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Menopause

Sleep and the menopause

Many women in midlife have difficulty sleeping and for those with moderate or severe sleeping problems it is likely that this will increase as they go through the menopause*. Women told us how menopausal symptoms affected their sleep, how they coped with less sleep, and what they did to get more sleep.

Menopausal symptoms and sleep disruption
Not everyone had a sleep problem. Some women didn’t worry about the occasional sleepless night or could function effectively on fewer than eight hours sleep. Others said they were good sleepers, who either slept through the night or got back to sleep even if they had hot sweats.

 

Marcia manages to sleep even though she has night sweats

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Age at interview: 46
Sex: Female
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Well they come when I’m sleeping and then I wake up and I’m like kind of drenched so I’ve been sweating so I’m drenched and or I might wake up and I feel really cold and that’s because I’ve been sweating and then you wake up you feel really cold. Yeah.

And what do you do about it?

I usually discover it just before I get up so it’s usually time to get up anyway, so I don’t really do much about it. But I noticed in the last four months that it’s becoming more frequent like every now and they used to come like every now again but just in the last four or five months I’ve started to notice that it’s like a couple of nights a week that I wake up feeling like that.

And does it affect your sleep?

No, no, no. I think that it occurs just before I wake up because although I think I’ve probably had a couple in the night but they’re not, it’s not to the state where I have to get up and strip the beds and things like that.

Many women, however, found it impossible to get a good night’s sleep during the menopause. Hot flushes and sweats are a major cause of sleep disruption (see ‘Hot flushes and night sweats’). Women talked about the ‘horrendous’ effect of hot sweats on their sleep, of sleeping fitfully and being woken up to a ‘dozen times a night’. Waking up feeling hot one minute, cooling down, dozing off to sleep only to be woken up again by a hot sweat can be a vicious sleep-wake-sleep-wake cycle. And after finally getting to sleep, women were woken all too soon by their alarm.

 

Rachel’s night sweats affected her sleep

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Age at interview: 51
Sex: Female
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Did you get them at night as well?

Yes I got them at night in bed.

How often at night did you get them?

During the night it could be two or three times in the night I had to get up and put the fan on.

And so were you sweating a lot as well?

Yeah.

Did you have to change your clothing or your bedding?

I’m a bit of a freak at night anyway. I’ve got a t shirt on and pyjamas and I jump into bed and if I got hot the pyjama top came off obviously I’ve got a t shirt on so if I felt hot that’s what I’d do. I’d get up and turn that on and take off the pyjama top which is only a nylon or cotton sort of thing. And put the fan on to cool down five or ten minutes and then go back to bed. But yeah, that would be a pattern in the night.

Did it have an impact on your sleep as a result of that?

Yes. Yeah. Because yeah I mean you’re working nine to five and you need a good night’s sleep and it certainly did make me feel erratic.

For women experiencing hot sweats, the night can be very active rather than a time of rest. Tossing and turning, throwing the covers off and on, looking for cool spots in the bed, changing night clothes and bedding, getting up to open the window or turn the heating down, putting the fan on, walking around, having a shower to cool off can all replace sleep. Some women slept in another room to get cooler or to protect their partner’s sleep.

 

Maureen describes a typical night’s sleep with hot flushes

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Age at interview: 59
Sex: Female
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Just kept waking up being really hot and throwing the blankets off me or the duvet off me. And was just lying there with my arms and legs spread eagled, trying to get every bit of me to have a bit of cool air somewhere, open the windows and hope the cool air’s going to hit me everywhere.

So that must have been quite difficult?

Yeah. And sort of tossing into a cooler place because I’ve got a double bed and of course I’m boiling hot there so I’d move over to a cooler part. And then when that’s hot try and move to another cooler part. Yeah.

How many flushes were you having a night, how often was it happening?

Well it does seem to go on. It didn’t seem to start and stop, it just seemed to go on. Like I’d wake up and I’d be having a hot flush and I’d go to sleep and then I’d wake and I’d still be having a hot flush, that’s how it seemed at the time.

Other symptoms can also influence sleep during the menopause. Heavy bleeding, heart palpitations, restless legs (a condition that causes uncomfortable sensations in the legs); getting up to pee, anxiety and emotional turmoil are also disruptive (see section on ‘Symptoms’). Some women slept poorly just before a period was due. In others their sleep was affected most nights, even after the periods had stopped and symptoms eased.

