How does sleep change in menopause?

During the menopause transition, sleep can go wrong in several different ways. Some nights it takes a long time to fall asleep. Other nights you do fall asleep, but wake in the middle of the night and cannot get back to sleep. And sometimes you wake very early in the morning and still feel unrested.

The NHS describes insomnia like this: regularly finding it hard to fall asleep, waking several times during the night, waking early and not being able to get back to sleep, still feeling tired after waking up, and feeling irritable during the day (NHS, Insomnia).

Difficulty sleeping is on the NHS list of menopause and perimenopause symptoms. The NHS notes that sleep problems can affect your daily life and can lead to irritability, stress and anxiety (NHS, Symptoms). The Menopause Society also counts sleep disturbances among the common symptoms of the transition (The Menopause Society, Symptoms). In Türkiye, an information note from Hacettepe University’s Department of Public Health lists sleep disturbances and insomnia among the symptoms of menopause (Hacettepe HSAD, 2024).

How common is insomnia in menopause?

Many women have trouble sleeping as they approach menopause and afterwards. A 2018 review reports that 26 percent of women have symptoms severe enough to affect their daytime functioning. At that level, the symptoms meet the criteria needed for a diagnosis of insomnia (Baker et al., 2018).

The same review points to long-term community studies. In these studies, sleep difficulties were linked to the stage of menopause and to changes in hormone levels, independently of age (Baker et al., 2018). In other words, poor sleep cannot be explained simply as “I’m getting older.”

How does insomnia show up during the day?

A bad night carries over into the next day. The NHS notes that sleep problems can affect your daily life and lead to irritability, stress and anxiety (NHS, Symptoms). People with insomnia still feel tired when they wake up and get irritated more easily during the day (NHS, Insomnia).

Forgetfulness and trouble concentrating can join the picture too. The Menopause Society counts difficulty sleeping among the menopause symptoms that can affect thinking and memory in midlife (The Menopause Society, Mental Health). We cover the forgetfulness side separately: Brain fog and forgetfulness.

The review by Baker and colleagues goes a step further. It notes that the impact of severe insomnia symptoms may not stop at quality of life, and that in midlife women it may extend to long-term mental and physical health (Baker et al., 2018). That is why it is worth raising the issue with your clinician rather than waiting for months on the assumption that “it will pass anyway.”

Broken sleep is not weakness or laziness. Your body is going through a transition. It is not surprising that tiredness becomes more noticeable during this time.

Why does menopause disrupt sleep?

Night sweats

The most visible cause is night sweats. A hot flash during sleep makes you wake up sweating. The Menopause Society stresses that night sweats break up sleep and that damp sheets add their own discomfort (The Menopause Society, MenoNote: Night Sweats). The review by Baker and colleagues also lists hot flashes as one of the main contributors to sleep complaints during this period. In sleep laboratory measurements, many, though not all, of these flashes are linked to waking up (Baker et al., 2018). We cover night sweats in detail here: Night sweats.

Mood

Mood and sleep feed into each other. The Menopause Society notes that vulnerability to depression increases during the perimenopause years, and that the risk is highest in women who have had depression before. Sleep changes are among the factors that affect mood. The unpredictability of hot flashes can increase anxiety (The Menopause Society, Mental Health). We cover the mood side separately: Mood swings and irritability.

Breathing and movement problems during sleep

Some sleep complaints may have another sleep disorder behind them. Baker and colleagues note that sleep-related breathing disorders and sleep-related movement disorders become more common, especially after menopause (Baker et al., 2018). The best known of these is sleep apnea: breathing that repeatedly stops or becomes very shallow during sleep. The Menopause Society lists sleep apnea among the possible causes of night sweats as well (The Menopause Society, MenoNote: Night Sweats).

Everyday factors

The NHS lists stress, anxiety and depression; noise and an uncomfortable bed; and alcohol, caffeine and nicotine among the common causes of insomnia. Some medicines and health conditions can also disturb sleep (NHS, Insomnia). During this period, these often overlap with menopause symptoms.

What else can cause insomnia besides menopause?

Poor sleep is not always down to menopause. These questions can help you tell things apart:

  • Are there also many nights when you wake up without sweating?
  • Do you snore? Has the person next to you noticed your breathing stop?
  • Do you feel hopeless, uninterested or very anxious throughout the day?
  • Have you started a new medicine?
  • Do you get up several times a night to use the bathroom?

The Menopause Society says that low mood, loss of interest, difficulty concentrating and sleep problems lasting more than two weeks, nearly every day and for most of the day, call for a visit to a health professional (The Menopause Society, Mental Health).

Seeing your own pattern

A practical way to connect your sleep problem to menopause is to record sleep and night sweats together. If your sleep score drops on nights when you sweat, your clinician will look in that direction. If you sleep badly even without sweating, other causes are discussed.

For a few weeks, you can note down:

  • What time did you go to bed, and what time did you wake up?
  • How many times did you wake in the night, and why?
  • Did you sweat?
  • Did you have caffeine or alcohol that day, and at what time?
  • Did you nap during the day?
  • How rested did you feel in the morning?

Sleep habits

The NHS gives some general advice for insomnia. It includes going to bed only when you feel sleepy, getting up at the same time every day, relaxing for at least an hour before bed, and keeping the bedroom dark and quiet. It recommends avoiding smoking, alcohol, tea and coffee in the six hours before bed, not using screens right before sleeping, and not napping during the day (NHS, Insomnia).

The Hacettepe public health note also recommends plenty of rest and building a regular sleep routine (Hacettepe HSAD, 2024). If night sweats are breaking up your sleep, keeping the bedroom cool matters too.

These habits are not always enough. This page does not recommend any medicine, supplement or product for sleep; talk through the options with your clinician.

When should you see a doctor about insomnia, and what should you ask?

The NHS advises seeing your family doctor (GP) if changing your habits has not helped, or if you have had sleep problems for months and they are affecting your daily life (NHS, Insomnia). If your mood has also changed noticeably, go sooner.

At the appointment, you could ask:

  • Is my sleep problem related to the menopause transition, or could there be another cause?
  • Should I be assessed for sleep apnea?
  • What options are there for me?