While one out of every two people struggle with sleep difficulties, complaints are twice as likely to be from women.^[1][4] Until more recently however, sleep studies have failed to focus on factors unique to aging females, including perimenopause, the period leading up to the cessation of menstruation.^[5] Where once, women lived scarcely two decades past the menopause transition, now they live roughly one-third of their life post menopause. Significant numbers of these women report trouble falling asleep at night, as well as waking too early in the morning.^[4]

How is a sleep disorder defined?

Individuals with insomnia report difficulty initiating or maintaining sleep 3 or more nights a week. This lack of sleep also causes daytime impairment in one or more ways including, occupational, social, or physical areas of functioning. Insomnia may involve dysregulation of the body's natural circadian rhythm, the internal clock that controls sleep, body temperature and hormone production.

Other sleep disturbances include:

• Periodic and frequent waking during the night
• Poor, non-restorative sleep that is chronic^[1]

How does perimenopause affect sleep?

Although there is no one medical condition that causes primary insomnia, changes, both physical and mental in a woman’s life may influence whether or not she gets productive, restful sleep.^[4]

Most perimenopausal women suffer with hot flashes and night sweats during the period leading up to actual menopause. These often disrupt deep, restful sleep making it difficult to return to slumber once awakened by discomfort. This may lead to a negative mood, as well as a reduction in productivity throughout the day. Chronic fatigue due to sleeplessness can put women at risk for many negative physical consequences as well. These include weight gain, cardiovascular disease, and diabetes.^[7]

Women report higher rates of insomnia than men, especially at certain critical periods in their lives including, pregnancy, postpartum, and menopause.^[2]

Why hormonal changes affect sleep?

While researchers know that women commonly suffer from sleep disturbances during perimenopause, they don’t exactly know why. Hot flashes, night sweats, hormone levels, and hormone use all appear to impact sleep cycles at this time. Stress, depressed mood, anxiety, backaches and joint pain also affect sleep quality. Independent of these symptoms however, perimenopausal women are 29% more likely to suffer sleep disturbances than women who have not yet entered this life phase. This may be due in part, to higher levels of the pregnanediol glucuronide hormone (by-product of progesterone) found in the body of middle-aged females.^[4] Whatever the root cause, each of the vasomotor symptoms discussed above appears to negatively affect quality of sleep as well.^[8]

How much sleep do women need?

According to the National Sleep Foundation Sleep Poll, women need approximately 20 more minutes of sleep per day than men. Because females tend to multi-task, more of their brain is used, creating a greater need for rest. This is in addition to 8 consecutive hours, recommended for most adults. Women (aged 30-60) only get about six hours and 41 minutes per day on average, however. This sleep deficit may lead to a number of negative consequences.

What are the effects of sleeplessness in perimenopausal women?

Loss of sleep can result in:

• Daytime fatigue
• Poor concentration
• Poor memory
• Headaches
• Inability to be efficient at work
• Increased risk of substance abuse
• Depression
• Increased risk of auto accidents^[1]
• Cell damage/aging^[6]

What perimenopausal women can do to get better sleep?

Pharmacological interventions, natural treatments, and lifestyle changes can help promote better sleep for women.

Drug therapies include prescription benzodiazepines that induce sleep, and melatonin antagonists that help normalize circadian rhythms and sleep cycles. Side effects may include dependence (benzodiazepines) and dizziness, fatigue, and daytime sleepiness (melatonin agonists).

Natural therapies may include:

• Meditation
• Acupuncture
• Cognitive behavioral therapy
• Yoga
• Deep breathing/relaxation
• Bright light therapy
• Herbal teas such as chamomile
• Natural melatonin enhancers
• Natural L-tryptophan

Lifestyle changes that promote sleep may include exercise, exposure to afternoon sun, avoidance of caffeine, maintaining a consistent sleep/wake schedule, taking a hot evening bath, avoiding television directly before bedtime, and keeping the bedroom cool, dark, and well ventilated.^[1][3]

While many women in midlife will have no sleep difficulties associated with the menopause transition, others will suffer the ill effects of sleeplessness, both physical and mental. Learning to make important lifestyle adjustments as we enter middle age, as well as decreasing certain substances and stressors is a critical first step toward better quality sleep that heals, restores and refreshes.