 

‘Inner turmoil’ as well as night sweats affected Margaret’s sleep for many years

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Age at interview: 59
Sex: Female
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I think the biggest problem of all through the menopause was lack of sleep. A combination of night sweats, my own particular emotional turmoils but I was very badly lacking sleep. For quite a long time. One of my friends said, “Now you know what it’s like having a new baby in the house.” That’s what it really was. For about eight years I suppose I didn’t have an uninterrupted night’s sleep. And funnily enough it started again after I had those big operations, and I don’t know if it’s the anaesthetic but actually I don’t sleep at the moment as well as I would like. My definition of a good night’s sleep is nine hours unconscious.

It’s often hard to say what disrupts sleep. The menopause is not always to blame. Sleep may also be disturbed by worries and concerns about family and work; by illness, pain and medication; by partners and children; and by the environment (see ‘Family, health and life events’ and Relationships, sex and contraception’). Poor sleep patterns which start earlier in life, for example while bringing up children, may continue through the menopause. Ageing can also influence the quality and quantity of sleep; many people feel they need less sleep as they get older (see ‘Getting older’).

 

Denise wakes at 3am and cannot get back to sleep, partly because she worries about her teenage sons

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Age at interview: 53
Sex: Female
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No, I mean people say, “Oh having children ruins your sleep pattern.” I’m not sure if it’s true or not but I mean I can look with envy at my elder sons sleeping from whenever they go to bed to solidly through to whatever time they may choose to be woken up really. And I can remember sleeping right through to eight, nine, ten, eleven in the morning and I just wouldn’t know what that is now. And I would love to experience it again but don’t. I would tend to go to bed quite early because I’m very tired in the evenings probably because I’m awake then at three in the morning, and will lie there until four or five and then I would sleep a couple of hours quite happily, unfortunately have to get up for work about half six. But I can’t get out of that sleep pattern so whether it’s a case of getting older, whether it’s something to do with the menopause, I’m not sure of that but my sleep patterns certainly have been disrupted. And haven’t returned to what I would consider normal. And I would be a light sleeper as well, not helped of course by teenage boys coming in a little bit later than normal now and out on their own and driving.

Effects of poor sleep
Women who suffered from lack of sleep said it affected almost everything. They felt tired, ‘comatosed’, irritable, snappy, and tearful. Unable to concentrate, focus or think clearly, some struggled to cope with the demands of a busy job and family life. Energy can be further sapped as women try to prioritise tasks and keep on good terms with staff, colleagues, partners and children (see ‘Work’). Unsurprisingly by the end of the day they feel stressed and worn out. For some women, tiredness becomes part of life.

 

Carole feels ‘absolutely shattered’ after waking up 5-6 times a night

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Age at interview: 51
Sex: Female
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We were talking about hot flushes. What effect did that have on your sleep?

Oh, horrendous. I mean it’s like being woken up five, six times a night from a deep sleep and of course then every time you woke up you wanted to spend a penny so you’re taking trips to the toilet as well. And then you’d go back to sleep, or try and get back to sleep once you’d cooled down. It’s just so, excuse the expression, but knackering, absolutely shattered, you’d wake up in the morning and feeling like you’d had a night on the tiles. You’d wake up with a fuzzy head, no energy, everything was an effort you’d, even now, I still get tired but it’s not through night sweats that’s just through the menopause in general, HRT can only do so much, it can’t deal with everything, but it’s just so very very tiring. The night sweats you just don’t want to be woken up at night. If I get six hours sleep it’s rare, but then I catch up at the weekends.

