For Olympic gold medalist Kelly Holmes, changes in her sleep patterns were one of the first indications that something was amiss. Throughout her athletic career, getting a good night’s sleep had always been a top priority and easily attainable. However, a few years ago, at the age of 51, she began struggling to fall asleep and often woke up around 3am. It wasn’t until a doctor informed her that this was a symptom of perimenopause that she realized what was happening.
She said, “As an active person, when your energy levels decline and your emotions become heightened, you feel stressed in the morning – it’s not a pleasant way to live. If you don’t get a good night’s sleep, you’ll be irritable before the day even begins.” Holmes still battles with these symptoms, as she typically only manages to get six hours of sleep on a good night, with four or five hours being more common.
Holmes’s experience is supported by statistics from the National Institutes of Health, which suggest that sleep disturbances occur in 16-42% of women before menopause, 39-47% during perimenopause, and 35-60% after menopause. Despite being one of the most common symptoms, many women, including those whom Holmes meets at menopause roundtables, are unaware of this fact.
A survey conducted by Censuswide for Dunelm, which polled 2,005 perimenopausal and menopausal women, discovered that three-quarters of them had experienced menopausal insomnia, yet over half were unaware that it was a symptom. Furthermore, 69% of these women reported that it had a negative impact on their emotional well-being.
The majority of women would often wake up around 3.29am and attempt to fall back asleep. Some would engage in activities such as reading, scrolling through social media, or watching television. Sleep scientist and author of How We Sleep, Professor Matthew Walker, explains that menopausal women experience insomnia due to hormonal changes and hot flushes.
He warns that disruptive sleep patterns on this scale pose significant public health challenges, as chronic sleep loss can increase the risk of cardiovascular disease, obesity, weakened immune systems, and worsen mental health conditions, including depression, anxiety, irritability, mood swings, chronic fatigue, decreased productivity, and a lack of enthusiasm for life.
Dr. Zoe Schaedel, a GP and specialist with the British Menopause Society, suggests that most women can find relief through lifestyle changes such as avoiding caffeine and alcohol. Additionally, hormone replacement therapy (HRT) can assist some women by increasing their estrogen levels.
Holmes has personally found relief by taking simple actions such as closing her curtains at night, relaxing with a warm bath before bed, keeping her bedroom screen-free, and switching to cooler cotton bedding. However, in some cases, the sleep problem may have become a habit, leading to a diagnosis of insomnia disorder or chronic insomnia if sleep disruption has occurred for at least three nights a week for three months or more. In these instances, women may be offered cognitive-behavioral therapy for insomnia (CBT-I) or medication.
Schaedel emphasizes that workplaces should offer support to menopausal women by providing flexible work arrangements. She states, “Most women mention how beneficial it is for work if they can begin a bit later.”
Dr. Hana Patel, a GP specializing in women’s and mental health, often encounters patients experiencing problems sleeping during the perimenopause or menopause stages. This can result in irritability, difficulties concentrating, and anxiety. However, Patel assures them that “this is a temporary symptom and that there are treatments available to help.”
For many women, establishing a regular sleep schedule by going to bed and waking up at the same time each day, developing a relaxing bedtime routine, such as reading or taking a warm bath, and avoiding screens in the bedroom, can be a great starting point. Creating a cool, well-ventilated, dark, and quiet sleep environment, as well as sleeping alone, can also prove beneficial, according to Patel.
Insomnia in menopause stems from two known causes: hormonal changes and hot flushes. Hormonal changes include a reduction in estrogen and progesterone levels, both of which promote sleep. Insufficient estrogen can disrupt sleep due to its impact on serotonin, a neurotransmitter linked to sleep regulation. Meanwhile, declining progesterone levels can make it difficult to fall asleep and stay asleep since progesterone possesses sedative properties.
Hot flushes, which occur due to blood vessel dilations and constrictions, can also disturb sleep. These nighttime occurrences lead to night sweats and thermoregulation difficulties. Walker explains that our core body temperature needs to decrease by approximately 1 degree Celsius in order to fall asleep and remain asleep. This is why falling asleep is easier in colder rooms than hotter ones.
Schaedel and Walker both agree that more research is necessary on this issue. Many questions remain unanswered, including potential ethnic differences and whether menopausal insomnia is linked to an increased risk of dementia.
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