Restful, uninterrupted sleep is a rarity for women in their mid-40s and 50s, more than half of whom report night wakings, insomnia, and generally awful sleep.
Hot flashes are often to blame — but they’re far from the only factor disrupting sleep. New life demands — including juggling child and parent caregiving responsibilities — as well as changing biology and shifting circadian rhythms contribute to the tangled knot of sleep issues in midlife. It’s a mess, but picking it all apart for a solution is worth the effort because poor sleep can fuel conditions like heart disease and depression.
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The Estrogen Cliff
People assume hormonal changes are responsible for midlife sleep challenges — and they certainly can cause trouble. Declining estrogen and progesterone in your 40s can trigger hot flashes and night sweats, which can wreak havoc on a good night’s sleep. Waking drenched in sweat, having to change your pajamas and/or your sheets, is a massive disruption to nighttime rest.
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Navigating the Estrogen Cliff
For some, losing weight has been found to help with hot flashes and night sweats. Acupuncture and meditation may help, as may lifestyle changes like avoiding dietary triggers such as spicy foods and alcohol. For moderate to severe hot flashes, hormone therapy may be a good option. There are also two non-hormonal medications that are approved for hot flashes, along with other medications like certain antidepressants that are used off label (meaning they aren’t FDA-approved for hot flashes).
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Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is a condition in which your breathing is interrupted continuously while you’re asleep, causing partial awakenings that can leave you feeling tired all day. OSA is not specifically caused by menopause, but age is one of the biggest risk factors. Nearly one in three women between the ages of 50 and 70 have OSA, and it often goes undiagnosed. Obesity also increases the risk of OSA, and an estimated seven out of 10 menopausal women are overweight or obese.
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Addressing OSA
First, look for signs of OSA, which can differ in women versus men. You may not snore (a common sign in men), but you may wake frequently to use the bathroom throughout the night, or suffer from a morning headache or daytime sleepiness even after a full night of sleep. If any of these symptoms sound familiar, discuss OSA with your health care provider, who can order an at-home sleep test.
First-line treatment for OSA is a CPAP (continuous positive airway pressure) device, a mask you wear on your face at night that gently pushes air into your mouth or nose to keep your airway open. There’s also an effective dental device some patients use to shift the position of your jaw during sleep. Losing weight can also help reduce OSA.
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Mental Health
Sleep is directly impacted by mental health issues like depression and anxiety, which tend to be more common in midlife. About 30% of postmenopausal women have depression, anxiety, and/or irritability. Women with depression have three times the risk of not getting enough sleep and twice the risk of having low-quality sleep and OSA.
Fluctuating hormones can directly influence the levels of neurotransmitters that impact mood. Other symptoms of perimenopause, such as hot flashes, and the shifting landscape of middle age with its unique relationship, work, and caregiving stressors, combined with a lack of social support, may play a role as well.
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Caring for Mental Health
If you’re struggling with depression or anxiety, consider seeing a therapist who can help you navigate life stressors, provide coping strategies, and possibly refer you to a prescriber to discuss medication options. If you also have other symptoms of menopause, hormone therapy may be effective for both.
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Age-Related Circadian Rhythm Changes
As you age, your sleep architecture changes. Your circadian rhythm shifts, causing you to wake up earlier in the morning. You spend less time in deep sleep, and the transition from sleeping to waking up is more sudden, making it feel as though you’re a lighter sleeper.
It may take longer to fall asleep, and you may wake more often during the night — either to urinate or because of anxiety, pain, or chronic conditions like OSA that are more common with age.
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Righting Your Circadian Rhythm
To help maintain healthy, restorative sleep, it’s important to follow some key sleep hygiene rules.
- Give yourself time to wind down before bed.
- Keep your bed for sleeping (and sex) only.
- Keep a regular sleep-and-wake schedule.
- Consider taking low-dose melatonin (.5 to 1 mg) 30 to 60 minutes before bed to help with sleep onset.
