Introduction 

I've heard dozens of stories about menopause insomnia. I understand insomnia to some degree. I've struggled with it for the past few years. But it's nothing like what I hear from women in menopause.

The night before last, I woke up and looked at my watch, feeling immediate anxiety. It was 3:25AM. I thought to myself, "Am I gonna be able to get back to sleep?"

The answer for me was . . . "NO!"

I finally gave up at around 5:30AM, after tossing and turning, listening to a soothing podcast, trying 10 different sleeping positions, going to the bathroom and just lying there, trying not to stress.

Menopause insomnia sleep problems YouTube comment

Because I get so many emails, chat messages, comments on my YouTube videos about sleep and insomnia and daytime fatigue and brain fog . . .

This is a comprehensive post that can really help YOU . . . especially if you're one of those women who are struggling with menopause insomnia.

I feel your pain because I've experienced a small sample of what you're going through.

Menopause Insomnia sleep deprivation YouTube comment

This post is divided into 2 major sections. The first is where I go over 10 Practical Steps you can take to optimize your sleep.

10 Practical Sleep Tips

These are 10 things I've found in my extensive research about insomnia in general and, especially, about Menopause Insomnia.

I've incorporated a lot of these strategies and tactics into my own sleep hygiene and they may be helpful for you as you work to improve your sleep during menopause.

Hormone Optimization

The second part of this blog post is all about hormones . . . of COURSE!

Once you've implemented all the practical sleep-enhancing tips, you may still find yourself struggling.

With Menopause Insomnia, there's a huge hormonal component to the loss of sleep that comes after you go into menopause. We'll take a very close look at several ways hormone optimization can make a big difference in the way you sleep.

Let's get started on the journey to better sleep and feeling like yourself again!

Section 1: Understanding Menopause Insomnia

What is Menopause Insomnia?

Menopause insomnia refers to the chronic difficulty in falling asleep, staying asleep, or experiencing restful sleep during menopause. This condition is primarily driven by hormonal fluctuations, particularly the decline in estrogen and progesterone levels. These hormonal changes can alter sleep patterns, making it challenging for women to get the restorative sleep they need.

How Common is Menopause Insomnia?

Menopause insomnia is remarkably common. Studies estimate that up to 60% of women experience sleep disturbances during menopause. This high prevalence underscores the need for effective management strategies to help women navigate this challenging phase of life.

Symptoms and Impact on Daily Life

The symptoms of menopause insomnia can vary, but they often include difficulty falling asleep, frequent nighttime awakenings, waking up too early, and feeling unrefreshed after sleep. These sleep disruptions can have a profound impact on daily life, leading to:

  • Daytime fatigue
  • Difficulty concentrating - aka Menopause Brain Fog
  • Mood swings
  • Increased stress and anxiety
  • Reduced overall quality of life

I get messages almost every day from women struggling with their sleep:

  • Elizabeth emailed me, "The sleep problem is the one that causes me the most trouble. I can't go on like this."
  • Police detective Amanda says, "I need help with SLEEP!!! I am a Detective and need to focus on my job!!! I seem to be losing focus from being so exhausted from NOT sleeping!!!!"
  • Cathy says, "All my menopausal symptoms have returned and I (may) sleep a couple hours a night or 3 hours with a sleeping pill."
  • Malabika told me, "My menopause symptoms are as bad as can get. Say a 10. Insomnia is the most traumatic and troublesome for me. I sleep about 2/3 hours every night. For years. My eyes are burning in the morning, I am tired, don’t feel like getting out of bed, resting heart rate was always high in the night, drenched in sweat at 2-2:30 AM."
  • Ela told me, "I slept about 2 hrs max 3 a night. Because . . . night sweats or just not falling asleep. I took 6 mg of Melatonin but didn't help. Since 2018 when I had those horrible night sweats I have tried everything natural possible to sleep, including CBD oil, valerian root, THC oil mixed with CBD oil. Nothing worked."

