Insomnia and Menopause Part 1 - Insomnia and Hormones
This article is part one of a two-part series on insomnia in menopause. Part 1 reviews the direct effects of menopause on sleep, and part 2 reviews the indirect effects that can contribute to developing insomnia.
So, what is menopause and exactly how does it affect sleep? Women in menopause can tell you exactly what it's like!
What is menopause?
Menopause refers to the time of life in which a woman shifts away from a period where she can menstruate and conceive, typically around the age of 50. Menopause happens as a result of a natural decrease in levels of reproductive hormones and of all the hormones that change, estrogen, and progesterone have the most significant impact on sleep.1
The insomnia symptoms women experience in menopause are not unique to them; however, the initial trigger for the insomnia is different than it is in other people. In the case of a menopausal woman, insomnia is caused in part by hormonal shifts that can directly affect sleep - as well as causing uncomfortable symptoms that can disturb sleep.2
Hormonal changes in menopause
Insomnia often starts with what we call a "precipitating factor" - the life stress, medical condition, or situation that "sets off" insomnia. In the case of a woman who is perimenopausal or menopausal, this precipitating factor is at least in part the hormonal change they are experiencing.
Hormone changes in menopausal women may prompt a change in her sleep quality and sleep patterns. This is a direct effect caused by changes in the two most key reproductive hormones - progesterone and estrogen.
Progesterone has a strong effect on sleep drive. Sleep drive is that desire to sleep that builds throughout the day. One of progesterone's jobs in the body is to help create more "relaxation" neurotransmitters in the brain. The higher the levels of progesterone, the more they can help promote sleepiness by helping create more of these chemicals. So, as progesterone drops, it's influence on building sleep drive does too, resulting in more restless sleep.3 Some women who are not in the menopausal years could see this happen during their monthly cycles as well.
Estrogen is another hormone which has strong effects on sleep. Estrogen interacts with melatonin receptors and plays a part in promoting melatonin production.3 Melatonin is a hormone very strongly associated with sleep. When a woman's estrogen drops, there is less estrogen to interact with those receptors, so there is less "response" triggered by melatonin receptors. And, if there is less estrogen overall, it can't help in the production of melatonin. Both of these things can affect sleep "drive" and our biological sleep rhythm.
Direct effects of hormonal change on sleep
The key takeaway here is that changing levels of both of these hormones and other contributing factors make it harder for a menopausal woman to fall asleep and wake up refreshed. These are the direct hormonal influences of menopause upon sleep.
Have you noticed changes in your sleep rhythm during your monthly cycle? And if you're perimenopausal or menopausal, did you notice changes in your sleep before you had any other symptoms?
Check out part 2 to learn more about how the restless sleep caused by these changes and the disturbed sleep caused by other symptoms can lead to insomnia.
Will you take our Sleep Disorders Survey to raise awareness for insomnia?