Menopause & Sleep: What No One Tells You

Lorraine Irlam, Registered Clinical Counsellor
Oct 7
5 min read

October is World Menopause Awareness Month

Decorative image of a neatly made white bed with white bedding in a modern, minimalistic bedroom.

If you’re navigating perimenopause or menopause and finding sleep harder than ever, you’re far from alone. Between 40–60% of women in this stage report regular insomnia. The most common complaint? Waking up in the night and not being able to drift back to sleep. Add in hot flashes, night sweats, or the mental weight of busy midlife responsibilities, and restful nights can feel out of reach.

But there’s more to the story than hormones alone. Researchers now know that menopause can bring hidden sleep disorders - like sleep apnea - that often go undetected because their symptoms mimic menopause or insomnia. Fatigue, poor concentration, and low mood might not just be “part of the transition.” In fact, after menopause, women are two to three times more likely to develop sleep apnea, a condition once thought to affect mainly men. What’s more, women often have subtler signs - such as insomnia, headaches, or nighttime awakenings - so it’s easier for both patients and doctors to miss. When insomnia and sleep apnea occur together (a combination called COMISA), health risks increase, but so do opportunities for effective treatment.

Why Sleep Changes With Menopause

Hormonal shifts play a big role: progesterone, which naturally supports relaxation and stable breathing, declines, while estrogen changes can make the body more prone to hot flashes and awakenings. Melatonin - the hormone that cues nighttime sleepiness - also decreases with age and during the menopausal transition, adding yet another layer of difficulty. On top of this, chronic pain conditions (such as fibromyalgia), weight changes, anxiety, and depression can compound the problem and be part of a vicious cycle.

Sleep quality also changes with age. Even without menopause, older adults tend to get less deep sleep, wake more often during the night, and experience shorter overall sleep time. Pair this with the menopausal transition, and sleep challenges can be amplified.

Why It Matters

Insomnia during menopause isn’t just frustrating - it can affect immune function and is linked to a greater risk of cognitive decline. The bi-directional relationship between poor sleep and mental health means anxiety and depression can worsen sleep, while sleep loss intensifies emotional challenges.

So, What Helps?

The good news? There are proven tools that work. Cognitive Behavioural Therapy for Insomnia (CBT-I) is widely recognized as the gold standard for treating chronic insomnia at any age. Recent research highlights that CBT-I should be the first-line treatment for insomnia in menopausal women, offering long-term relief with fewer side effects than medication.

Studies show CBT-I not only helps women fall asleep faster, but also return to sleep more easily after nighttime awakenings - whether triggered by hot flashes, pain, or other disruptions. Beyond sleep itself, CBT-I has also been shown to improve mood, daily functioning, and even address underlying factors such as unhelpful sleep-related beliefs.

Mindfulness-based approaches may also provide relief - though it’s important not to “try too hard” to relax. If you’re a subscriber of Insomnia Help Canada’s newsletter, you will already know “Why Relaxation Strategies for Insomnia can Backfire” and what to do instead!

Practical strategies can also support better nights:

Cool the room: Keep your bedroom slightly cooler than usual and use breathable sheets. A bedside fan can bring immediate relief during a hot flash.

Add layers of bedding so you can quickly remove damp sheets in the night

Set a steady rhythm: Try to keep a consistent bedtime and wake time, even on weekends. Routine signals the body when it’s time to power down.

Daylight matters: Exposure to natural light during the day helps regulate circadian rhythms, which can be especially important when hormones are fluctuating.

Wind down gently: Create a pleasant evening ritual—reading, gentle stretching, or breathing exercises. Avoid screens in the last hour before bed, as the light can interfere with melatonin production. But that’s not as straightforward as you might think. For more info, have a look at why evening screentime affects some people’s sleep and not others.

Limit late stimulants: Caffeine, alcohol, and heavy meals close to bedtime can all disrupt sleep or trigger hot flashes.

Ask your doctor about sleep apnea - especially if fatigue feels overwhelming or other symptoms point to snoring or breathing disruptions at night.

Practice mindful self-compassion: sleep struggles are common in this transition, and blame or pressure only heightens the struggle. When life gets hard, remember you’re not alone – especially when it comes to menopause and sleep struggles. Self-kindness takes practice, but it can go a long way towards easing the burden while doing what you can and waiting for “this too to pass.”

Talk to Your Doctor About

Melatonin: Decreasing melatonin levels doesn’t necessarily mean melatonin supplements will be helpful. There is limited evidence to suggest that melatonin may help with falling asleep sooner in the short term, but it tends to lose effectiveness in the long term. It’s also possible that supplements, such as melatonin, may interact with other medications.

Obstructive Sleep Apnea: Some symptoms include snoring, choking or gasping during sleep, frequent nighttime urination, headaches, high blood pressure, and feeling sleepy during the day, even after enough sleep time.

Hormone Replacement Therapy (HRT): Your doctor can advise whether the benefits of HRT outweigh the risks for you.

The Takeaway

Sleep in menopause is influenced, not only by hormones, but also by age, lifestyle, and health conditions as well - and while the challenges are real, so are the solutions. With the right strategies, many women find they can reclaim more consistent, restorative sleep and feel steadier in both body and mind.

Struggling with hot flashes? If you’re finding it tough to stay cool and rested, you’re not alone.

Explore more practical tips to stay cool for better sleep:

👉 13 Cool Sleep Tips to Beat the Summer Heat

👉 Top 12 Hacks for Staying Cool and Sleeping Well in Summer Heat

References

Carmona, N. E., Millett, G. E., Green, S. M., et al. (2023). Cognitive-behavioral, behavioural and mindfulness-based therapies for insomnia in menopause. Behavioral Sleep Medicine, 21(5), 488–499. https://doi.org/10.1080/15402002.2022.2109640

Guthrie, K. A., Larson, J. C., Ensrud, K. E., et al. (2018). Effects of pharmacologic and nonpharmacologic interventions on insomnia symptoms and self-reported sleep quality in women with hot flashes: A pooled analysis of individual participant data from four MsFLASH Trials. Sleep, 41(1), zsx190. https://doi.org/10.1093/sleep/zsx190

Lam, C. M., Hernandez-Galan, L., Mbuagbaw, L., et al. (2022). Behavioral interventions for improving sleep outcomes in menopausal women: A systematic review and meta-analysis. Menopause, 29(10), 1210–1221. https://doi.org/10.1097/GME.0000000000002051

Ntikoudi, A., Owens, D. A., Spyrou, A., Evangelou, E., & Vlachou, E. (2024). The effectiveness of cognitive behavioral therapy on insomnia severity among menopausal women: A scoping review. Life, 14(11), 1405. https://doi.org/10.3390/life14111405 PubMed

Maki, P. M., Panay, N., & Simon, J. A. (2024). Sleep disturbance associated with the menopause. Menopause, 31(8), 724–733. https://doi.org/10.1097/GME.0000000000002386

Looking for support with your sleep? Book a free 15-minute phone consultation with Lorraine - your opportunity to learn more about one-on-one sessions for anxiety and/or CBT for insomnia (CBT-I).