 

Sandra’s poor sleep affects her daily life

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Age at interview: 47
Sex: Female
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Well I’d go to bed fairly early and it’s probably in the back of my mind am I going to have one tonight, if I do am I going to wake up and all this. So I’d go off to sleep fine but I was fine I was waking up at certain times without even having the hot flushes. I got myself into a routine expecting to have one and of course once you’re in that circle it’s very difficult to break, but then when I do have one and it does wake me up I then lie there thinking am I going to have another one; is it going to come on soon; am I just going to drop off to sleep; then I’ll have another one; then I look at the time; then I’m thinking I’ve got to get up soon and it’s like a circle. You don’t seem to be able to get, well I don’t seem to be able to get back to sleep. And then just as I do drop off it’s time to get up. And of course that’s when I’m really tired. And doing the sort of work that I do I can’t really afford to be tired because it's figure work and then some of the companies that I go to are quite a distance to drive to so there’s that element as well. I haven’t as yet lost my temper with anyone I think or got cross or anything. I’ll probably get a bit cross when I get home but that’s with myself, cross because I haven’t been able to perhaps work as quick as I would like to but then I’m thinking as you get older you slow down anyway.

Ways of getting more sleep
As well as trying to minimise the effects of hot sweats (see ‘Hot flushes and night sweats’), women had used a range of approaches to improve their sleep, with varying success. These included going to bed early, having an afternoon nap, catching up with sleep at the weekend, sleeping in the spare bedroom, having separate duvets, taking regular exercise, and cutting down on coffee, alcohol and spicy foods (see ‘Non-HRT and lifestyle options’). Relaxation and visualisation techniques also helped. But everyone’s circumstances are different; what works for some women may not work for others.

 

Visualisation helped Rhonda to calm her hot flushes so she could get back to sleep

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Age at interview: 46
Sex: Female
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One of my other coping mechanisms was visualisation as well especially at night. I would visualise myself in a lovely beautiful blue sea somewhere on holiday. I’d be laying on the beach, with this, and this hot flush would come over me and I’d run in the water, lots of cold water and that’s what I visualise. And then just try and relax myself and to get through it and I actually found it worked for me. But I actually don’t do that as often now which I think is telling me now they have died down, they’re not as aggressive, unless I’ve had over the Christmas period where I have over indulged in things that perhaps I wouldn’t normally eat, I have drunk more. And then for a week after or so I don’t sleep very well. I’m not a good sleeper, since this I’m not a good sleeper and the hot flushes will wake me up. And I know enough’s enough and I give myself a break for a week or so and then I do start sleeping better and I’m not waking up with hot flushes as bad. So I do know there’s trigger points and hot spicy food, I love curries, hot spicy food is a trigger point as well for me.

 

Rose’s sleep improved when she went to bed early and drank less red wine

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Age at interview: 50
Sex: Female
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And again the tiredness I’ve learnt that I have to go to bed by 10 o’clock at night. I used to stay up till eleven, eleven thirty, twelve o’clock. I used to be back up at six in the morning. Now I have to make sure I’m in bed by ten at night and I don’t get up until about quarter to seven in the morning. I have to make sure, even if I’m not getting eight hours sleep, because I don’t even now, I probably function on about six hours sleep, but I’m getting the rest. It’s listening to what my body needs and responding in the right way.

So your sleep has improved on what it was at its worst?

Yes, the fact that I get far fewer hot flushes now I’ll perhaps just get one or two a night and they’re less severe. Sometimes I can even sleep through them. I now get about five to six hours sleep a night which is fine for me I can function on that. It was when it went down to about two, three, four hours a night that I couldn’t function.

And I actually, the reality is the more red wine I drink the more hot flushes I get, the worse my sleep pattern is. I try now and have at least three if not four nights a week where I have no alcohol and it pains me to say it but I sleep better and the hot flushes are reduced.

 
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Joyce tried breathing and relaxation techniques

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Age at interview: 48
Sex: Female
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The other thing I found was I couldn’t sleep. I’d be really tired and I’d get to sleep, but I’d then wake up again in the middle of the night, with my mind churning, and then fretting about what I couldn’t remember. Because things I hadn’t been able to remember during the day would then come back, so, it wasn’t that the memory chip was completely dead, but they’d come back at the most inopportune moments. And I find that once I’m awake, I’m awake. And I practise relaxation techniques so that when I woke up in the night and the world was either churning or I was remembering something which I’d struggled to remember earlier on, I’d unpack it, I’d practise the relaxation and the breathing techniques which I’d practised at yoga because by now I was starting to take up some classes at the gym to try and improve my well-being. But none of that worked and it was interesting because I’ve always needed eight hours sleep, but gradually I was finding that in fact I wasn’t needing eight hours sleep. And if I only got five, yes I’d feel tired during the day, but I was actually able to function. So a noticeable change was this inability to stay asleep for long periods of time, what I would consider a reasonable time for me, but in fact it wasn’t having a majorly detrimental effect on me. No more than I suppose I take tiredness as a fact of life.

