Sleep problems are one of the hallmark symptoms of menopause – 50% to 80% of women with menopausal symptoms complain of sleep issues. Menopause onset typically occurs around 51 to 52 years of age, but many patients will begin having symptoms years before. Unfortunately, many patients feel their providers do little to help them with their symptoms.
Patients with vasomotor symptoms, also known as hot flashes, have lower sleep efficiency, as they tend to wake multiple times during the night due to discomfort. Some have to change their night clothes because of perspiration. Over time, this can lead to insomnia and depression.
Hormone replacement therapy may abate insomnia symptoms, as this treatment helps decrease vasomotor occurrences during sleep. Of course, I would recommend consulting a provider who has a specialty in hormone replacement and who can discuss the risks and benefits of replacement therapy.
Obstructive sleep apnea increases among menopausal women to rates equal to those seen in men. When a menopausal woman complains that she is overly fatigued, a decrease in hormones may not be the only cause. If the patient reports that she has started snoring, consider sleep-disordered breathing, and send her for a polysomnogram.
As any of your menopausal patients will tell you, maintaining a healthy weight can become more difficult. Weight gain also increases the risk for obstructive sleep apnea, so be sure you discuss the importance of diet and exercise with these pateints.
Hypertension incidence also sharply increases in menopausal women. The reason for this is still being studied, but it may be related weight gain and increases in sleep-disordered breathing.
Restless leg syndrome is another sleep disorder to look out for in this population. It is hard to determine whether hormonal changes or increasing age, in general, account for RLS, but it needs to be managed in order to keep from exacerbating insomnia and depression.
Inability to fall asleep is the most common complaint among menopausal women. Talk to these patient about practicing good sleep hygiene, and prescribe sleep aids if needed. Most importantly, remember that reassurance can be very helpful.
Do not discount a woman’s feelings about this important transition in her life, and remember there are also psychological effects that come with these physical changes. Menopausal women may be experiencing some depression and feelings of sadness, and you may be the only person they feel comfortable talking to about them. You can make a difference, if you are willing to listen.
Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.
- Attarian HP, Schuman C. Clinical Handbook of Insomnia. 2nd edition. New York: Humana Press, 2010. Print.