Menopause & Sleep: What Everyone Needs to Know (Men Included!)

Sleep changes with age for all of us - yet for women, the menopausal transition brings a unique set of challenges that can significantly disrupt rest, energy, and emotional stability. And this doesn’t just affect women. Partners, husbands, sons, managers, friends - understanding what’s happening can strengthen relationships, reduce misunderstandings, and help create more supportive environments at home and at work.

This is not “just hormones”. It is biology, temperature regulation, neurotransmitters, airway changes, and a rewiring of the systems that control sleep.

Let’s break down the science and take a look at the evidence-based solutions.

Why Sleep Gets Harder With Age

Across the lifespan, two things naturally decline for everyone:

• Melatonin production

Our sleep hormone steadily reduces after puberty, making it harder to fall asleep and stay asleep (Duffy et al., 2015).

• Slow-wave sleep (deep sleep)

This is the brain’s most restorative sleep stage. As it declines, the nervous system becomes more vulnerable to awakenings and sleep fragmentation (Ohayon et al., 2004).

But women face extra challenges due to sex hormones, temperature regulation, and major reproductive milestones.

The Female Sleep Curve: Why Women’s Sleep Changes Dramatically

Women’s sleep is shaped by interactions between:

• Oestrogen, which supports serotonin, mood stability, and a lower core body temperature at night (Baker et al., 2018).
  
• Progesterone, which has calming, GABA-enhancing effects and supports smooth breathing during sleep.
• Female physiology, including menstruation, pregnancy, postpartum changes, and perimenopause.
  

Although men experience decreasing sleep quality with age too, women undergo sharper changes because their hormone shifts are more dramatic.

When Hormones Decline: The Menopause Turning Point

During menopause, the ovaries stop producing oestrogen and progesterone, and sleep often takes the hit.

Common symptoms:

• Difficulty falling asleep
• Frequent night-time awakenings
• Lower overall sleep quality
• Greater risk of insomnia and sleep disorders
  

In fact:

39%-47% of perimenopausal women, 35%-60% of postmenopausal women report chronic sleep issues (Kravitz et al., 2015)

And for many, sleep troubles begin years earlier, during the 39-45 years peri-menopausal window.

Why Sleep Becomes So Disrupted

• Hot flushes and night sweats

Around 75–85% of women experience these. Interestingly, which comes first?

In 1/3 of cases, the hot flush causes the awakening.
In 2/3 of women, the brain awakens first, then the hot flush occurs.

This is why some women say:
“I woke up boiling,” while others say:
“I woke up, then the heat hit.”

Both are biologically accurate!

• Mood changes

Oestrogen supports serotonin, which influences mood, anxiety levels, and sleep regulation. Reduced serotonin can increase vulnerability to anxiety and low mood, creating a cycle where poor sleep worsens emotional resilience (Rybaczyk et al., 2005).

• Breathing-related sleep disorders (progesterone decline)

Progesterone is a respiratory stimulant. When levels fall, airway muscle tone decreases, and together with age-related weight gain, this increases the risk of:

- Obstructive sleep apnoea (OSA)

- Hypopnoea (partial airway collapse)

The Apnoea-Hypopnoea Index (AHI) is used to classify severity:

- Mild cases: Often treated with a mandibular advancement device (brings jaw forward, increases airway space)

- Moderate-severe cases: Often requires CPAP (Continuous Positive Airway Pressure), which gently pumps air to keep the airway open

OSA is under-diagnosed in women, often mistaken for “insomnia”, “stress”, or “anxiety”.

Managing Sleep in Menopause: What Actually Helps

• Medication & Medical Options

Hormone Replacement Therapy (HRT) remains one of the most effective options for easing hot flushes and improving sleep, though it always requires a personalised discussion about risks and benefits (The North American Menopause Society, 2022). Other medical routes, such as SSRIs and SNRIs, can offer support for mood and temperature regulation, while short-term hypnotics may be considered with care, particularly for those with potential sleep apnoea. Nutritional and supplement-based strategies show mixed but emerging promise, with soy-derived phytoestrogens, certain herbal combinations, and blends like magnolia bark with soy indicating potential benefits for sleep and symptom relief in early studies (Chen et al., 2021).

• Mind-Body Interventions

Practices such as yoga and gentle stretching have been consistently linked with better sleep quality and fewer menopausal symptoms, offering a calming, low-risk way to support both physical and emotional balance during this transition (Newton et al., 2014). Acupuncture also shows emerging promise, with some studies reporting reductions in hot flush frequency, although the evidence base remains limited and continues to evolve.

• CBT-I (Cognitive Behavioural Therapy for Insomnia)

CBT-I (Cognitive Behavioural Therapy for Insomnia) is one of the most robust, evidence-supported treatments for menopausal insomnia, helping to ease sleep-related worry, reset unhelpful routines, rebuild confidence in the ability to sleep, and improve overall sleep efficiency without relying on medication (Qaseem et al., 2016). Research, including smaller trials focused on peri- and post-menopausal women, consistently demonstrates meaningful improvements in sleep quality, symptom burden, and next-day functioning, making CBT-I a highly effective non-pharmacological option during this transitional stage.

