Menopause and Sleep

Introduction

If you are a person assigned female at birth (AFAB) and you stop having your period (or menstrual cycle) due to lower hormone levels for more than 12 months, you have reached menopause. Menopause can cause a variety of symptoms and it can have a great impact on your life, through your work, relationships and your sleep.¹

What is menopause?

Menopause is the natural, biological cessation of menstrual blood for a period longer than 12 months.² It takes place in all menstruating people as they age due to oestrogen deficiency. It usually occurs between the ages of 45 and 55.¹ It's simply the end of a person's menstrual cycle.

Every person AFAB has ovaries. These ovaries store the eggs that are released during menstruation. The ovaries make the hormones (oestrogen & progesterone)  that control menstruation and the cessation of this whole process is usually due to the deficiency of oestrogen thereby causing menopause.¹

Symptoms

Approximately, 1.5 million people AFAB undergo a transitional stage into menopause. The transitional stage into menopause comes with unsettling  symptoms such as sleep disturbances, mood changes, hot flashes, vaginal dryness, disrupted sleep, and sexual dysfunction.³

Sleep problems are very common during menopause

Ageing comes with some difficulties and deteriorating health conditions, for people AFAB, it seems to be worse. People AFAB are reported to suffer sleep difficulties twice as much as people assigned male at birth.³ Asides from ageing, hormonal changes due to the transition into menopause could be a major cause. Mood disorders along with poor sleep and hygiene are also noted to be contributing factors.³

Sleep disorders are very common and it  affects 39 to 47 per cent of perimenopausal people AFAB, and 35 to 60 per cent of postmenopausal people. These hormones i.e progesterone and oestrogen are the same hormones that aid and affect certain bodily processes such as appetite, sleep, mood, and sex drive. 

The symptoms-insomnia cycle

Some sleep disorders in people AFAB are commonly associated with menopause. Some of these include:

Night sweats involve the unexpected and sudden heat sensations that are spread all over the body co-occurring with sweating at night. These sensations are generally called hot flashes and can affect 75 to 85 per cent of menapausal people. They could typically occur for seven years but can continue for more than ten years.

Hot  flashes are known to reduce a person AFAB’s quality of sleep or ability to go back to sleep due to the increase in adrenaline and body heat, this could be quite energising, making sleep futile. The poor quality of sleep causes  fatigue by the next day. It is said that 44 percent of  people AFAB who report hot flashes or night sweats meet the clinical criteria for chronic insomnia.⁴

Insomnia is a common sleep disorder that is characterised by the inability or difficulty in falling asleep, staying asleep, or getting good quality sleep. Insomnia can get in the way of a person’s daily activities and could cause  sleepiness and fatigue during the day. Sleep deprivation from insomnia could increase the risk of anxiety, inflammation, increased headaches and irritation.⁴

Other sleep disorders that could develop during menopause include periodic limb movements disorder and restless legs syndrome. These disorders are often associated with involuntary leg movements that disrupt sleep due to the uncomfortable sensations that accompany them.

Sleep complaints by people in menopause are usually accompanied by depression and anxiety, which can worsen sleep issues. Whereas, a lack of sleep can cause or contribute to anxiety and depression^{. 4}

The disrupted sleep is caused by hormonal imbalances

When a person’s ovaries stop producing oestrogen and progesterone, menopause occurs.

Oestrogen, one of the hormones produced by the ovaries, is usually deficient when menopause occurs. This hormone plays a role in the metabolism of serotonin and other neurotransmitters that affect our sleep-wake cycle. Oestrogen also helps keep our body temperature low at night, and therefore more conducive to restful sleep. Oestrogen also has an antidepressant effect. As a result, individuals with limited oestrogen can suffer increased body temperatures, insufficient sleep quality and bad moods. 

Ageing is also a factor that affects the sleep-wake cycle. This causes early tiredness, waking up earlier and overall lesser quality of sleep. For menopausal people, it is double the trouble. They have ageing factors and hormonal changes depriving them of quality sleep, making them patients of insomnia.⁴

People AFAB may also begin taking medications, whether due to menopause or other symptoms of ageing, which may interfere with their sleep. Several more factors associated with aging can effect sleep quality, for example Joint pains, body aches, and bladder problems. 

Tips for improving sleep quality during menopause

Menopause is not a disease that needs to be cured, but its discomforting symptoms could be managed.

Tips that help improve quality of sleep in menopausal people,⁴ 

1. Keeping to a healthy and balanced diet whilst managing one’s weight. It is noted that people AFAB tend to gain weight easier after menopause
2. Developing a bedtime routine helps in alleviating stress, including relaxation techniques in this routine e.g deep breathing, and reading are found to be very helpful
3. Avoid drinks containing alcohol and/or caffeine in the evenings as they disrupt sleep, thereby reducing sleep quality
4. Having a cool bedroom temperature, especially at night. Placing a fan next to you or keeping the air conditioning on at night
5. Wearing light materials to bed such as cotton, and using lightweight beddings
6. Reduce stress and stressful thoughts as these make it harder to sleep well at night
7. Using the restroom before going to bed to avoid waking up at night

Conclusion

As cool as it sounds to not have to deal with period cramps, menstrual blood and all the hormonal changes that come with menstruation, menopause could also cause physical and hormonal changes in people. This includes poor sleep quality which could cause anxiety and depression and the cycle continues. All of these cause a reduced quality of living. It is essential that people AFAB are informed of these symptoms and see their health practitioner when necessary and take steps that help to improve their quality of living, despite these hormonal changes that come with the cessation of menstruation.