Menopause and Sleep Disruption

Sleep disturbance during menopause is a common and important complaint faced by many women. There are many factors that may play a role in this problem, including vasomotor symptoms and changing hormone levels, circadian rhythm abnormalities, exacerbation of primary insomnia, mood disorders, coexistent medical conditions, lifestyle factors and an increased risk in developing primary sleep disorders including sleep disordered breathing. Vasomotor symptoms, such as hot flashes and night sweats, occur in 60–80% of women during the menopause transition and persist, on average, for 4–5 years. Vasomotor symptoms have been associated with cortical arousals and disruption of sleep architecture, such as reduced sleep efficiency, increased nocturnal awakenings and changes in sleep stages. The Study of Women's Health Across the Nation study, with a population of 12,600 women found two times greater odds for sleep problems in women with vasomotor symptoms compared with asymptomatic women. Women reported trouble falling asleep, frequent awakenings during the night and early morning awakenings.

There are many medical and physical disorders that may aggravate or cause sleep problems during menopause. Primary sleep disorders, such as sleep disordered breathing (SDB), restless legs syndrome (RLS) or periodic limb movement disorder (PLMD), as well as other medical conditions may coincide with menopause. For example, The Wisconsin Sleep Cohort Study showed the prevalence of SDB is increased threefold in women following the menopausal transition, and the risk of sleep apnea after menopause is equivalent to men. This may be due to the protective effects of sex hormones prior to menopause as well as changes in fat distribution that occur during this period. Lifestyle factors, such as poor sleep hygiene (irregular schedules, insufficient sleep and napping), as well as food (caffeine, excessive alcohol) and environmental disturbance (snoring partners etc.), may also exacerbate sleep disturbances during this transition in a woman’s life.