Perimenopause to Menopause: Reclaiming Restful Sleep

If you're going through perimenopause or menopause and wondering where your good night’s sleep went, you're definitely not alone. Six in ten people have trouble sleeping during this time. You might feel completely exhausted yet lie awake for hours, or wake up multiple times feeling hot and sweaty. The changes happening in your body, plus the stress of a life transition, can make bedtime feel stressful instead of restful.

Here is the good news - the sleep trouble won’t last forever, and there are effective ways to help yourself sleep better. Keep reading to find out more about sleep challenges during menopause, and how you can rest easier.

Why Your Sleep Changes During Menopause

During perimenopause and menopause, two important hormones - estrogen and progesterone - start to change, and this directly affects how well you sleep. In perimenopause, the time leading up to menopause, the hormones don’t just gradually drop off - they fluctuate. This means that one day your estrogen level might be high, and the next it might be low. This hormonal rollercoaster can affect how you feel and sleep. In menopause, which marks the end of ovulation and menstrual periods, both estrogen and progesterone levels drop off, affecting sleep quality.

How progesterone and estrogen effects sleep:

• Both estrogen and progesterone play important roles in how well you sleep, but they work in different ways. Progesterone tends to help promote sleep - it's like a natural sleep aid that can help you fall asleep and stay asleep. When progesterone levels drop sharply, like they do just before your period, you might notice your sleep gets worse. Estrogen's relationship with sleep is more complicated. It helps control your body temperature at night (which is important for good sleep) and affects brain chemicals that influence sleep. However, its effects on sleep can vary depending on other hormones and where you are in your menstrual cycle. When these hormones are working together properly, they help you move smoothly through different stages of sleep during the night. But when their levels change dramatically, like before your period, during pregnancy, or during menopause, you might experience sleep problems like trouble falling asleep, waking up during the night, or not feeling rested in the morning.
• Estrogen also helps your body maintain a steady temperature.. As estrogen levels fall during menopause, your body's temperature control system stops working as well. This is why you might suddenly get those infamous hot flashes in the middle of the night, which can wake you up feeling sweaty and uncomfortable.
• Estrogen helps maintain stable circadian rhythms. Its reduction can disrupt the body's natural sleep-wake cycle, leading to earlier wake times or difficulty maintaining consistent sleep schedules. The loss of progesterone compounds these effects, since progesterone has natural sedating properties and promotes deeper sleep. Together, the hormonal changes create a perfect storm for sleep disruption that affects the majority of women going through menopause.

While estrogen and progesterone play big roles in sleep, it’s not all about them – it's about how everything connects. Poor sleep leads to increased stress hormones like cortisol, which makes it even harder to sleep. Meanwhile, mood changes like anxiety can increase difficulty relaxing and falling asleep.. If lifestyle management is not working for you, consider speaking with your provider about Hormone Replacement Therapy or other medications to help ease common symptoms like hot flashes and night sweats. Cognitive behavioral therapy for insomnia (CBT-i) is a fantastic option whether you’re pursuing hormonal and medication treatments or not.

Your treatment plan: What Actually Helps

Stick to a calming bedtime routine:

• Go to bed and wake up at the same time every day - yes, even on the weekends!
• Wind down before bed - Take a warm bath, read a book, or listen to calming music before bedtime.
• Avoid Screens- turn off electronics at least one hour before bedtime, as blue light from phones, computers, and TVs can interfere with sleep.

Optimize your sleep environment

• Keep your bedroom cool, ideally between 60-67 degrees F.
• Minimize distractions by using blackout curtains, a white noise machine and ear plugs if needed.
• Choose comfortable bedding made of breathable fabrics like cotton or linen to keep you cool and comfortable.

Manage hot flashes and night sweats

• Wear layers of clothing to bed so you can adjust easily if you get too warm.
• Use breathable fabrics for clothes and bedding.
• Keep a fan by your bed.
• Drink plenty of water throughout the day but not too close to bedtime to help regulate body temperature.

Support sleep with exercise, nutrition, and supplements

• Exercise regularly, but finish vigorous workouts at least 2 hours before bedtime (light exercise later in the day, like a walk as the sun is setting, can be beneficial) to reduce stress and improve sleep quality.
• Limit caffeine and alcohol, as both can worsen hot flashes and interfere with deep sleep stages. Try cutting off caffeine after 12 p.m. if you’re having trouble sleeping.
• Cut back heavy, spicy, or sugary meals within 3 hours before bed. These foods can trigger hot flashes or reflux that disrupts sleep.
• Consider sleep aides like over the counter melatonin, valerian root, chamomile or magnesium in consultation with your provider

Consider therapy and relaxation training exercises

• Pursue cognitive behavioral therapy for insomnia (CBT-I). This structured therapy is shown to be one of the most effective long-term treatments for insomnia, including menopause-related sleep disruption.
• Practice relaxation training exercises, such as progressive muscle relaxation training, guided imagery and mindfulness, which have been shown to further improve sleep quality. These can be found on the internet, health apps, or a mental health provider.

To create your personalized plan, it’s time to assemble your medical team. The One Medical team can help wherever you are on your journey: book the peri/menopause visit for dedicated 1:1 time to discuss your plan with a menopause-trained provider.