By Sara McCloskey-Nieves and Haley Tenore 

If that cup of coffee isn’t cutting it after a night of tossing and turning from hot flashes – you are not alone. About 40% to 60% of women have trouble sleeping or insomnia when they go through menopause. 

While menopause is a normal part of life, it doesn’t mean you have to suffer. 

VCU Health News spoke with Maha Alattar, M.D., director of VCU Health Sleep Medicine, and Jane Limmer, M.D., an OB-GYN at VCU Health who is a Menopause Society Certified Practitioner. They explained the science behind sleep disturbances in menopause and ways to improve sleep quality. 

Menopause and sleep 

What is menopause? 

Menopause is a natural stage in life when your body stops having menstrual cycles. In your late 40s or early 50s, your hormone levels decline, especially estrogen and progesterone. These hormonal changes can affect how your body regulates temperature, mood and sleep – triggering a variety of symptoms, including hot flashes, night sweats, mood changes and fatigue.

Jane Limmer, M.D., is an OB-GYN at VCU Health who is a Menopause Society Certified Practitioner. (Tom Kojcsich, Enterprise Marketing and Communications)The effects of this transition can feel disruptive, especially when they interfere with your daily routine or sleep. 

“Menopause is a biological change. We cannot reverse it. We cannot undo it. But women should really take extra steps to ensure they address their overall health,” Alattar said. 

How does menopause affect my sleep? 

Hormonal changes during menopause, such as estrogen and progesterone, can interfere with your regular sleep cycles. You may have trouble falling asleep, staying asleep or feeling rested when you wake up. 

“The most common reason women have trouble sleeping during menopause is due to night sweats that frequently wake them up. Women may develop additional health conditions as they age, such as anxiety, depression and chronic pain, which can also contribute to poor sleep,” Limmer said. 

Sleep disorders in women 

When is poor sleep a sign of something more serious? 

While occasional restless nights are common during menopause, ongoing or worsening sleep issues may signal something more serious. Conditions like obstructive sleep apnea or restless leg syndrome can develop during this time, and the symptoms are not always obvious. 

“Menopause in and of itself does not cause sleep apnea. However, women often experience weight gain in perimenopause and menopause, which increases their risk of sleep apnea,” Limmer said. “In general, sleep apnea is significantly underdiagnosed, especially in women with normal BMI (Body Mass Index), and it may contribute to poor sleep in a large percentage of the population.” 

Signs your sleep issues may need medical attention include: 

• Ongoing insomnia or disrupted sleep 
• Waking up frequently without a clear reason 
• Feeling tired even after a full night’s sleep 
• Night sweats that seem severe or unusual 
• Daytime fatigue or trouble concentrating 

“For men, snoring and pauses in breathing are prominent symptoms of sleep apnea. However, when a woman goes through menopause, snoring or pauses in breathing are not necessarily the symptoms of sleep apnea,” Alattar said. “They will have very subtle symptoms of waking up, insomnia, disrupted sleep, some sweating, feeling tired and when they wake up – they're not rested.” 

At what point should I talk to my doctor about sleep disturbances? 

It’s important to talk with your doctor if you notice consistent changes in your sleep, such as frequent waking, fatigue during the day or feeling unrested. These symptoms may not just be part of menopause and could require further evaluation. 

Maha Alattar, M.D., director of the VCU Health Center for Sleep Medicine. (Enterprise Marketing and Communications)

“Women should seek medical help when difficulties with sleep are affecting their quality of life and their ability to carry out normal activities either at home or at work – or both!” Limmer said.  

Talking with your primary care provider can help identify underlying causes, such as sleep apnea or other disorders. Addressing these issues early can improve both your sleep quality and your overall health. 

“Anytime you notice that change, it’s always good to start with your primary care physician and bring them up. Your doctor may order a sleep study, review your sleep history and – if you do have significant sleep problems – refer you to a sleep clinic,” Alattar said.  

Coping with sleep loss in menopause  

What lifestyle changes can improve my sleep during menopause? 

There are several steps you can take to improve your sleep during menopause. Building consistent habits can help regulate your body’s internal clock and support better rest over time.  

Simple habits that can improve your sleep include: 

• Going to bed and waking up at the same time every day 
• Keeping your bedroom cool and comfortable 
• Limiting screen time before bed 
• Avoiding alcohol before bedtime 
• Reducing caffeine later in the day 
• Exercising regularly (but not right before bed) 
• Managing stress and building strong social support 

Incorporating new habits sounds easier than it really is, so Alattar encourages her patients to set practical goals that they can stick with.  

“It's important to adopt a healthy lifestyle so you can try to offset the effects of menopause on sleep – but you need to be realistic. Don't expect to change 100% of your habits right away. Let's shoot for 50% or even 25%. Realistic expectations will go a long way. If you expect that you will go 100%, then you will set yourself up for failure,” Alattar said. 

What treatments can help me sleep better during menopause?  

When you are having trouble sleeping, Alattar doesn't recommend using sleeping pills or supplements like melatonin since they may lead to sleep apnea. For insomnia, Limmer notes that one of the gold standards for treatment is Cognitive Behavioral Therapy – it helps your brain and body relearn how to sleep naturally. 

If hot flashes and night sweats are the main cause of your restless nights, there are different treatments available that can help manage those menopause symptoms. These include FDA-approved hormonal therapies that mimic substances already found in the body and non-hormonal options that target the part of the brain where we believe hot flashes originate. 

“Although menopausal hormone therapy is not recommended for all women, it can have significant benefits for those who need it, including reduction in frequency/severity of vasomotor symptoms, improved sleep, improved mood, and decreased risk of osteoporosis, among others,” Limmer said.  

A full night of sleep may feel out of reach right now, but it’s not gone for good. With healthy habits and a little patience, restful nights will soon return. Pay attention to what helps, and don’t hesitate to reach out to your doctor if you need more support.  

Sleep better, live better. There are many reasons you or a loved one may be unable to sleep. Learn more about VCU Health Sleep Medicine.

It’s important to talk to a women’s health specialist to manage your menopause symptoms. Our women’s health experts are ready to work with you to create a personalized treatment plan.