proper sleep can go a long way to restoring your health.

What causes insomnia during menopause?

Here’s what’s going on: The presence of estrogen helps regulate several hormones necessary for sleep, including serotonin, melatonin, and gamma-aminobutyric acid (GABA). A drop in estrogen affects all these hormones, which can cause insomnia. Other menopause-adjacent experiences can increase the odds of insomnia.

Take hot flashes, for example. Many women find it hard (or nearly impossible) to get comfortable at night because they’re so hot. Night sweats, which usually last about 30 seconds, can also cause increased waking. Anxiety and depression during menopause — whether you had them before or not — can also worsen your sleep.

How long does menopausal insomnia last?

You probably already know that quality sleep is vital for overall health, not to mention day-to-day functioning. While you may not be able to stop the hormonal roller coaster, you can take a few steps to improve your sleep and treat bouts of insomnia. Here’s how to start dealing with it.

Be consistent. If you’re having a hard time dozing off or waking up a lot in the middle of the night, start by optimizing your sleep schedule. Suzanne Fenske, a board-certified gynecologist and founder of TārāMD in New York City, recommends going to bed and waking up around the same time each day — this can train your circadian rhythm to make you sleepy and energized at the right times.

Soak in some morning light. Another way to optimize your body’s internal clock? Susan D’Addario, a New York–based certified sleep science coach, recommends getting 15-20 minutes of light exposure every morning before 8:30 a.m. Morning light signals to your body it’s time to get up, which can help your brain make you sleepy at night. 

Practice sleep hygiene. Another huge part of restful sleep is sleep hygiene — basically, all the stuff you do to ready your mind and body to doze off. First on the list is setting the mood for sleep.

Along with dimming your overhead lights, D’Addario suggests blocking sleep-disrupting blue light from screens an hour before bedtime. That can mean buying a snazzy pair of blue-light blocking glasses, changing your iPhone to night mode, or simply putting your devices down before bed. (Easier said than done, we know.) When it’s time to cozy up, create the atmosphere in your room. Make the bedroom pitch-dark and as cool as you can (think blackout curtains or an eye mask, and a thermostat set to the upper 60s).

Get your body cozy. Because peri/menopause can cause joint and muscle pain (and let’s be honest, so can midlife), making your body more comfortable can play a big role in how you sleep at night. Choose a comfortable mattress that supports your joints and muscles (you’ll know it’s a good one when it’s comfy when you’re lying down and you don’t hurt more when you wake up). A pillow that keeps your neck in a neutral (not curved) position while you’re resting can also be a game changer, so if you’ve been thinking of replacing yours, this is an ideal time.

Just rest in bed. It can be frustrating to lie in bed wide awake, but anxiety over not sleeping is only going to make it worse. Instead of ruminating on your sleep deprivation or getting up to do something else, La Follette suggests simply lying in bed and resting. Accepting that you’re awake and relaxing might trick your body into sleep, and besides, a few hours of rest is better for the body than a few hours of anxiety. “Remind yourself that your body will eventually get used to this new state and you won’t have sleep disruption all the time,” says La Follette.

Manage your stress levels. Daytime stress keeps your cortisol levels high, which can result in more nighttime wake-ups and daytime exhaustion and fatigue. Do your best to mitigate stress through meditation, yoga, breath work, and mind/body therapies like acupuncture.

Home in on your nutrition. Convenient as the standard American diet is, it’s not doing your sleep (or your long-term health) any favors. Simple carbs — think sugary, processed foods — might give you an immediate bump in energy, but you’ll more than likely crash afterward. Instead, eat more complex carbs, such as whole grains, in combination with proteins and healthy fats. To improve your nighttime sleep, D’Addario recommends that you eat your last meal a few hours before bed (ideally three) so your body can focus on restorative sleep rather than digestion.

When should I talk to my doctor?

Everyone — especially those of us in (peri)menopause — experiences occasional sleep challenges that make it difficult to fall asleep and stay asleep. But if your insomnia’s getting worse — you’re facing challenges at least three times a week for three months or more — D’Addario recommends seeking out professional help for insomnia, for which tons of helpful, evidence-based treatment options are available.