In the next section, we'll dive into practical tips that can help manage menopause insomnia. These strategies are designed to give your body and brain the best chance to get a good night's sleep, setting the stage for a more restful and restorative night.

Section 2: Practical Tips for Managing Menopause Insomnia

Managing menopause insomnia can be challenging, but implementing practical strategies can significantly improve your sleep quality. Several of these tips are distilled from conversations between neuroscientist Dr. Andrew Huberman and sleep expert Dr. Matthew Walker. Here are 10 practical tips to help you get a good night's sleep and manage menopause insomnia effectively.

1. Early to Bed, Early to Rise - Managing Menopause Sleep Issues

Going to bed and waking up at the same time every day can help regulate your body’s internal clock. Consistency in your sleep schedule reinforces your body’s sleep-wake cycle, making it easier to fall asleep and wake up refreshed.

2. Here Comes the Sun - Light Exposure for Better Sleep

Low-angle sunlight early in the morning and late in the evening can help reset your circadian rhythms. Exposure to natural light during these times helps signal to your brain when it’s time to be awake and when it’s time to sleep. Never look directly at the sun but going without sunglasses is helpful for this tip. Contact lenses or prescription glasses are OK.

3. Block the Blue (Light) for Better Sleep Quality

Avoid screens like TVs, phones, and tablets, especially within about an hour of bedtime. The blue light emitted by these devices can interfere with your body’s production of melatonin, a hormone that regulates sleep. Blue blocker glasses can reduce the impact of blue light on your eyes and your sleep. If you must look at a screen late at night, these may help. But be sure to dim all the lights as you get closer to bedtime.

4. Coffee (and Cocktail) Break - Limit Stimulants

Avoid caffeine within 10 hours of bedtime and limit alcohol intake. If you have a glass of wine or a cocktail, make it earlier, before dinner. Both caffeine and alcohol can disrupt your sleep cycle, make it harder to stay asleep through the night, and generally give you a poorer night's sleep.

5. Don't Forget to Breathe - Relaxation Techniques

Calm your mind with deep breathing exercises, meditation, or gentle yoga. Long, slow, deep breaths have been shown to stimulate the Vagus nerve, which can slow your heart rate and help you relax. These relaxation techniques can help reduce stress and anxiety, making it easier to fall asleep and stay asleep.

6. Bust A Move - Exercise for Better Sleep

30 minutes of moderate exercise every day can help improve your sleep quality. Regular physical activity can help you fall asleep faster and enjoy deeper sleep. Just be sure to finish exercising at least a few hours before bedtime to avoid being too energized to sleep.

7. No European (i.e., 10:00 PM) Dining

Avoid eating any food, especially sugar and carbohydrates, within 3 hours of bedtime. Increasing blood glucose within this time frame can make you more prone to insulin resistance and can disrupt your sleep. Research has clearly shown that increasing your blood glucose near bedtime can make you more prone to insulin resistance and type 2 diabetes. When your system is busy working to burn glucose, it has fewer resources to devote to shutting down and going to sleep. Try to finish eating before 7:00PM if you plan to go to sleep around 10:00. Stay away from late-night refrigerator raids for ice cream or leftovers.

8. Manage Stress for Better Sleep

Find healthy ways to manage stress, such as walking around the block, calling a friend just to check in, or listening to some of your favorite, calming music. Chronic stress can interfere with your sleep, so it’s important to find effective strategies to cope with stress.

9. Supplements Proven to Improve Sleep

Evidence supports several supplements that help you relax and sleep better. These supplements can promote relaxation and improve sleep quality. However, it’s essential to consult your healthcare provider before starting any new supplements to ensure they’re safe and appropriate for you.

