Poor sleep in menopause: causes and what to do

It is quarter past three. You lie wide awake, the sheets damp with sweat, and your thoughts go everywhere except toward sleep. Tomorrow you have to function again, and that realisation only makes it worse.

I hear this pattern often from women around menopause. My conviction: poor sleep is dismissed too easily as something that simply comes with the territory. Often there is an explainable cause behind it, and with that a point to act on. Below you read where it can come from and what can help.

Why do you sleep worse in menopause?

During menopause your estrogen and progesterone fall, and that affects your sleep in several ways. Progesterone has a calming effect, so less progesterone can make falling asleep harder. On top of that, hot flushes and night sweats cause broken nights. The four most common causes:

• Hot flushes and night sweats that wake you
• Less progesterone, which normally brings rest
• More worrying, stress or a restless mind
• Needing to urinate more often or physical discomfort

Which type of sleep problem do you have?

Not every sleep problem has the same cause. It helps to name where it goes wrong: falling asleep, staying asleep or waking too early. The table below gives a first direction, not a diagnosis.

Cortisol is your main stress hormone and has a daily rhythm: high in the morning, low in the evening. With prolonged stress that rhythm can be disrupted, leaving you wide awake at night. A blood test gives a first impression here. The Menopause Check includes your cortisol and estradiol (E2), so you can see what plays in.

Poor sleep and your weight

Sleep and weight are connected. With little sleep your hunger and fullness hormones fall out of balance, so you crave sweet and fatty food more often. So poor sleep in menopause can also contribute to weight gain. It sometimes works like a vicious circle.

Alongside sleep problems, do you also struggle with weight gain? Read our article on weight gain in menopause and what helps.

Poor sleep and brain fog

A few bad nights show up during the day: you are forgetful, your concentration falters and your head feels foggy. This is commonly called brain fog, and poor sleep is one of its best-known drivers. Often your head improves as soon as your sleep improves.

Do you mainly recognise forgetfulness and concentration problems? Read our article on brain fog in menopause.

What helps with better sleep?

There is no quick fix, but a calm evening routine and a cool bedroom help many women. Thuisarts.nl names sleep hygiene as the first step for persistent sleep complaints. What works differs per person, so give it time. What helps many women:

• A cool, dark bedroom, pleasant during night sweats
• Less caffeine and alcohol, especially in the evening
• A fixed sleep rhythm, including at the weekend
• Keep screens and worrying thoughts out of the bedroom as much as possible

Want the full picture of menopause first? Read our pillar on perimenopause, symptoms and solutions. If the complaints persist, discuss it with your GP.

When to see your GP?

An occasional bad night is normal. It becomes more important when sleep problems persist and affect your daily life. The Dutch GP guideline on sleep problems (NHG) describes how GPs assess long-term insomnia. Consider a conversation or check if you recognise this:

• You have slept poorly for weeks to months
• You are exhausted during the day and struggle to concentrate
• Alongside sleep problems you also feel low or anxious
• You want to know whether you are in menopause

An abnormal blood result is not a diagnosis, but a starting point for a conversation with your GP.

Frequently asked questions

Is poor sleep really part of menopause?

Yes, it is a common complaint. A large share of women sleep worse around menopause, often due to hot flushes, night sweats and hormonal fluctuations.

Does melatonin help with sleep problems in menopause?

For some women it seems to help, for others not. Discuss use with your GP or pharmacist, especially if you take other medication. There is no solution that works for everyone.

Can a blood test explain my sleep problem?

A blood test does not explain sleep on its own, but it can show whether, for example, your estrogen or cortisol plays a part. That gives a more targeted starting point for a conversation with your GP.