What’s your sleep number?

Posted by on Mar 13, 2009 in hot flash, Meditation/mindfulness therapy, menopause, mind-body therapy, sleep disturbance | 2 comments

[Rembrandt van Rijn, Sleeping Woman, 1658]

On a scale of 1 to 5 would you say that your sleep number (the quality of your sleep) is:

  1. nonexistent, I never sleep
  2. occasional, I sleep one or two nights a week
  3. obstructed, I sleep but I wake up regularly throughout the night
  4. pretty good, I rarely wake up
  5. great, I typically sleep through the night

If you are like most peri- post menopausal women, it’s likely that you rate the quality of your sleep about a “3. ” In fact, a review in the journal Current Neurology and Neuroscience Reports suggests that 28% to 64% of peri- or postmenopausal women have some form of sleep disturbances that may aggravated by sleep apnea, periodic limb movements syndrome (restless leg syndrome) and psychological distress (anxiety, major depression).

One of the primary causes of sleep disruption during menopause is declining estrogen levels, which increase peripheral and central temperature, dilate blood vessels and lead to hot flashes. Unfortunately data also suggest that  hot flashes double the time spent awake although ironically, they often follow rather than proceed awake times.

More good news: both sleep apnea and periodic limb movements syndrome increase with age. Menopausal women are espeically at risk due to declining progesteron levels and increased body mass index (and associated increases in neck circumference). Both sleep apnea (in which the airways become partially or totally obstructed) and periodic limb movements obviously interefere with sleep quality. In fact, sleep researchers have documented apnea, restless leg syndrome or both in up to 53% of women between the ages of 44 and 56.

The evidence is less certain for mood disturbances and sleep, although studies have shown clear links between reproductive hormonal changes and clinical depression in women going through menopause. What’s more, women in menopause who are clinically depressed have reported more frequent and longer times awake than those who do not have any mood disturbances.

Steps to take

I’ve written previously on this issue and there are a variety of non-pharmacologic steps that might improve sleep quality including standardized herbs and acupuncture.

Hypnosis, relaxation techniques that include breathing and/or biofeedback) may also assist. These strategies are part of a larger approach called cognitive-behavioral therapy for insomnia (CBT-I) which in a small study, was found to significantly improve anxiety, depression, partner relationships, sexuality and hot flashes in menopausal women.

Notably, the benefit of HRT for sleep/mood disturbances remains unclear and studies are inconclusive.

As with any issue associated with menopause, it’s critical to speak to a health practitioner about the issue so that the course of therapy can be safely individualized and personalized.

What about you? How’s your sleep? And what are you doing about it?


  1. 3-18-2009

    Thanks for the informative posting. I’ve had great success giving menopausal women transdermal progesterone to help them sleep. Physiologically this makes sense since progesterone receptors in the brain are believed to help regulate sleep functioning and most menopausal women have declining progesterone production. The existing scientific data supports the safety of progesterone as well.

    • 3-18-2009

      Thanks Peter. I’ve used transdermal progesterone quite successfully and agree; it’s helped.


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