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Sleep Problems

Difficulty sleeping (insomnia) is one of the most common complaints of women during the menopause transition. Stress and insomnia are closely linked. Many midlife women experience changes (job-related stress, loss of a life partner through death or divorce, caring for younger or older family members). Insomnia may be associated with pain or other chronic illnesses that become more common at midlife. Certain medications also can disturb sleep.

Sleep disturbances during the menopause transition are often related to hot flashes and night sweats. Women with these symptoms report difficulty falling asleep and staying asleep, in addition to early morning awakening. The sleep difficulties caused by vasomotor symptoms commonly coexist with depressed mood and anxiety, which may further influence sleep problems.

The management of sleep problems begins with developing good sleep habits. However, if these behavior changes are not enough, consult a healthcare provider to rule out underlying causes of sleep problems such as thyroid disorders, allergies, anemia, depression, restless legs syndrome, or sleep-disordered breathing such as obstructive sleep apnea. Many women with restless legs syndrome find that their symptoms worsen during menopause. In addition, more postmenopausal women experience sleep apnea than do premenopausal women, and women at midlife are more likely to experience sleep apnea that’s more severe. Women with long-term sleep problems may benefit from a referral to a sleep center for diagnosis and treatment options.

Most over-the counter sleep aids are not effective and may even be harmful. Although melatonin supplements may help shift workers to get sleep and prevent or treat jet lag, there are limited data showing that it provides relief from menopause-related sleep disturbances. A number of prescription medications may be used to treat insomnia, although adverse events (AEs) should be discussed with a healthcare provider. Hormone therapy may be recommended for hot flash-related sleep disturbances because of its effectiveness in improving sleep quality.

The DOs and DON’Ts for Healthy Sleep


  • Awaken at the same time every morning
  • Increase daytime bright light exposure
  • Establish a daily activity routine
  • Exercise regularly
  • Set aside a “worry time,” including journaling or writing down thoughts and feelings
  • Establish a comfortable sleep environment
  • Do something relaxing before bedtime
  • Try a warm bath
  • Develop regular rituals before sleep and stick to a regular bedtime
  • Nap (unless you’re a shift worker)
  • Drink alcohol
  • Use stimulants such as caffeine or nicotine
  • Expose yourself to bright light at night
  • Exercise within 3 hours of bedtime
  • Eat a heavy meal or drink within 3 hours of bedtime
  • Expose yourself to a noisy sleep environment
  • Try to sleep in an excessively warm or cold bedroom
  • Use the bed for things other than sleep or sex
  • Be a clock-watcher
  • Try to sleep, because the harder you try, the more difficult it will be to fall asleep
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