The Ultimate Guide to Sleep in Menopause

Transform your sleep with actionable steps designed for women in the menopause transition.

One in two women aged 40–59 wake up feeling tired. More than half of them sleep less than seven hours.

I believe that sleep deprivation is the most critical modern epidemic today.

We know that sleep disorders are associated with many chronic health conditions. And women tend to suffer more from it than men. In fact, almost every woman I see in my Menopause clinic has some issues with their sleep.

Sleep sounds easy. But with so many tasks and distractions fighting for our attention, it became a challenge to most of us, especially with the added hormonal changes in menopause.

My previous article discussed why sleep matters and how menopause affects it. Here's a hint if you still need to read it — it affects women's sleep a lot, and not in a good way. Some perimenopausal symptoms can start as early as in our 30s, so don't think this article is relevant just later in your life.

Knowledge empowers us to make a change and can help fuel our motivation.

But just knowing is not enough, and today, we will dive deep into the practical tools to improve your sleep during the menopause transition.

There is a lot here. You might feel overwhelmed, especially if you didn't sleep well last night. So take your time to read it and choose to implement two to three small things first.

Small, consistent steps lead to big goals. And if you're reading this, you're ready for change. So, let's start.

Assess If You're Getting Enough Sleep

Are you trying to sleep longer on the weekends to catch up on sleep? Would you sleep past your alarm if it didn't go off? Do you feel like you need a nap before noon and cannot function without coffee? Do you fall asleep easily watching TV when you didn't intend to?

If you answered "Yes" to any of these questions, chances are you're not getting enough sleep, or the quality of your sleep is poor.

The best validated questionnaire to assess your long-term sleep is the Pittsburgh Sleep Quality Index. It can be enough to convince my patients to take their sleep seriously.

Another way to assess your sleep is via various sleep trackers. Smartwatches, rings and even special mattress covers can give valuable insight into your sleep quality and help you find where to put your attention first.

However, for some, poor sleep scores can add to stress. For others, it might feel like being watched by a night owl. Consider taking a "sleep tracker holiday" every few months.

One simple option to improve your sleep is to keep a journal where you record your bedtime, wake-up time, and how well you slept. By tracking your sleep patterns for a short period, you can evaluate which methods you have tried are effective.

Set Yourself Up For Success With Routines, Habits and Sunlight

While it's a time of change, you can navigate menopause more comfortably with simple lifestyle adjustments and regular routines.

Your body likes a rhythm not only on the dance floor.

Morning Routine: Sets the tone for the rest of your day and night

• Aim to wake up at the same time, even on the weekends. Sunday lie-ins might sound tempting but can disrupt your sleep cycle, delaying melatonin production. Remember, there's no "quick fix" for sleep debt!
• Get morning sunlight outside within the first hour of waking. It sets your body to release melatonin 16 hours later, just in time for sleep. Five to ten minutes is enough on a sunny day, 20–30 minutes on a cloudy one. Don't wear sunglasses, but no need to look directly at the sun. If it's dark when you get up, you can use bright LED light devices at home.
• Create a similar routine each morning to set yourself up for the day. It can be walking, stretching, having a few mindful minutes, or anything else that signals your body that you are starting your day.

Evening Routine: Create a wind-down ritual

• You have an alarm for your morning. Sleep scientist Dr Matt Walker advises setting it up for bedtime, too. Rewire your brain and give your body a clear signal that it's time to rest.
• Dedicate at least 30 minutes to unwind before bedtime. You can read, journal, listen to soothing music or meditate.
• Try a hot bath with essential oils to relax. It helps to reduce your core body's temperature, which helps with falling asleep.
• If you wake up at night and find it hard, go back to sleep within 20 minutes, get out of bed and move to another room. Do something calming, and return to bed once you start feeling drowsy. Rewire your brain that bed is just for actual sleeping.

Exercise Regularly

• Exercise is the last thing on your to-do list when you're tired and sleep-deprived. However, many studies have shown that regular exercise improves sleep, duration, and quality. And if you take your exercise outside, exposing yourself to sunlight helps to regulate your body's clock.
• Avoid vigorous activity two to three hours before bedtime, as this raises your body's temperature and disrupts sleep.
• Any amount of exercise is better than none at all. Even if it's for five minutes.

