By Avni Dalal, ND
Sleep disturbances are one of the most common and frustrating symptoms of menopause and perimenopause, impacting up to 60% of women transitioning through this stage of life. While hot flashes and night sweats (vasomotor symptoms) are often blamed for poor sleep, the reality is far more complex. Hormonal changes, psychosocial stressors, and the presence of other sleep disorders all contribute to disrupted sleep, making it difficult for menopausal women to get the restorative rest they need.
Addressing all the factors that influence sleep—rather than just focusing on temperature regulation—is key to improving sleep quality and overall well-being. Let’s explore why sleep becomes more difficult during menopause and evidence-based strategies to support better rest.
Why Is Sleep Disrupted During Menopause?
1. Vasomotor Symptoms (Hot Flashes & Night Sweats)
One of the most well-known reasons for sleep difficulties during menopause is the presence of hot flashes and night sweats, also known as vasomotor symptoms (VMS). These episodes occur due to fluctuations in estradiol (a form of estrogen) and follicle-stimulating hormone (FSH), which affect the body’s ability to regulate temperature.1 Waking up drenched in sweat can lead to frequent awakenings, making it difficult to fall back asleep and reducing overall sleep efficiency.1
Beyond the immediate discomfort, anticipatory anxiety about waking up in a sweat can create a cycle of stress, further worsening sleep quality. Women experiencing frequent night sweats often develop sleep-maintenance insomnia, where they wake up multiple times per night and struggle to return to sleep.2,3
2. Psychosocial Stress and Mood Changes
Menopause is often accompanied by significant life changes and emotional stressors—including caregiving responsibilities, career transitions, aging parents, and changes in self-identity. These stressors can contribute to chronic worry, anxiety, and depressive symptoms, all of which are linked to poor sleep quality and insomnia.4
Additionally, hormonal changes during menopause affect neurotransmitters like serotonin and gamma-aminobutyric acid (GABA), which play a role in mood regulation and relaxation.2,4 Lower estrogen and progesterone levels can lead to increased anxiety, irritability, and feelings of stress, making it harder to unwind before bedtime.
3. Increased Risk of Sleep Disorders
Menopause doesn’t just cause sleep disturbances—it’s also associated with an increased risk of sleep disorders, including:
- Insomnia: Difficulty falling or staying asleep, often due to hormonal fluctuations, stress, and night sweats.
- Obstructive sleep apnea (OSA): Declining estrogen and progesterone levels may increase airway collapsibility, putting menopausal women at higher risk for sleep apnea, which causes snoring, gasping, and repeated awakenings throughout the night.5
- Restless leg syndrome (RLS): Some women experience an increase in leg discomfort and an uncontrollable urge to move their legs at night, further disrupting sleep.5
The presence of these sleep disorders means that simply addressing hot flashes is often not enough—comprehensive management is required.5,6
Strategies for Improving Sleep During Menopause
1. Manage Vasomotor Symptoms to Reduce Nighttime Awakenings
Since hot flashes and night sweats significantly disrupt sleep, reducing their frequency and intensity can help improve sleep continuity.
- Copaiba extract (beta-caryophyllene) & rhapontic rhubarb: This combination has been shown to work synergistically to reduce hot flashes, night sweats, sleep disturbances, and anxiety by up to 93%.7,8*
- Hormone therapy (HT): For women with moderate to severe symptoms, estrogen therapy (with or without progesterone) can help stabilize thermoregulation, reducing night sweats and improving sleep quality.9,10
- Cooling strategies: Keeping the bedroom cool, using moisture-wicking bedding, and wearing lightweight sleepwear can help manage temperature fluctuations.
2. Cognitive Behavioral Therapy for Insomnia (CBT-I)
CBT-I is the gold standard for treating chronic insomnia and is particularly effective for menopausal women.11 This therapy helps reframe negative thought patterns about sleep, reduces sleep-related anxiety, and establishes healthier sleep habits.11 Techniques include:
- Sleep restriction therapy (limiting time in bed to increase sleep efficiency).
- Stimulus control (associating the bed only with sleep and intimacy).
- Cognitive restructuring (challenging anxious thoughts about sleep).
3. Treat Underlying Sleep Disorders
If poor sleep is caused by a sleep disorder, it’s important to seek appropriate treatment:
- For sleep apnea: Women experiencing snoring, gasping for air, or excessive daytime fatigue should be evaluated for obstructive sleep apnea and consider CPAP therapy or other airway management solutions.6
- For restless leg syndrome: Addressing iron deficiency, magnesium levels, and dopamine function can help alleviate symptoms along with functional movement and stretching.6
4. Balance Mood and Stress for Better Sleep
Since anxiety and mood changes often accompany menopause, integrating stress-reduction techniques can help improve relaxation before bed:
- Mindfulness and meditation: Practicing deep breathing or guided meditation can reduce nighttime anxiety.
- Regular exercise: Physical activity, especially morning sunlight exposure and strength training, supports better sleep regulation.
- Herbal and nutrient support: Adaptogenic herbs like ashwagandha and calming nutrients like magnesium and L-theanine may help promote relaxation.*
5. Optimize Sleep Hygiene and Bedroom Environment
Simple environmental adjustments can make a significant difference in sleep quality:
- Keep the room dark, quiet, and cool (ideally around 65°F).
- Avoid screens and blue light exposure at least an hour before bedtime.
- Stick to a consistent sleep schedule to regulate circadian rhythms.
- Limit caffeine and alcohol intake, as both can exacerbate night sweats and sleep disturbances.
Final Thoughts
Menopausal sleep disturbances are influenced by more than just hot flashes—psychosocial stressors, hormonal changes, and sleep disorders all play a role in disrupting rest. Addressing vasomotor symptoms, improving sleep hygiene, managing mood fluctuations, and treating underlying sleep disorders is key to restoring healthy sleep patterns.
By combining evidence-based strategies—such as hormone therapy, CBT-I, targeted nutrients like rhapontic rhubarb and copaiba extract, and lifestyle modifications—women can regain restorative, high-quality sleep during the menopause transition. Prioritizing sleep not only improves energy, mood, and cognitive function but also supports long-term metabolic and cardiovascular health.
If sleep disturbances are affecting your quality of life, seeking personalized treatment from a healthcare provider can help identify the best approach for you.
References:
1. Coborn J et al. The Journal of Clinical Endocrinology and Metabolism. 2022;107(10):e4144-e4153.
2. Baker FC. The Journal of the International Menopause Society. 2023;26(3):198-205.
3. Salin SAE et al. Menopause (New York, N.Y.). 2023;30(11):1106-1113.
4. Chenji S et al. Maturitas. 2024;189:108111.
5. Zolfaghari S et al. Menopause (New York, N.Y.). 2020;27(3):295-304.
6. Caretto M et al. Maturitas. 2019;128:1-3.
7. Kaszkin-Bettag M et al. Alternative Therapies in Health and Medicine. 2008;14(6):32-38.
8. Heger M et al. Menopause (New York, N.Y.). 2006;13(5):744-59.
9. Pan Z et al. Menopause (New York, N.Y.). 2022;29(5):627-635.
10. Cintron D et al. Endocrine. 2017;55(3):702-711.
11. Qaseem A et al. Annals of Internal Medicine. 2016;165(2):125-133.
