One of the most common, and often frustrating, changes that many women experience during menopause is disrupted sleep. For some of us, this means difficulty falling asleep but for many it means, waking up at night or waking earlier than preferred. Once our sleep quality is affected, other aspects of our lives (anxiety, focus, energy level) are impacted as well. So better sleep is critical for our lives to function.
Let's start with understanding normal sleep before we get into how menopause can affect sleep. Normal sleep is comprised of four stages:
Rapid Eye Movement (REM) sleep occurs about every 90 minutes during sleep periods, with each episode getting longer as the night progresses, and makes up about 20-25% of sleep. Story-like dreams occur during REM sleep. The remaining 3 stages (stages 1, 2 & 3) are collectively called non-REM sleep.
Stage 1 - sleep is a very light sleep, comprising 5% of total sleep time.
Stage 2 - sleep makes up about 50% of sleep time.
Stage 3 - sleep is deep sleep, which is difficult to wake out of and makes up about 20-25% of sleep time. The first period of stage 3 sleep is the longest of the night, and each subsequent period of stage 3 becomes shorter.
Waking during sleep is considered a normal part of the sleep period. A recent meta-analysis concluded normal adult women, on average, are awake 55 minutes during the attempted sleep period (men are awake slightly less – 51 minutes). As we age, the amount of time awake increases, from ~30 minutes in early adulthood to ~80 minutes when elderly. 1
In addition to these age-related changes, the menopause transition can further disrupt sleep due to physiological changes associated with this. Some studies show more than 50% of post-menopausal women have disturbed sleep or a sleep disorder of some kind.2
Hormone effects on circadian rhythm:
We all know our hormones are crazy at this stage of life. But, changes in estrogen and progesterone levels can disrupt sleep patterns. The circadian rhythm is less well-defined in post-menopausal women than in pre-menopausal women which contributes to fragmented sleep.4 The circadian rhythm controls many aspects of our physiology (sleep/wake pattern, bowel movements, blood pressure, etc).
Estrogen helps regulate sleep cycles. Likewise, higher levels of follicular stimulating hormone is associated with waking more often during sleep.5 The rate of change in FSH and estrogen has been found to be associated with poorer sleep (i.e. a faster change was associated with more disrupted sleep).6,7 As hormone levels fluctuate, it can lead to difficulties falling and staying asleep. That is why one night I sleep great, and the next night I’m staring at the ceiling at 2 am.
There are steps you can take to maintain good quality sleep during this transition. I share your frustration with sleep disturbances. That’s why I created the 7-day Sleep Reset - a free download with steps for better sleep in perimenopause. Click here to get the pdf 7-Day Sleep Reset, and start taking steps today to get Better sleep for a Better you.
Also, check out our natural products formulated for Better Sleep. We offer CBN to help you stay in deeper sleep stages, and Dreamy Cream - a Magnesium CBD combo to help you relax and drift off to sleep.
References:
- Boulos MI, Jairam T, Kendzerska T, Im J, Mekhael A, Murray BJ. Normal polysomnography parameters in healthy adults: a systematic review and meta-analysis. Lancet Respir Med. 2019;7(6):533-543.
- Salari N, Hasheminezhad R, Hosseinian-Far A, et al. Global prevalence of sleep disorders during menopause: a meta-analysis. Sleep Breath. 2023;27(5):1883-1897.
- Kravitz HM, Ganz PA, Bromberger J, Powell LH, Sutton-Tyrrell K, Meyer PM. Sleep difficulty in women at midlife: a community survey of sleep and the menopausal transition *. Menopause. 2003;10(1):19-28.
- Gómez-Santos C, Saura CB, Lucas JAR, Castell P, Madrid JA, Garaulet M. Menopause status is associated with circadian- and sleep-related alterations. Menopause. 2016;23(6):682-690.
- de Zambotti M, Colrain IM, Baker FC. Interaction between reproductive hormones and physiological sleep in women. J Clin Endocrinol Metab. 2015;100(4):1426-1433.
- Sowers MF, Zheng H, Kravitz HM, et al. Sex steroid hormone profiles are related to sleep measures from polysomnography and the Pittsburgh Sleep Quality Index. Sleep. 2008;31(10):1339-1349.