Perhaps You Can't Blame Menopause for Your Insomnia After All

Patient Expert

older woman with insomnia

As we get older, sleep problems often become more common. It has long been suggested that for women, symptoms of menopause are to blame for sleep difficulties — however, is there any real science to support this claim?

A study published in the journal Menopause set out to estimate just how prevalent sleep problems are at menopause, and to determine the predictors of sleep issues at menopause.

The study involved 255 women aged between 35 and 48 who were premenopausal at the start of the study. All participants reached natural menopause during the 16-year follow-up period between 1996-2012.

None of the participants had any serious health issues known to affect ovarian function. Participants were not permitted in the study if they had suffered a major psychiatric disorder in the previous year, were pregnant or breast-feeding, had uncontrolled hypertension, were taking hormonal or psychotropic medications, or abusing alcohol or drugs.

Participants were assessed roughly every nine months over the course of 16 years. Data was collected primarily through in-home visits. These were timed to the days two-through-six (or the early follicular phase) of the menstrual cycle, for two consecutive menstrual cycles, or approximately one month apart in non-cycling women. Monitoring lasted for 14 assessment periods. The final two 15th and 16th assessments were conducted by telephone interview.

Sleep quality was measured through a validated menopausal symptom questionnaire that asked the following question:

“Have you experienced trouble sleeping in the past month?”

Additional questions then determined the frequency and severity of poor sleep.

The study found that:

  • At premenopause, 28 percent of women reported moderate/severe poor sleep
  • At the final menstrual period, 34 percent reported moderate/severe poor sleep

Interestingly, at late postmenopause (at least three years after the final menstrual period), poor sleep was found to decrease slightly.

The primary predictor of poor sleep at menopauseAfter analyzing all the data, researchers found that** premenopausal sleep quality was the strongest predictor of poor sleep in the years around the final menstrual period.**

In fact, women with moderate to severe poor sleep before menopause were three-and-a-half times more likely to suffer from moderate to severe poor sleep around the final menstrual period.

Women with mild poor sleep before menopause were one-and-a-half times more likely to suffer from moderate to severe poor sleep around the final menstrual period.

Can we blame hot flashes for poor sleep at menopause?

Those with moderate to severe hot flashes were nearly twice as likely to experience poor sleep at the final menstrual period — however, hot flashes were not experienced by all of those who experienced poor sleep.

Other risk factors for moderate/severe poor sleep at menopause included anxiety and perceived stress.

Just as poor premenopausal sleep quality predicted poor menopausal and post-menopausal sleep quality, the greatest impact of perceived stress on poor sleep occurred in the pre-menopausal period.

Interestingly, this study found that changes in reproductive hormone levels were not linked to poor sleep quality.

In conclusion

This research is important because it revealed that we can't simply blame poor sleep on menopause or hot flashes alone.

Instead, it found that sleep quality before menopause was the greatest predictor of poor sleep in the menopausal and post-menopausal period.

Although there was a link between poor sleep quality and hot flashes, a significant number of study participants reported poor sleep without experiencing any hot flashes.

It would appear, therefore, that the absolute best thing you can do to avoid poor sleep in the menopausal period is to improve your sleep before menopause hits.

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