Insomnia and Menopause Part I — Common Physiological and Hormonal Causes

Many women approaching their late forties and early fifties discover the insomnia and menopause connection, much to their dismay. This link, however, can be misleading sometimes.

Certain physiological changes related to menopause and perimenopause can directly interfere with sleep. But there are so many other causes of insomnia that it’s often difficult to isolate which ones are menopausal-related and which are simply due to other causes. In some cases, a hormonal-related episode of sleeplessness can trigger sleep anxiety which then begins the familiar feedback-loop of chronic insomnia that persists after the original trigger is resolved.

The Insomnia and Menopause Direct Link–Hormones and (What Else) Hot Flashes

As we know, the technical term of menopause means the ovaries have stopped producing estrogen, at least in the quantity needed for ovulation. But the transition to this phase can take place over several years, even a decade or longer. In this time period, called perimenopause, although we often call it menopause in the latter stages, estrogen levels can fluctuate wildly. And for some strange reason, this causes hot flashes. No one has really figured it out as well as we would like, but there it is.

Hot flashes, which can occur several years before menstruation stops (and also several years afterwards, much to the chagrin of women everywhere), are the leading direct cause of the insomnia and menopause connection. No surprise there.

The nocturnal hot flash is one of the biggest disruptors of slumber known to womankind — outranking thunder, minor earthquakes and catfights outside the window. One minute you’re blissfully unconscious, all bundled up with your cozy blankets on a cold winter night… and the next thing you know, you’re wide awake and throwing off those covers like they were on fire… and often you sweat so much it feels like the fire department already showed up and hosed you down.

While some women are able to get up, cool off, change their nightclothes and go back to sleep, others simply cannot. And if you already have a tendency toward chronic insomnia, returning to sleep after a hot flash/ night sweat can be most frustratingly out of reach. Especially since… that’s right… more keep coming while you’re lying there.

Many women find that their hot flashes occur at roughly the same time each night. From what I’ve gathered and experienced myself, 3:00 AM seems to be a common hour, and may be due to some mysterious connection between the sleep cycle and the estrogen cycle… but of course anytime can be the “right” time for a little night sweating.

Sleep and Body Temperature

Oddly enough, a hot flash doesn’t need to be severe to interrupt sleep. As I’ve pointed out in this article about sleep and body temperature, our internal thermostat plays a big role in helping us to sleep. Specifically, a lowering of body temperature, which takes place naturally when we are in sinc with our daily circadian cycles, is conducive to sleep. This is why it’s so important not to do any strenuous exercise before bed, and to avoid hot baths directly before bedtime, when you are experiencing insomnia.

Women have more variation in their body temperature due to the natural ebb and flow of estrogen, which also regulates the internal thermostat. This is why some women experience occasional sleep irregularities even before perimenopause — in response to the subtle rises and falls of body temperature that takes place during the ovulatory cycle.

When estrogen levels become unstable and imbalanced, body temperature can dance right along with them. The hot flash is the most noticeable result, but many women find that body temperature changes on a larger scale–for example, their base temperature feels hotter in general, in addition to the flashes.

Again, this body temperature change can be quite subtle and still cause the insomnia and menopause connection. It’s possible that if you’re bothered by middle insomnia or terminal insomnia, hot flashes may be the culprit, even if you’re not sweating or even feeling especially hot when you wake up.

More Hot Flash Trouble

Increased instability in body temperature has other effects on the body that can also interfere with sleep in a more indirect way. You might find, for example, that your skin is more prone to rashes and itching, and increased perspiration makes that tendency even worse. There is nothing quite so annoying as a rash or itch waking you up at night, and making it nearly impossible to go back to sleep.

Other Physical Causes of Insomnia during Menopause

Besides the body temperature connection, there are numerous other physical factors linking insomnia and premenopause. Here are just a few:

  • Bloating, cramps, and indigestion — estrogen imbalance can affect the entire digestive system, and that’s just made worse by conditions such as fibroids and other uterine disorders that so often appear during the perimenopausal phase.
  • Weight gain — most women find it’s easier to gain and harder to lose. Women often find their body shape changing at this time. It’s quite common to develop more problems associated with weight gain, such as sleep apnea and snoring.
  • More menstrual and premenstrual pain — breast pain and uterine cramping can worsen during perimenopause, adding fuel to the insomnia and menopause link. Headaches, muscular aches, neuralgia and other pain syndromes can also get worse during perimenopause and beyond.
  • Increased vaginal and skin dryness — most women notice changes in personal areas, as well as in their skin and scalp, which can lead to more itching, discomfort during sex, which of course leads to other problems… and the insomnia and menopause connection continues…
  • Heavy periods — many women get heavier periods that can be quite problematic at night, causing numerous wake-ups and trips to the bathroom, not to mention the anxiety of getting through the night without mishaps. And that’s not even mentioning the actual discomfort involved.
  • Heart and nervous system irregularities — hormonal instability seems to lead to nervous system imbalances — at least that is the experience of many perimenopausal and menopausal women. Heart palpitations (“jumping” or “fluttering” in the heart), a pulse that seems faster at times or more changeable than usual, and other symptoms of nervous system instability, such as increased involuntary muscular movements at rest, are all too common.
    These symptoms contribute greatly to the insomnia and menopause link, causing frequent wake-ups and interruptions in the sleep cycle and a more restless, lighter type of sleep. These symptoms can also be quite worrisome to those who have never experienced them before.

NOTE: Of course any unusual, persistently annoying, or worrisome symptoms you’re having at any time of life should be checked out by a doctor.

OK, we’ve covered many causes of insomnia and menopause difficulties. In Part II, I’ll be discussing natural treatment options.

Return to the Types of Insomnia page.