10. Relaxation, Rest, and Relationship - Optimize Your Sleep Environment

Make your bedroom a cool, relaxing sanctuary reserved for sleep and sex. Get rid of TVs, phones, tablets, and other electronic distractions - even digital alarm clocks. The bedroom is a great place for real paper books. Reading before bed helps you unwind and get sleepy. As much as you can, make sure the temperature in your bedroom is on the cool side. When your body cools down, you're more likely to experience restful sleep. Keep the lights low and darken your bedroom with a blackout shade if you can.

By implementing these practical tips, you can improve your sleep quality and manage menopause insomnia more effectively. In the next section, we’ll delve into how optimizing your hormone levels can further enhance your sleep quality and help you get the rest you need.

Section 3: Hormonal Changes and Sleep Disruption

How Hormones Affect Menopause Insomnia

Menopause marks a significant decline in the levels of key hormones, particularly estrogen and progesterone. These hormonal changes disrupt the body's natural processes, leading to various symptoms, including sleep disturbances.

  • Estrogen: This hormone helps regulate your sleep-wake cycle by maintaining the production of serotonin, a neurotransmitter that promotes sleep. As estrogen levels decline, you may experience more frequent awakenings and lighter sleep.
  • Progesterone: Often referred to as the body’s natural sedative, progesterone has a calming effect that helps you relax and fall asleep. Declining levels of progesterone can lead to difficulty falling and staying asleep.
  • Testosterone: Although typically associated with male health, testosterone also plays a crucial role in women's health. Optimal testosterone levels contribute to better sleep quality by influencing mood, energy levels, and overall well-being.

How Estrogen, Progesterone, and Testosterone Levels Affect Sleep

Estrogen's Role in Sleep Regulation

Research has shown that women with optimal estrogen levels experience fewer disruptions during sleep and better overall sleep quality. Additionally, estrogen can help reduce the frequency and intensity of hot flashes and night sweats, which are common disruptors of sleep during menopause.

Progesterone: The Natural Sedative

Progesterone’s calming effect helps you relax and drift off to sleep. It interacts with GABA receptors in the brain, promoting a sense of calm and reducing anxiety. This is particularly beneficial if you find your mind racing at bedtime. Studies have demonstrated that optimal progesterone levels can help you fall asleep faster and stay asleep longer. A woman named DF emailed me about progesterone, saying "Can’t do without it. Makes all the difference in my sleep."

Testosterone's Impact on Sleep Quality

Testosterone contributes to better sleep quality by enhancing mood, energy levels, and overall well-being. Low testosterone levels are linked to fatigue and sleep disturbances, exacerbating insomnia during menopause. Optimal testosterone levels can reduce the fatigue and energy dips that often interfere with sleep, helping you wake up feeling refreshed and energized.

Systematic Review

A systematic review titled "Associations between sex hormones, sleep problems and depression: A systematic review" highlights the complex relationship between hormonal changes and sleep disturbances during menopause. The review emphasizes that:

  • Hormonal Imbalances: Fluctuations in estrogen, progesterone, and testosterone are closely linked to sleep problems and mood disorders during menopause.
  • Sleep Architecture: Changes in sex hormones can alter sleep architecture, leading to fragmented and less restorative sleep.
  • Depression and Anxiety: Hormonal deficiencies can contribute to depression and anxiety, which further exacerbate sleep issues.

These findings underscore the importance of addressing hormonal imbalances to improve sleep quality and overall well-being during menopause.

Section 4: The Role of Hormone Optimization in Improving Sleep

HRT for Sleep: Optimizing Hormones to Combat Menopause Insomnia

If you've tried all the practical tips and still find yourself battling menopause insomnia, it's time to take a closer look at hormone optimization. Hormone Replacement Therapy (HRT) can make a significant difference in the quality and quantity of your sleep. The root problem for most, if not all, menopausal symptoms, including insomnia, is the loss of hormones. Only by addressing hormonal deficiencies of menopause can you achieve the restful and restorative sleep your body craves.

