As we sleep, the brain cycles through four different stages of sleep

  • NREM -Nonrapid eye movement, (N1)
  • NREM-Nonrapid eye movement, (N2)
  • NREM-Nonrapid eye movement, (N3)
  • Rapid eye movement

And our sleep is predominance by two important methods

  • The process of Homeostatic
  • The process of Circadian

The two most communal symptoms found in postmenopausal women are fatigue and insomnia. Menopause is defined as the period, in which there is a lapse of a good 1 year since the last LMP, last menstrual period. Though the changes in hormonal levels can be observed 7 to 10 years before the onset of menopause, causing the decline in inhibin as well as estradiol levels and an upsurge in two major hormone levels, namely luteinizing hormone as well follicle-stimulating hormone respectively. But what causes sleep problems in Menopause? Approximately 40 to 60 percent of women signify improper sleep during the menstrual transition period. Insomnia-like dimensions with low and improper quality of sleep are pre-requisite of menstrual transition. During the year 2005, the NIH State-of-the-Science Conference Statement on the management of menopause-related symptoms divulges that sleep disturbance is the primary cause of menopause. Women, therefore, undergo several psychological and physical changes, for instance,

  • Mood swing
  • Anxiety
  • Depression
  • Sexual dysfunction
  • Loss of memory

What causes sleep problems in menopause?

Menopause is regarded as the major milestone contributing to sleep problems in menopausal women. In menopause, the ovaries of the female inhibit the production of two core hormones, estrogen, and progesterone. These two hormones are greatly responsible to affect mood, sex drive, etc. They are also responsible for accord sleep complications, including sleep apnea respectively. During the night, estrogen is liable to keep the estrogen at a lower level, making it more favorable towards restlessness. Low levels of estrogen also contribute to

  • High body temperature
  • Improper sleep quality
  • Disturbed mood

Does menopause cause sleep problems?

Menopause prejudices women to many symptoms that pointedly decrease the life quality. One of the major symptoms contributing to it is sleep problems, especially insomnia and sleep apnea. Menopausal transition in women solely contributes to sleep problems which are caused by

  • The decline of sex hormones
  • Aging
  • Could be both

Sex hormones, especially the estrogen receptor in the brain are responsible for the pattern of sleep regulation. Therefore, sex hormones together influence sleep through various neurotransmitters. Decreased levels of sex hormones in women are associated with an extremely worse subject quality of sleep.

Why does menopause affect sleep? 

Menopause causes various unpredictable physical and psychological changes in the female body, with 60 percent of women reporting fragmented rest and insomnia at the same time. The primary sleep problems reported by most of the women are listed below

  • Hormonal changes especially hot flushes
  • Decrease in melatonin production
  • Insomnia
  • Obstructive sleep apnea
  • Vasomotor symptoms
  • Restless legs syndrome followed by periodic limb disorder
  • Mood disorders

Hormonal changes-hot flushes

Hormonal changes are very common to experience after menopause. Hot flushes are defined as the unexpected and sudden sensation of heat in the entire body following sweating. The hot flushes can be observed firstly on the face and then on the rest of the body. The hot flushes can last for a minimum period of 30 seconds and a maximum period of five minutes. According to the study, approximately 75 to 85 percent of women go through hot flashes after the transition of menopause. Hot flushes increase the production of adrenaline hormone, which makes it harder to fall asleep again at night

Melatonin production 

Melatonin plays a major role in the sleep pattern of menopausal women. It regulates the circadian rhythm through a block arousal mechanism. These effects support the human body to fall asleep at night. However, the relationship and bonding between menopause and melatonin are still unclear to scientists. The episodes of melatonin are decreased with aging; however, this is not always associated with menopause. A recent study showed that the levels of melatonin in postmenopausal women suffering from insomnia are relatively decreased than in those suffering from perimenopausal. Melatonin is also involved in body temperature regulation. Insomnia is defined as a condition in which a person has trouble staying and falling asleep for three consecutive nights. The deprivation of sleep in insomnia may contribute to

  • Increase in restlessness and irritability
  • Loss of memory
  • Impaired and loss of focus
  • Headache Inflammation

Obstructive sleep apnea

Increased levels of estrogen and progesterone work as a shield and protect the women before menopause. These hormones are mainly responsible for maintaining the muscle airway pathway. But once menopause has occurred, it will decrease the levels of estrogen and progesterone, causing pronounced sleep apnea. Women also tend to put on weight after menopause, this increases the neck circumference level, hip-waist ratio, and body mass index. Therefore, the airway path changes anatomically and causes obstructive sleep apnea.