• Lifestyle & Environment

Creating an optimal sleep environment starts with temperature management, as even small variations in thermal comfort can disrupt your ability to fall and stay asleep. Research suggests that a cooler bedroom, typically around 16-18°C, supports the natural drop in core body temperature needed for sleep initiation (Kräuchi & Deboer, 2010). Choosing natural fibres and breathable cotton bedding or pyjamas helps regulate heat and minimise night-time sweating, while keeping spare bedding close by allows for quick adjustments if you become too warm or too cold. Avoiding spicy meals in the evening can reduce the risk of reflux and body-temperature spikes, both of which can interfere with deep sleep. Similarly, limiting late-night liquids reduces overnight awakenings due to increased bathroom trips, helping you maintain a more consolidated and restorative sleep cycle.

• Sleep Hygiene

Good sleep hygiene hinges on creating conditions that allow the brain and body to settle into rest effortlessly. Cutting off caffeine after lunch helps prevent the adenosine-blocking effects that can delay sleep onset, with research showing caffeine consumed even six hours before bedtime can significantly disrupt sleep quality. Reducing alcohol and nicotine is equally important; while alcohol may initially make you feel drowsy, it fragments sleep later in the night, and nicotine is a stimulant that raises heart rate and alertness. Keeping evening meals light avoids nocturnal digestive discomfort, and maintaining a clutter-free bedroom free from “daytime tasks” minimises cognitive arousal and supports the brain’s association of this space solely with rest. Avoiding vigorous exercise late in the evening prevents elevations in core body temperature that can delay melatonin release, and reducing screen time helps limit blue light exposure, which is known to suppress melatonin and shift circadian rhythms. Together, these simple yet powerful habits help reinforce your natural sleep–wake rhythm and elevate overall sleep quality.

Navigating Menopause Together: Practical Ways Men Can Support

It can be incredibly helpful for men to understand that menopause often influences sleep, mood, and communication in ways that are unintentional and sometimes difficult to articulate. When sleep becomes disrupted, it may show up as irritability, withdrawal, or low energy, but these changes are often grounded in biology rather than disinterest or distance. By being aware of this, men can offer meaningful support by encouraging an earlier wind-down routine, or recognising when emotional shifts may be hormonally influenced. Being present at medical appointments can also strengthen understanding and teamwork which can often make a profound impact on how well both partners navigate this transition together.

The Bottom Line

Sleep during menopause is a complex interplay of hormones, temperature, neurotransmitters, airway structure, and psychological factors. The good news? With the right knowledge, targeted interventions, and supportive environments, sleep can dramatically improve.

Key References:

Baker, F. C., Lee, K. A., & Summers, P. (2018). Physiological sleep changes across the menstrual cycle: A review. Journal of Clinical Sleep Medicine, 14(7), 1081–1088.

Bansal, R., & Aggarwal, N. (2019). Menopausal hot flashes: A concise review. Journal of Midlife Health, 10(1), 6–13.

Chen, L. R., Ko, N. Y., & Chen, K. H. (2021). Isoflavone supplements and menopause symptoms: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 18(4), 1881.

Duffy, J. F., Zitting, K.-M., & Chinoy, E. D. (2015). Aging and circadian rhythms. Sleep Medicine Clinics, 10(4), 423–434.

Kravitz, H. M., et al. (2015). Sleep symptoms in menopausal women: Prevalence and use of sleep aids. Menopause, 22(9), 1–10.

Kräuchi, K., & Deboer, T. (2010). The interrelationship between sleep regulation and thermoregulation. Frontiers in Bioscience (Landmark Edition), 15(2), 604–625.

Newton, K. M., Reed, S. D., Guthrie, K. A., Sherman, K. J., Booth-LaForce, C., Caan, B., Sternfeld, B., Carpenter, J. S., Learman, L. A., Freeman, E. W., Cohen, L. S., Joffe, H., Anderson, G. L., Larson, J. C., Hunt, J. R., Ensrud, K. E., & LaCroix, A. Z. (2014). Efficacy of yoga for vasomotor symptoms: A randomized controlled trial. Menopause, 21(4), 339–346. 

Ohayon, M. M., Carskadon, M. A., Guilleminault, C., & Vitiello, M. V. (2004). Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: Developing normative sleep values across the human lifespan. Sleep, 27(7), 1255–1273.

Qaseem, A., et al. (2016). Management of chronic insomnia disorder in adults: ACP guideline. Annals of Internal Medicine, 165(2), 125–133.

Rybaczyk, L. A., Bashaw, M. J., Pathak, D. R., Moody, S. M., Gilders, R. M., & Holzschu, D. L. (2005). An overlooked connection: Serotonergic mediation of estrogen-related physiology and pathology. BMC Women's Health, 5, Article 12.

The North American Menopause Society. (2023). The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause, 30(6), 573–590.