Women are at risk for unique sleep issues throughout different stages of their lives. Some of these challenges can be traced to hormonal changes during perimenopause, menopause, and post-menopause. Symptoms of menopause that affect sleep can include night sweats, increased urination, inflammation, restless legs, insomnia, and obstructive sleep apnea. While menopause begins at different times for everyone, the onset of hot flashes, hot sweats, decreased mental acuity, restlessness, daytime fogginess, and nighttime insomnia may precede menopause by months, or years. For others, it may be much shorter. Furthermore, not every woman experiences the entire spectrum of symptoms.
Night Sweats
Hot flashes or the feeling of warmth and the sweat that follows can differ in intensity. Hot flashes can be uncomfortable, especially when followed by excessive sweating to cool the body. When this occurs at night, bed clothes may be soaked to the point of awakening. These episodes may occur rarely, or frequently, even multiple times a night. The frequency and intensity of an individual’s night sweats and hot flashes is often similar to other female family members’ history of menopause. A new class of medication that does not require hormonal supplementation is available to treat hot flashes. However, monitoring blood work for liver function is recommended. Speak to a trusted medical professional to learn more.
Urination
Frequent urination is another symptom of menopause that can disrupt sleep. Increased urination may be a direct result of hormonal changes prior vaginal birth that alters the pelvic anatomy or a side effect of medication. It could also be an effect of a breathing disorder that causes more abdominal pressure swings, or abdominal obesity that puts more pressure on the abdomen. If urination is more than once per night, it disrupts sleep. More than half of adults over age 50 struggle with frequent urination disrupting their sleep. Because the cause of increased urination can vary so much, it is important to be evaluated to determine the underlying cause. If frequent urination is impacting your sleep, contact a medical professional.
Inflammation
Inflammatory disorders such as arthritis, neuropathies, or chronic pain syndrome can become more common after menopause, causing significant pain and disrupting sleep Inflammation can also contribute to higher cholesterol in those with genetic factors. As heart disease remains the number on killer of women, awareness of menopause changes can be critical. Regular attention to any new developments is crucial for overall health and wellbeing.
Restless Legs Syndrome (RLS)
RLS presents as an uncomfortable and persistent sensation affecting the feet, legs, or even the whole trunk. Though it generally improves after menses stop. Some women may develop RLS after multiple pregnancies. RLS often manifests at nighttime, impairing your ability to fall asleep or return to sleep after waking. Iron has been shown to improve the symptoms of restless legs; if you are experiencing RLS symptoms, be sure that your diet includes enough iron. It’s important to note that frequent use of antacids may prevent absorption of oral iron supplements.
Insomnia
Menopause may also bring a return of depression, anxiety, or insomnia to those with a history of these disorders. Estrogen metabolizes into serotonin. As estrogen decreases during menopause, serotonin, which promotes mood stability, will also decrease. With less progesterone on board, sleep may become more easily interrupted. Women are more likely than men to have trouble staying asleep. Waking up repeatedly can prime the brain to wake up prematurely. Longer periods of insomnia can reprogram the brain to awaken even when there is no stress. Cognitive behavior therapy with a trained psychologist can help calm those with insomnia, leading to better sleep.
Obstructive Sleep Apnea (OSA)
Hormonal fluctuations from menopause may also affect the airway. Vocal cords and the mucus that coat them become thicker, and the entire vocal cord descends, creating more resistance to airflow. This generally creates more resistance to airflow. Some women that never had symptoms of breathing abnormality may begin to experience them after menopause. Regardless of hormone replacement, the farther a woman is from date of menopause, the more likely she is to experience breathing abnormalities such as obstructive sleep apnea (OSA). Hormonal replacement may slow down this process, but currently it cannot reverse this tendency. For those that begin to snore, or have stoppages in breathing, it is important to have an evaluation to prevent side effects like daytime sleepiness, fatigue and possibly risks of dementia.
Conclusion
Menopause can present challenges, but with exercise, proper diet, and medical support, your sleep doesn’t have to suffer. Getting proper sleep can also help alleviate waking menopausal symptoms. That’s why good sleep is good medicine.
Kin Yuen MD, MS is an associate physician diplomate at University of California at San Francisco and adjunct faculty member at Stanford University School of Medicine. Dr. Yuen has been a principal investigator in clinical research of cardiac arrhythmia, medical devices, and has co-authored articles in health economic evaluations, women, and sleep disorders.