Some women bought herbal remedies and over-the-counter products such as valerian, Kalms and Nytol to try to improve sleep. Though at first encouraging, they did not always work long-term (see ‘Complementary therapies’).
 

Anne tried various products to improve her sleep. She found Menopause Plus the most helpful

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Age at interview: 58
Sex: Female
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Yeah, well I mean I’ve always been a good sleeper and I just went through patches where I would not sleep or maybe get a couple of hours a night and wake up. I would always eventually fall asleep in the morning and then wake up feeling absolutely dreadful, really sort of trembly because I’d had so little sleep. And if we went away it would be, holidays would be ruined in a way because I felt so tired but I found if I exercised then I felt better. So I had a friend who was very keen on walking so I used to go walking quite a lot. And I found that helped so if I did something first thing in the morning I actually felt better for the rest of the day.

But I have tried lots of things. I’ve tried Nytol Herbal and there are some other herbal things. I didn’t particularly want to take sleeping tablets but then I started taking these Menopause Plus* and I’ve found they’ve really helped.

What made you choose them?

Well, they’ve got isoflavones in so I thought maybe it was the lack of oestrogen that was causing it. So I thought I’d try them. I think I was getting desperate. I was going, I’d have tried anything. So and they’ve really helped.

How often do you take them?


Once a day.

And you’ve been on them for?

Since August. So now I get, I mean I don’t get an uninterrupted night’s sleep but I always go back to sleep if I wake up, so I wake up with a hot flush and go straight back to sleep.

(*Note' Available over-the-counter, Menopause Plus is a mixture of seven different herbal preparations.)

Other women, desperate to relieve symptoms and get a good night’s sleep, turned to prescription medication, including antidepressants to reduce depression and anxiety, HRT to ease hot flushes, and sleeping pills such as temazepam (see ‘Hormone replacement therapy (HRT)’). When used short-term, these medications may help restore sleeping patterns. However, women are advised to seek advice from their GP about the risks and possible side effects before taking any medication.
 

Maggie uses sleeping pills sparingly to relieve her insomnia

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Age at interview: 49
Sex: Female
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And you mentioned the insomnia as being a bit of a problem for you. How often did that happen? Was there any pattern to that?

It’s still happening now, and it’s only got a pattern in the sense that I very rarely get a good night, a whole night’s sleep. So sometimes I’ll drop off no trouble at all and I’ll wake up at one or four or five, just a bit too early, and other times I just can’t drop off and I finally will drop off and then I’ll sleep very heavily until morning. Yeah. I mean I have tried various things for that, some of which worked, but not consistently, all the time.

Was there any link between waking up and the hot flushes?

Yeah, at first, I mean I don’t really have any hot flushes now, but definitely at first, I think that’s what got me into a pattern of waking up was feeling this heat and that was the thing that woke me up.

Yeah. I’ve used lots of different things, I’ve used valerian, in tincture and capsules. And they worked really well for a short time, then they seemed to not work. And they also worked really well for getting off to sleep, but not so good for when I wake up in the middle of the night and can’t get back to sleep. And I tried melatonin which again seemed to work fairly well for a while, and in amongst that period I was doing some night shifts and I was just not sleeping in the day, and I got a bit desperate so I went to the GP and the GP gave me temazepam. So I get thirty from him about every five months and I use them sort of very sparingly really, I take a half when I really need to, if I feel like I have to sleep otherwise I won’t be able to work the next day.

Some women continue to be troubled by poor sleep throughout the menopause and into later life (see our Healthtalk website on ‘Sleep problems in later life’). For others, disruption is short-lived with sleep patterns returning to normal once symptoms ease. The importance of good sleep cannot be underestimated. As one woman observes, ‘Sleep is highly underrated in my book. As soon as you sleep you just feel human again’.

*Ellen W. Freeman, PhD, research professor in the department of Obstetrics and Gynecology at the Perelman School of Medicine at the University of Pennsylvania.

 

Last reviewed July 2018.
Last updated February 2015.
 

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