Sleep Disorders
Learn more about sleep disorders and how the menopause can impact your sleep
Sleep disturbances
Whilst sleep disturbances increase with age in both men and women, there can be little doubt that it is exacerbated by hormonal changes around the menopause. There is an increase in incidence around the menopause. Around 40%-60% of women report sleep disturbances in the perimenopause, this can involve difficulty getting off to sleep, but more often women experience disturbed sleep, waking several times a night. Similar sleep disturbances are reported in women after surgical menopause and in those receiving treatment with GnRH which induces a medical menopause.
What are the consequences of poor sleep?
Poor sleep is associated with a reduced quality of life and is associated with long-term health risks including an increase in cardiovascular disease.
Poor sleep can further exacerbate symptoms that are normally experienced around the menopause such as depression, anxiety, irritability, mood swings, difficulty in concentrating, forgetfulness as well as tiredness.
How does the menopause affect sleep?
The hormonal changes around the menopause can have a direct effect on sleep or indirectly due to the symptoms of the menopause below.
- Vasomotor symptoms which include hot flushes and night sweats – experienced by approximately 80% of women. They are sometimes worse in the perimenopause and may be relatively short-lived but can last for up to ten or twenty years. These symptoms often disturb sleep
- Depression and Anxiety – these symptoms are common around the menopause, and are 2-4 times more likely to occur in menopausal women compared to younger women. Women with a history of PMS, postnatal depression, or pre -existing depression are more likely to suffer from these symptoms
- Urogenital atrophy – The oestrogen deficiency resulting from the menopause can result in atrophy of the vulva, vagina, and urinary tract giving rise to symptoms of vaginal dryness, itching and increased frequency of micturition, including waking up several times each night to pass urine
- Musculoskeletal – Aching joints are also common around the menopause and can have an adverse impact on sleep
- Sleep apnoea – This condition occurs in both men and women but is more common in men and is associated with obesity, alcohol consumption and smoking. Women suffering from sleep apnoea often report worsening of symptoms with the menopause
- Restless Leg syndrome – This symptom also increases with age but an association with the menopause has been identified
How does HRT help poor sleep?
Hormone replacement therapy can improve sleep, with a reduction in difficulty in getting off to sleep and reduced night-time wakening, and women report that they feel more refreshed. Improvements to sleep often occur with improvement in vasomotor or other symptoms but there is also thought to be a direct effect.
Hormone replacement therapy is safe and should be considered as the first line treatment for climacteric symptoms including poor sleep. Apart from alleviating these symptoms in the long-term, HRT is known to prevent osteoporosis, reduce the risk of heart disease, and overall mortality is reduced in women taking hormone replacement therapy.
Book your appointment
Book your appointment with our specialist team
Dr Neale Watson
Consultant Gynaecologist
Dr Mike Savvas
Consultant Gynaecologist
Dr Marilena Nicou
GP Menopause specialist
Frequently Asked Questions
What can I do to help improve my sleep, what does good sleep hygiene involve?
Poor sleep is common in women as they age and is an important symptom of the menopause. HRT can often help but can persist despite taking hormonal treatment. Good sleep hygiene can help, this includes:
- Take regular exercise
- Avoid large meals before bed
- Reduce alcohol consumption. Whilst alcohol may make you drowsy, your sleep is often disturbed
- Avoiding caffeinated drinks particularly from early afternoon onwards, because the half-life of caffeine is six hours
- Ensure that your bedroom is dark, quiet and cool
- Take a shower before bed
- Wear light bed clothes
- Avoid taking naps in the afternoon
- Keep to the same bedtime routine to directly help regulate your body clock, this means trying to get to bed at the same time and getting up at the same time every day, including weekends
- If you wake up during the night and cannot get back to sleep it is advisable to go to another room and read a book or magazine, or listen to a podcast and return to your bed when you’re feeling tired and sleepy
- Avoid the use of computer or telephone screens in the evenings
What is CBTI?
Is a structured form of CBT or cognitive behaviour therapy for insomnia. It focuses on influencing your thoughts and behaviour which are impacting your sleep and has been shown to improve insomnia and sleep quality.
What to Expect From Your Visit
The first visit will entail a comprehensive consultation, examination and hormone profile testing if required. Our highly qualified menopause specialists will guide you through the process of choosing the safest and most effective treatment to manage your symptoms.
A prescription will usually be issued, at the first visit if appropriate and a follow-up is arranged after 2-3 months to assess the effectiveness of the treatment and make changes as required. Our clinic allows for remote consultation for those who cannot make an in-person follow-up. This may be via a video or telephone call.
Additional services such as pelvic ultrasound scan, coil fittings, smear tests and bone density scan (DEXA) may also be performed as appropriate. We can also arrange for you to have a mammogram if you need one.