4 Symptoms of Menopause and How They Impact Sleep
These symptoms might be seriously affecting your health and your sleep.
Posted Sep 10, 2019
Poor and disrupted sleep are common symptoms of menopause. Insomnia, and changes to typical sleep patterns, are often an early signal of a woman in perimenopause, who is experiencing changes to estrogen, progesterone, and other hormones that influence sleep.
In this post, I’ll run through four frequently experienced symptoms of menopause, and discuss how they might exacerbate sleep issues—in ways that might surprise you.
These nighttime hot flashes, a surge of body heat accompanied by intense sweating, are the body’s response to drops in estrogen. For many women, hot flashes and night sweats begin during perimenopause and tend to increase in frequency until a couple of years into post-menopause before beginning a gradual decline.
Night sweats make sleep uncomfortable and difficult. I treat many patients who, throughout menopause, are regularly awakened from sleep drenched in sweat and have trouble falling back asleep, or wake feeling tired and unrested because of restless sleep caused by night sweats.
Night sweats can also make sleeping with a bed partner difficult, and put stress on relationships—sometimes, women experiencing nighttime hot flashes are uncomfortable sleeping close to another person.
New research indicates a link between night sweats, hot flashes, and obstructive sleep apnea in menopausal women. Obstructive sleep apnea and other sleep disorders become more common in women as they age and move through menopause. A recent study shows women with severe hot flashes during the day or night may be at significantly higher risk for obstructive sleep apnea than women who experience mild hot flashes, or none at all.
Wearing the right clothes for sleep and investing in good bedding—natural fabrics, layers that can be removed, not overdressing for bed—can help improve sleep when you’re contending with night sweats.
Anxiety, depression, and mood swings
I often see women in the menopausal transition who are struggling with sleep issues as well as anxiety and erratic, unpredictable changes to mood. In addition to mood swings that take you from sadness to anger to fear, women in menopause are also more likely to experience panic attacks and other physical symptoms of anxiety, including sweating and heart palpitations.
One of estrogen’s functions in a woman’s body is to regulate other hormones and neurotransmitters, including several that affect mood. Serotonin, dopamine, and norepinephrine are hormones and neurotransmitters that work to lift and stabilize mood. They also play direct roles in regulating sleep-wake cycles. When estrogen levels are irregular and erratic, that creates changes to levels of these mood-shaping hormones that can affect how you feel throughout the day—and how you sleep at night.
The decline in progesterone, with its calming, relaxing, estrogen-balancing effects, can also contribute to feelings of anxiety, irritability, and restless agitation. One of the most common complaints I hear from women in perimenopause is, “I can’t turn off my mind at night.” Racing thoughts, and persistent feelings of stress, make it difficult for many women experiencing menopause to unwind.
Anxiety, depression, and sleep have what’s known as a bi-directional relationship. Anxiety and depression can trigger sleep problems, and sleeplessness exacerbates both depression and anxiety. Women going through menopause may develop sleep issues as one symptom of mood problems—and they may be more likely to face struggles with mood because of poor sleep.
If you have a history of anxiety or depression, or are facing high levels of stress in your life, you may be more likely to experience mood swings and the development of a mood disorder in menopause—and therefore at greater risk for sleep problems. It’s important to discuss all of these symptoms with your doctor, so they don’t get worse when left untreated.
The foggy-headed forgetfulness and difficulty maintaining focus are some of the most frustrating symptoms for many of my patients who are in the menopausal transition. Estrogen helps keep the mind sharp, fueling the production of neurotransmitters that not only support mood, but also support a woman’s executive functioning—complex thinking, reasoning, and decision making. Estrogen plays a critical role in memory, and supports the overall health of the brain. One way appears to do this? By its influence with BDNF, a protein in the brain that is essential for maintaining healthy neurons.
Progesterone also aids in brain health and function—and it’s a hormone that’s important to successful healing in the brain after injury. A recent study found progesterone levels in post-menopausal women are linked to verbal memory and to overall cognitive abilities.
The shifts and declines in these hormones throughout menopause can interfere with waking performance. Many of the women I see in my practice are regularly frustrated by these changes to their focus, memory, and thinking—and say it affects their productivity, and the outlook with which they approach their work. This frustration over a lack of mental sharpness frequently creates stress that directly interferes with their sleep.
Changes to sex drive
As with all symptoms of menopause, changes in sexual drive and sexual function don’t happen for every woman. But for many, the decreased estrogen, progesterone, and testosterone that come with menopause create a reduced interest in, and pleasure from, sex. Some women experience pain during intercourse. Estrogen helps to keep vaginal tissues elastic and lubricated, and low estrogen can lead to thinning of vaginal tissue and vaginal dryness that may make sex uncomfortable.
Among my patients who experience this common symptom, the change in sex drive often creates frustration and confusion, as they wonder why their interest in sex feels different—and wonder how to revive that interest. This change associated with menopause also can create tension and distance in women’s relationships with their partners. These emotional and relationship challenges generate worry, frustration, and anger that can compromise sleep.
In my next post, I will discuss three symptoms of menopause that a person with menopause may experience and how they might be physically damaging sleep.
Michael J. Breus, PhD, DABSM
The Sleep Doctor™