If you are a woman in your mid-40s or 50s, your ovaries are on their way to retirement. Nature has her way of letting a woman end her reproductive years. Estrogen and progesterone levels fluctuate and eventually drop. And such a rite of passage comes with challenges.

As women approach menopause, their sleep quality deteriorates, with frequent complaints of fitful sleep, tossing and turning, hot flashes, night sweats and waking up in the middle of the night, all wired up. Fatigue, low energy and anxiety are common complaints.  Many women are so familiar with these ruthless symptoms. According to the National Sleep Foundation, 60% of menopausal women suffer from a sleep disorder.

The cycle of insomnia and fatigue makes most women frustrated. To make matters a bit worse, their memory and concentration are just not the same. The bottom line:  Female sex hormones influence sleep.

What is menopause? It is the complete cessation of menstruation in women that typically occurs in their 50s. Menopause is a normal part of women’s physiology, marked by reduction of hormones. It is important not to treat it as a disease, but to accept it as a natural transition in life, and to try to find ways to ease some of the unpleasant symptoms.

What is perimenopause? That time in life when you are approaching menopause.

Why does perimenopause cause all these undesirable symptoms?  Estrogen declines during menopause, which then causes a decrease in the level of the brain’s neurotransmitter, serotonin. Serotonin is the good stuff that you want to have! It helps you sleep better and gives you a sense of well-being.

Hormone replacement therapy (HRT) is an effective treatment for many perimenopausal symptoms, including insomnia. However, HRT is no longer used routinely to treat menopausal symptoms. A large study, the Women’s Health Initiative, identified increased risks of cancer, heart disease and stroke in women using combination estrogen-progestin therapy . Before the study, the combination hormone therapy was a common treatment for menopausal women. Some women are still treated with hormone therapy, and for some-especially those who are candidates for estrogen-only therapy – the benefits may outweigh the risks. But the decision to use HRT must be individualized.

The decision to use HRT must be individualized, with physicians helping patients develop a strong knowledge of the risks and benefits. More women are pursuing non-pharmacological and alternative treatments for the management of their menopausal symptoms. The effectiveness and safety of those treatments need more studies.

Sleep disturbances do not always stem from hormonal changes. They can be caused by depression, the change of life and its transitions, and medical problems such as pain (migraines, arthritis) or sleep disorders like sleep apnea and restless legs syndrome.

Sleep apnea is more common in adult men than women. However, menopausal women catch up with their male counterparts. Women with sleep apnea tend to have their diagnosis delayed because they present with atypical sleep apnea symptoms such as insomnia and daytime fatigue rather than the typical symptoms of snoring and witnessed apneas. Sleep apnea should definitely be considered in women in this age group. A 2004 October study published in the issue of Diabetes, nutrition and metabolism found that postmenopausal women have higher prevalence of sleep apnea compared to premenopausal women.

Tips to on managing sleep problems during perimenopause and menopause

  • Keep good sleep habits
  • Maintain regular bed and wake times even if you suffer from insomnia.
  • Avoid caffeine, alcohol and smoking- especially close to bedtime
  • Eat a low-fat diet. Choose foods that are low in fat, saturated fat and cholesterol
  • Check with your doctor to make sure you are getting enough minerals and vitamins, especially calcium and vitamin D.
  • Work on reducing stress through stress reduction techniques such as yoga and exercise.
  • Keep your bedroom on the cooler side, especially when you experience hot flashes. Consider wearing light-fitting clothes that breathe, and possibly using a fan.
  • Talk to your doctor about the risk of sleep apnea syndrome. Pay attention to symptoms such as snoring, gasping at night and frequent awakenings (insomnia).
  • Do things that increase serotonin levels in the brain are prayer, meditation, music, exercise.
  • Try aromatherapy with lavender for example
  • Few medications might be needed to help you if you continue to struggle with your sleep:
    • A recent 2012 study in the March issue of Menopause concluded that “Among healthy perimenopausal and postmenopausal women with hot flashes, escitalopram at 10 to 20 mg/day compared with placebo reduced insomnia symptoms and improved subjective sleep quality at 8 weeks of follow-up.”
    • Another October issue of 2004 study published in Clinical Therapeutics found that Zolpidem (Ambien) was effective in the treatment of menopause-related insomnia in perimenopausal and postmenopausal women in that it increased total sleep time, decreased awakenings and improved daytime functioning.
    • Eszopiclone (Lunesta) was also found to be very helpful in this population according to a December 2006 study in Obstetrics and Gynecology; it “provided significant improvements in sleep and positively impacted mood, quality of life, and menopause-related symptoms in perimenopausal and early postmenopausal women with insomnia.”