Introduction to Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy involves supplementing the body with hormones that have decreased due to menopause. The primary hormones used in HRT are estrogen, progesterone, and sometimes testosterone. The goal is to restore these hormones to levels that alleviate menopausal symptoms, including sleep disturbances.

Benefits of Estrogen in HRT

Reducing Hot Flashes and Night Sweats

One of the most disruptive symptoms of menopause is hot flashes and night sweats, which can wreak havoc on your sleep. Estrogen plays a key role in regulating your body’s temperature control. As estrogen levels drop during menopause, the body’s thermostat can become erratic, leading to sudden, intense heat episodes followed by excessive sweating. These night sweats can cause you to wake up multiple times during the night, leaving you feeling exhausted and drenched. By optimizing your estrogen levels, you can significantly reduce the frequency and intensity of hot flashes and night sweats, leading to fewer sleep disruptions and better overall sleep quality.

Stabilizing Sleep Cycles

Optimal estrogen levels can improve the stability of your sleep cycles and reduce the frequency of nighttime awakenings. Research has shown that women with adequate estrogen levels experience fewer disruptions during sleep and better overall sleep quality.

Progesterone and Sleep: A Natural Sedative

While progesterone helps most women in menopause dramatically improve their sleep, it doesn't help everyone equally. The calming effect of progesterone is primarily due to liver metabolism that converts progesterone into a breakdown hormone called allopregnanolone. Allopregnanolone interacts with receptors in the brain called "GABA-A receptors." In some women, particularly those who have experienced premenstrual dysphoric disorder (PMDD), the interaction of allopregnanolone with GABA-A receptors can cause an opposite reaction. Women with progesterone intolerance can experience severe depression, anxiety, and paradoxical insomnia. Still, the vast majority (up to 90%) of women in menopause experience progesterone as a "miracle hormone" that helps them sleep through the night for the first time in years.

Testosterone’s Impact on Sleep

Optimal testosterone levels can contribute to better sleep quality by influencing mood, energy levels, and overall well-being. Low testosterone levels in women have been linked to fatigue and sleep disturbances, which can further exacerbate insomnia during menopause. Ensuring your testosterone levels are optimal can help reduce the fatigue and energy dips that often interfere with sleep, helping you wake up feeling refreshed and ready to take on the day. By addressing low testosterone levels, you can improve your sleep quality and overall health during menopause.

Conclusion

If you’ve made it this far, you’re on the path to better sleep and a better life during menopause. You already know the frustration of losing precious sleep night after night for months or even years. We’ve explored some practical strategies to give your body and brain the best chance for a good night’s sleep. We've also looked closely at optimizing your hormones and how that can make a massive difference in your sleep.

Optimal hormone levels—including estrogen (estradiol), progesterone, and testosterone—can significantly improve your sleep quality and overall well-being during menopause. If you’re struggling with severe sleep deprivation from menopause, a hormone optimization specialist can help you get your hormones to just right levels that transform your sleep. Fill out my referral request form at simplehormones.com/referral to find a hormone optimization specialist near you.

Interested in using hormone replacement therapy to treat insomnia and other menopause symptoms but you're just not sure? Check out my comprehensive course, "The Menopause Solution," on hormone optimization. All the details about "The Menopause Solution" are available on my website at simplehormones.com/decision. This course is specifically designed to help you make your own HRT decision . . . in about 2 hours.

Thanks for stopping by, and here’s to better sleep and feeling like yourself again!

References

  1. Associations Between Sex Hormones, Sleep Problems and Depression: A Systematic Review. Morssinkhof MWL, van Wylick DW, Priester-Vink S, et al. Neuroscience and Biobehavioral Reviews. 2020;118:669-680. doi:10.1016/j.neubiorev.2020.08.006.