The vasomotor symptoms

The vasomotor symptoms are relatively the primary symptoms reported in menopausal women. Vasomotor symptoms often called hot flushes, are defined as the sudden increase in the flow of blood that appears on the face, neck, chest, and lower limb area followed by profuse seating respectively. When these vasomotor symptoms occur during the night period, then these are typically called night sweats leading to abnormal sleep patterns. The episodes of vasomotor symptoms can occur for a minimum period of 30 seconds to a period of up to 5 minutes. Vasomotor symptoms can also be associated with

  • Perspiration
  • Flushing
  • Anxiety
  • Chills
  • Heart Palpitation

The most deliberating effect of these vasomotor symptoms can be observed in the first two years of menopause. However, in some women, it may indefinitely persist.

Restless legs syndrome followed by a disorder of periodic limb movement

Restless leg syndrome is a disorder in which a person feels leg movement which is escorted by an excruciating sensation. Even though restless leg syndrome is not linked with hormonal therapy and/or menopause, it is seen to increase with increasing age. The causes are unknown, but are known to be associated with

  • Pregnancy
  • Iron deficiency anemia
  • Uremia

On the other hand, periodic limb movement disorder is the continuous and repetitive jerking of the leg every 20 to 30 second during the night. It is therefore considered one of the major causes of improper quality of sleep.

Mood disorders

Certain mood disorders, for instance, depression and anxiety are associated with menopause. Trouble falling asleep during the night may cause

  • Anxiety
  • Irritability
  • Inadequate sleep
  • Depression
  • Insomnia is the main cause of depression.

Additionally, women suffering from hot flashes also advance depression.

Does menopause cause you to wake up in the middle of the night?

Menopause causes one to wake up in the middle of the night. This could be due to hot flashes, vasomotor symptoms, and restless leg syndrome. Often the sleeplessness due to menopause is linked with hot flashes. The body temperature rises at a certain level, and there is the extreme sensation of heat along with sweating. Perspiration may occur as a part of hot flashes. Unexpected awakenings are often associated with night hot flushes. Waking up in the middle of the night could also occur due to sleep apnea. In sleep apnea, the woman is unable to breathe properly due to anatomically changed structures after menopause.

Does menopause insomnia go away?

Menopause insomnia can go away, if it is related to hormones. Hormonal therapy is the recommended treatment to balance the hormone levels after menopause and to treat insomnia. Options include

  • Hormone replacement therapy
  • Intake of low doses of antidepressants
  • Intake of low doses of birth control
  • Intake of Melatonin

These above-mentioned options are found to be useful in treating menopause-related insomnia.

Can menopause cause sleep apnea?

Menopause can cause sleep apnea in women suffering from menopause. The prevalence is seen more in postmenopausal women than in perimenopausal women. During recent studies, nearly 47 to 67 percent of women with post-menopause suffer from sleep apnea. Women are more likely to put on weight after menopause. this increases the neck circumference level, hip-waist ratio, and body mass index. Therefore, the airway path changes anatomically and causes sleep apnea.

Conclusion

Sleep disorders are mainly due to aging because the cause of sleep complications in menopausal women is multifactorial. Though the etiology of the sleep disorder is not very clear, it is seen that hormonal therapy right after menopause has decreased the complications related to sleeping pattern. It is considered the primary and most recommended treatment for sleep disorders in menopausal women. Sleep complications may also be connected with

  • Limb movement syndrome
  • Depression as well as Anxiety
  • Restless leg syndrome

Hence, to alleviate the sleeping disorder in postmenopausal women, it is recommended to find the root cause.