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Publication:
Australasian Menopause Society
Author:
Various
Date:
February 2025
Article Summary
Let's talk about sleep and menopause, especially the common sleep issues many face. The Australasian Menopause Society says disrupted sleep during menopause is as common as finding keys in the fridge, frustratingly frequent.
Here's what's happening while we're trying to get some decent sleep: our oestrogen and progesterone levels are having a party (and not the good kind), which throws our circadian rhythm completely out of sync. Think of it as your body's internal clock deciding to operate on a different time zone without consulting you first.
The main culprits keeping us awake are hot flushes and night sweats. Nothing feels quite as startling as being jolted awake, feeling like you've been dipped in molten lava, only to find yourself changing the bedsheets at 3am.
Research shows these pesky interruptions tend to happen during non-REM sleep, which is why many of us wake up feeling exhausted the next morning.
Post-menopausal women are more prone to sleep disordered breathing, like snoring and sleep apnoea, due to lower hormone levels altering fat distribution, which can block airways.
Symptoms often include daytime fatigue and reduced energy, rather than noticeable snoring, making symptoms more subtle.
Restless leg syndrome can join the party, along with the bidirectional relationship between poor sleep and mental health, where anxiety and depression worsen sleep, and poor sleep worsens anxiety and depression. It's like a merry-go-round, but less fun.
The good news is that practical solutions exist. Treating hot flushes often improves sleep, lifestyle changes help, and cognitive behavioural therapy for insomnia (CBTi) is effective for chronic sleep issues. The key is identifying and addressing the specific cause of your sleep problems.
"Just a friendly reminder: I'm sharing what I've learned, not prescribing what you should do. Always chat with your GP about what's right for your unique situation!"
The HotFlush Fix - Your Sleep Rescue Plan
IMMEDIATE SLEEP ENVIRONMENT FIXES
• Keep bedroom cool and well-ventilated
• Use moisture-wicking bedding and sleepwear
• Place a fan near the bed for quick cooling
DAILY RHYTHM RESET
• Set a strict wake-up time (yes, even on weekends)
• Get sunlight exposure first thing each morning
• Avoid caffeine after 2 pm (including chocolate and green tea)
• Limit alcohol, especially in the evening
HOT FLUSH MANAGEMENT
• Track your hot flush triggers in a simple diary
• Consider discussing hormone therapy with your GP
• Try cooling techniques before bed (cool shower, cold compress)
• Dress in easily removable layers
PROFESSIONAL SUPPORT
• Discuss persistent sleep issues with your GP after 3 months
• Ask about cognitive behavioural therapy for insomnia (CBTi)
• Consider online CBTi programmes if in-person isn't available
• Request referral to sleep specialist if needed
TONIGHT'S WINS
• Set your alarm for the same time tomorrow
• Remove one caffeinated drink from your afternoon routine
• Write down three things that went well today (anxiety reduction)
Remember: Normal adults wake up for about 55 minutes during the night anyway, so don't panic if you're not sleeping like a teenager. The goal is better sleep, not perfect sleep.
Medication Options for Menopause Sleep Problems
When lifestyle changes aren't enough, medication might help with menopausal sleep issues. Here are the main options your doctor might discuss:
Hormone Therapy
Estrogen combined with progesterone is often advised for women within about 10 years of menopause who experience moderate to severe hot flushes. It can significantly help improve sleep, decrease hot flushes, and support mood. Just remember, it isn't suitable for everyone because of certain health risks.
Antidepressants (SSRIs/SNRIs)
Examples: Paroxetine, venlafaxine Best for: Women who cannot take hormones. Helps with: Hot flushes and mood issues affecting sleep. Watch for: Side effects like nausea or sexual dysfunction.
Melatonin
It's a natural sleep hormone supplement designed to support sleep timing issues and difficulty falling asleep. It can help regulate your sleep-wake cycles, although the benefits are modest and the dosing may vary. Always consider consulting with a healthcare professional for personalised advice.
Sleep Medications
Examples: Zolpidem, benzodiazepines. Best for: severe insomnia, short-term use only. Important: risk of dependence and falls in older adults.
Other Options
- Gabapentin: Sometimes used for hot flashes and sleep
- Neurokinin B antagonists: New therapy showing promise for hot flashes
The Bottom Line
All medications have benefits and risks. Your doctor will consider your specific symptoms, health history, and any other medications you are taking before recommending a treatment. Regular monitoring ensures safety and effectiveness.