  2. The Role of Ovarian Hormones in the Pathophysiology of Perimenopausal Sleep Disturbances: A Systematic Review. Haufe A, Baker FC, Leeners B. Sleep Medicine Reviews. 2022;66:101710. doi:10.1016/j.smrv.2022.101710.
  3. When Does Estrogen Replacement Therapy Improve Sleep Quality?. Polo-Kantola P, Erkkola R, Helenius H, Irjala K, Polo O. American Journal of Obstetrics and Gynecology. 1998;178(5):1002-9. doi:10.1016/s0002-9378(98)70539-3.
  4. . Sleep, Vigilance and Cognition in Postmenopausal Women: Placebo-Controlled Studies With 2 Mg Estradiol Valerate, With and Without 3 Mg Dienogest. Saletu B. Climacteric : The Journal of the International Menopause Society. 2003;6 Suppl 2:37-45.
  5.  Different Regimens of Menopausal Hormone Therapy for Improving Sleep Quality: A Systematic Review and Meta-Analysis. Pan Z, Wen S, Qiao X, et al. Menopause (New York, N.Y.). 2022;29(5):627-635. doi:10.1097/GME.0000000000001945.
  6.  Effects of Estradiol and Venlafaxine on Insomnia Symptoms and Sleep Quality in Women With Hot Flashes. Ensrud KE, Guthrie KA, Hohensee C, et al. Sleep. 2015;38(1):97-108. doi:10.5665/sleep.4332.
  7.  Modulation of the Sleep Electroencephalogram by Estrogen Replacement in Postmenopausal Women. Antonijevic IA, Stalla GK, Steiger A. American Journal of Obstetrics and Gynecology. 2000;182(2):277-82. doi:10.1016/s0002-9378(00)70211-0.
  8.  Progesterone Reduces Wakefulness in Sleep EEG and Has No Effect on Cognition in Healthy Postmenopausal Women. Schüssler P, Kluge M, Yassouridis A, et al. Psychoneuroendocrinology. 2008;33(8):1124-31. doi:10.1016/j.psyneuen.2008.05.013.
  9.  Progesterone Prevents Sleep Disturbances and Modulates GH, TSH, and Melatonin Secretion in Postmenopausal Women. Caufriez A, Leproult R, L'Hermite-Balériaux M, Kerkhofs M, Copinschi G. The Journal of Clinical Endocrinology and Metabolism. 2011;96(4):E614-23. doi:10.1210/jc.2010-2558.
  10.  Effects of Hormone Therapy With Estrogen and/or Progesterone on Sleep Pattern in Postmenopausal Women. Hachul H, Bittencourt LR, Andersen ML, et al. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics. 2008;103(3):207-12. doi:10.1016/j.ijgo.2008.07.009.
  11.  The Relationship Between Sleep Disorders and Testosterone in Men. Wittert G. Asian Journal of Andrology. 2014 Mar-Apr;16(2):262-5. doi:10.4103/1008-682X.122586.
  12.  The Association of Testosterone Levels With Overall Sleep Quality, Sleep Architecture, and Sleep-Disordered Breathing. Barrett-Connor E, Dam TT, Stone K, et al. The Journal of Clinical Endocrinology and Metabolism. 2008;93(7):2602-9. doi:10.1210/jc.2007-2622.
 

The Menopause Solution!

Confused about whether HRT is right for your  menopause? My digital course helps you gain the confidence and clarity to make your HRT decision . . . in about 2 hours.

Hormone Practitioners: Find out how you can use The  Menopause Solution to simplify your hormone practice.

About the Author

With over 26 years of experience as a licensed pharmacist in Utah and Colorado, I specialize in hormone optimization and menopause management. I hold certifications in Advanced Bioidentical Hormone Replacement Therapy (ABHRT) from Worldlink Medical, C4 Hormone Replacement Therapy from the Professional Compounding Centers of America and the American Academy of Anti-Aging Medicine, and I am a Brain Health Coach certified by Amen Clinics.

I also share my expertise on my Simple Hormones YouTube channel where my over 100 videos have been viewed over 1,000,000 times and over 19,000 viewers have subscribed.

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