Watch When You Eat

• Avoid large meals two to three hours before bedtime, as digestion slows down. Eat a protein-dense dinner for stable energy levels during the night.
• Avoid excessive water intake to reduce night trips to the bathroom.
• No coffee or caffeinated drinks after 12-1 pm. It takes your body about eight to ten hours to clear caffeine from your body. Even if you think you can fall asleep after a cup of coffee, it still affects the quality of your sleep.
• Reduce or completely eliminate alcohol before bed. Even one or two glasses disrupt both your sleep quality and quantity. It induces micro-awakenings at night, even if you don't remember them. You lose most restorative deep sleep and wake up fatigued the following day.
• Nicotine also acts as a stimulant ****and should be avoided. Moreover, both alcohol and nicotine worsen menopausal symptoms like hot flashes and night sweats.

Screens and Blue Lights

• I often see guilty looks when I ask about this one. For some, scrolling on the phone equals 'relaxing' time. Screens emit blue light that interferes with your sleep hormones. Steer clear of TVs, computers, and phones before bed.
• Avoid screens one hour before bedtime, and progressively dim the lights in the house, too. A red-filtered light bulb can reduce sleep inhibition, so use it in the evening or when you need to get up at night.
• Blue-blocking glasses can help reduce the disturbance caused by screens. However, the information that comes from them affects sleep even more. Watching news, checking email or doing work before bedtime stimulates your brain and makes you more likely to wake up with anxious thoughts.

Keep it Cool, Dark and Comfortable

• Maintain a comfortable, cool bedroom temperature (around 18°C) for better sleep quality, especially if you get hot flashes.
• Lightweight pyjamas, moisture-absorbing sleepwear (or sportswear), and breathable bedding can help.
• If you get night sweats, you can have a damp cloth nearby for easy access. It's always a good idea to keep a spare blanket in case your current one gets wet. Additionally, having a fan in the room can help keep you cool and comfortable.
• A bedroom should be as dark as a cave. If it's difficult to achieve this, consider using an eye mask. For me personally, this made a huge difference.

Remember, menopause is a cycle. Stay committed to your routine, and you'll notice improvements in your sleep quality within a few days.

Should You Nap or Not?

As the questions suggest, there are two opinions.

Naps can definitely make up for some lost sleep. And, in general, a short nap (less than 30–45 minutes) before 3pm should not affect your sleep.

However, if you have true insomnia, you shouldn't be napping. Building sleep pressure during the day helps you sleep better at night.

There is one other option you could choose instead of napping, and my patients love it.

I'm talking about a relaxation technique called **NSDR (non-sleep deep rest)** or its cousin, Yoga Nidra (aka sleep yoga). For some, this technique restores energy more effectively than a nap and can replace lost sleep as well.

NSDR not only improves sleep but also creates new brain connections and improves memory and cognitive function. It helps with more profound relaxation, stress reduction and even pain management.

You can do it before sleep or if you wake up in the middle of the night.

As with most practices, it will take some time and a regular routine to get the full benefits of NSDR.

Replacing Your Hormones

We know that improving estrogen, progesterone, and (if needed) testosterone levels helps many women get better sleep quality and duration.

For example, vaginal estrogen cream can help with frequent bathroom trips due to dryness and bladder sensitivity which often disrupt sleep. This is a safe and effective solution for women at any stage of menopause.

On the other hand, I often see quick, dramatic, and positive changes in overall sleep quality after women start systemic hormone replacement therapy (HRT).

HRT might not be suitable for all. But, regardless of medical background, you deserve a conversation with your health care provider if you're considering this option.

If you're worried about cancer risk, a comprehensive analysis of multiple studies with nearly a half million participants showed that sleep deprivation significantly increased breast cancer risk. And we're not even talking about other health-related issues caused by sleep issues.

Why Am I Keep Waking Up In The Middle Of The Night, and What To Do About It?

This is one of the more frequent questions I get. Many women tell me that falling asleep is not the issue. But staying asleep is. It's so common that it deserves its own paragraph.

First of all, it is absolutely normal to wake once or twice at night. We get a natural spike in stress hormones around 3–4 am. Or we just need to go to pee. The problem comes if we cannot get back to sleep after.

