How Menopause Disrupts Sleep and What You Can Do About It
Struggling with sleep during menopause is a frustrating and often exhausting reality for many women. At Philadelphia Integrative Psychiatry, Dr. Danish and Dorota Ketch, PMHNP, recognize the profound impact that menopause-related sleep disturbances have on overall health and quality of life. By staying at the forefront of mental health research, they provide evidence-based, personalized treatments to help patients find relief from insomnia, restless sleep, and related mood changes.
A recent review article, Menopause and Sleep Disorders, published in the Journal of Mid-life Health, explores the connection between menopause and sleep disturbances, highlighting key risk factors, common sleep disorders, and potential treatment approaches. Below, we break down the essential findings from the study and discuss the most effective ways to address sleep disruptions in menopausal women.
How Menopause Disrupts Sleep
Research shows that sleep disorders become more prevalent during menopause, with incidence rates ranging from 16% to 47% in perimenopause and 35% to 60% in postmenopause. The most common sleep-related complaints include:
Insomnia – Difficulty falling or staying asleep, affecting up to 51% of women in midlife.
Obstructive Sleep Apnea (OSA) – Increased risk due to hormonal changes and weight gain, making postmenopausal women more vulnerable.
Restless Leg Syndrome (RLS) and Periodic Limb Movement Syndrome – Disruptive leg movements during sleep that worsen with age.
Mood Disorders – Anxiety and depression often co-occur with menopause-related insomnia, creating a cycle of poor sleep and worsened mental health.
The Role of Hormones in Sleep Disruptions
Hormonal shifts during menopause, particularly the decline in estrogen and progesterone, play a crucial role in sleep disturbances. Estrogen affects serotonin and norepinephrine levels, both of which are involved in sleep regulation. Meanwhile, progesterone has a natural sedative effect, and its decline can contribute to increased wakefulness. Additionally, melatonin levels decrease with age, leading to difficulty in maintaining restful sleep.
Treatment Approaches for Menopause-Related Sleep Issues
Non-Addictive Medications for Sleep and Mood Support
At Philadelphia Integrative Psychiatry, Dr. Danish and Dorota Ketch, PMHNP, prioritize non-addictive treatments for sleep disturbances in menopausal women. Instead of benzodiazepines or Z-drugs, they recommend:
Trazodone – A serotonin modulator that promotes sleep without the risk of dependence.
Hydroxyzine – An antihistamine with sedating properties that can aid sleep and reduce anxiety.
Clonidine – Originally used for blood pressure, this medication can also reduce night sweats and improve sleep quality.
Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) – Medications like escitalopram and duloxetine can improve both mood and sleep.
Gabapentin and Mirtazapine – Effective for patients experiencing both insomnia and mood disturbances.
Melatonin and Ramelteon – Useful for regulating circadian rhythms, particularly for sleep maintenance issues.
Hormone Replacement Therapy (HRT): When Is It Appropriate?
HRT can sometimes improve sleep by addressing estrogen depletion, which is linked to increased insomnia. However, Dr. Danish and Dorota Ketch typically reserve HRT for more intense cases of insomnia, particularly when severe mood disturbances such as major depression, depression with anxiety, mania, or psychosis are thought to be related to menopause. While HRT can be beneficial, it is not the first-line treatment for sleep issues due to potential risks, including cardiovascular and cancer concerns.
Non-Pharmacological Approaches: Sleep Hygiene and Lifestyle Changes
Cognitive Behavioral Therapy for Insomnia (CBT-I) – Considered the gold standard for treating chronic insomnia without medication.
Exercise and Meditation – Moderate exercise improves sleep efficiency, while mindfulness techniques like self-hypnosis have been shown to reduce sleep disturbances in 50% to 77% of menopausal women.
Dietary Adjustments – Avoiding caffeine, alcohol, and heavy meals before bedtime can significantly improve sleep quality.
Optimizing Sleep Environment – Keeping the bedroom cool, using blackout curtains, and reducing screen exposure before bed can help regulate sleep patterns.
Getting in Touch with Dr. Danish and Dorota Ketch, PMHNP
If menopause-related sleep disturbances are affecting your quality of life, Philadelphia Integrative Psychiatry offers a range of tailored treatment options. Whether through medication management, therapy, or holistic interventions, our team is here to help you regain restful sleep and improve your overall well-being. Schedule an appointment today to explore the best treatment approach for you.
For More on This Topic and Related Subjects, Check Out These Blogs by Dr. Danish:
https://phillyintegrative.com/blog/hormones-and-mental-health-navigating-womens-unique-challenges
Sources
https://pubmed.ncbi.nlm.nih.gov/35707298/