In this case, anxiety and stress hormone imbalance usually are the main culprits. During menopause, they can even cause night hunger cravings, which you may have never had before.

There is no quick fix, but it definitely can be tamed.

You will need a daily plan you can follow for at least a month before you see a significant improvement, especially if you live a stressful life.

Start with a daily breathwork routine or vagus nerve stimulation techniques. This can be 25 rounds of deep breathing before you leave bed in the morning.

A new study from Stanford Medicine showed that a daily five-minute practice of cyclical sighing done for 1 month significantly improved mood and reduced anxiety more than mindfulness meditation. You inhale deeply through your nose, inhale a bit more on top, and then focus on a slow exhale through your mouth.

Inhale-inhale-slow exhale-repeat.

Where can you find an extra five minutes every day?

Sleep Medications Are Not Giving You Natural Sleep

In 2020, **[one in ten](https://www.cdc.gov/nchs/products/databriefs/db462.htm#:~:text=Key findings-,Data from the National Health Interview Survey,generally increased with increasing age.)** women in the US took sleep medication in the last 30 days.

None of the sleep medications (old or new) on the market can induce natural sleep. Instead of enhancing your sleep, they only sedate you. They knock you similarly to how alcohol does. They also have many side effects and can be highly addictive.

According to longevity expert Peter Atia MD, "They can induce unconsciousness, but so could Muhammad Ali's right cross."

Sleeping pills are detrimental to your health and increase the risk of various health problems. They can be helpful for the short term while you address the underlying problems, but your doctor should have a clear plan on how and when to stop them and what to do instead.

If you're taking sleep medication, I do not suggest stopping it immediately. This can cause rebound insomnia, and your sleep might be even worse than before. Please talk to your health care provider and make a plan to taper them off over time.

Try This Instead: CBT-I

No, it's not a code name for a new Netflix series.

Cognitive behavioural therapy for insomnia, or CBT-I, helps you break bad sleep habits, teaches you how to cope with anxiety around it and improves confidence in your ability to sleep.

You'll work with a therapist for a few weeks to develop an individual plan to create new habits, learn relaxation techniques and restructure your thoughts.

Numerous studies show that CBT-I is more effective than sleep medications. This first-line treatment, suggested by the British Menopause Society and the National Institute for Health, offers long-term benefits. The same can't be said about the sleeping pills.

There are also many online resources which can guide you through the process. You can start at the National Sleep Foundation website or one of the many new apps for CBT-I.

And let me be clear. If your doctor does not offer (or at least discuss) CBT-I before prescribing you sleeping pills, you need a new doctor.

A Quick Note on Supplements

Supplements are always a hot topic. But they are just a small part of the sleep solution.

Supplements can be both a help and a harm, depending on what you take and what other medications you are on.

First, focus on your routine and lifestyle changes, and we will look at supplements more in-depth in a future story.

If Your Sleep Deprivation is Severe, Consult a Doctor

Did you try everything and still find yourself grappling with severe sleep deprivation?

In this case, seeking guidance from a medical professional is crucial. This is particularly important if you suspect you may be dealing with conditions like insomnia or sleep apnea.

If you take medications for other health problems, such as high blood pressure or asthma, be aware that some can impact your sleep patterns. Consult your health care provider about adjusting the timing of them.

Don't hesitate to seek help. As a professor of sleep science, Russel Foster said- "The best bridge between despair and hope is a good night's sleep."

Control What You Can and Let Go of the Rest

I know life can be unpredictable. There are some late-night celebrations or days when things just didn't go as planned. We all get them.

More than half of women going through menopause struggle with sleep at some point. So, on those restless nights, know you're not alone. Instead of watching the clock, reflect on the joys in life or breathe deeply. We're not seeking perfection — just harmony.

Aim for balance, and try sticking to your routine at least 80% of the time.

However, it's always helpful to have a clear action plan in place. So, write in the comments what you will change in your routine today, and let me know if you have any other questions! Sleep is the key to our vitality and a topic worth exploring more.

Please also share what has worked for you in the past. We can all learn from each other! And make sure to save this article for the future in case you're having a bit of a brain fog today. More on which in my future stories!

Medical Disclaimer: This article is for general information and education purposes only. It's important to consult your healthcare provider for personalised advice related to your sleep and health.