Menopause and sleep: night sweats, insomnia and ways to sleep better

Changes in sleep are one of the most commonly reported symptoms around the menopause. The NHS includes sleep problems in its list of perimenopause and menopause symptoms, saying not being able to get to sleep or stay asleep can affect your daily life and make you feel irritable, stressed and anxious. It also lists menopause among the causes of insomnia on its general insomnia page.

The same NHS page defines insomnia as regularly finding it hard to go to sleep, waking several times in the night, lying awake, waking early and not being able to go back to sleep, still feeling tired after waking, and finding it difficult to concentrate during the day. Short-term insomnia lasts less than 3 months and long-term insomnia lasts 3 months or longer.

The NHS describes hot flushes as a sudden feeling of being very hot or cold in the face, neck and chest, which can make you sweat a lot, cause palpitations or anxiety, or make you feel dizzy, and which can occur at night as night sweats and last for several minutes. Sleep problems may be worse if you also have night sweats.

For this reason, treating night sweats is often part of treating sleep. NICE recommends that HRT be offered to people with vasomotor symptoms associated with menopause, and that menopause-specific CBT is considered as an option, in addition to HRT or for people for whom HRT is contraindicated or who prefer not to take it.

The NHS menopause advice includes getting plenty of rest and keeping to regular sleep routines. For hot flushes and night sweats it suggests wearing lightweight clothing, keeping your bedroom cool at night, taking a cool shower, using a fan or having a cold drink, reducing stress and avoiding triggers such as spicy food, caffeine, hot drinks, smoking and alcohol, exercising regularly and keeping to a healthy weight.

The NHS insomnia advice adds general sleep habits that apply to anyone.

• Go to bed only when you are sleepy and get up at the same time every day.

• Relax for at least an hour before bed, for example with a bath or a book.

• Keep the bedroom dark and quiet, with comfortable bedding.

• Exercise regularly during the day, but not within 4 hours of bed.

• Avoid smoking, alcohol, tea or coffee for at least 6 hours before bed, and avoid big late meals.

• Avoid screens right before bed, napping during the day and sleeping in after a bad night.

On HRT, the NHS says oestrogen is the main type and can help manage symptoms, taken as tablets or used as patches, spray or gel, and that progestogen is needed to protect the womb if you have not had a hysterectomy. If HRT does not work or is not suitable, the NHS says other options are available, including CBT for hot flushes and night sweats, and if that does not help a doctor may suggest clonidine or an antidepressant.

NICE's guideline says to consider menopause-specific CBT as an option for people who have sleep problems such as night-time awakening in association with vasomotor symptoms. The NHS insomnia page explains that CBT, face-to-face with a therapist or through an online self-help programme, can help change the thoughts and behaviours that keep you from sleeping.

Pharmacy sleep aids are mentioned by the NHS, which says they may help you sleep better for 1 to 2 weeks but should not be taken for longer and some can cause drowsiness. Check with your doctor before taking anything for your sleep problems.

The NHS advises seeing a GP if changing your sleeping habits has not helped, you have had trouble sleeping for months, or your insomnia is affecting your daily life in a way that makes it hard to cope. A GP will try to find out what is causing it, and may refer you to a sleep clinic if you have symptoms of another sleep disorder such as sleep apnoea.

Loud snoring with pauses in breathing, waking gasping, or falling asleep suddenly in the day point to a sleep disorder rather than a menopause symptom, and are worth mentioning. Persistent low mood or anxiety alongside poor sleep also deserves attention.

Daytime tiredness can reduce concentration and mood. The NHS notes that memory and concentration symptoms may feel worse if you have sleep problems and feel very tired. The NHS insomnia advice says to wake at the same time every day, not to nap during the day and not to sleep in after a bad night.

Do not drive when you feel sleepy, as the NHS insomnia advice stresses.

On the NHS, a GP, nurse or pharmacist can discuss HRT and other options for menopause symptoms, and CBT for insomnia may be offered face to face or online. NICE says healthcare professionals should discuss all the treatment options with you and explain the benefits and risks.

Private menopause clinics and sleep clinics are also used, mainly for quicker access or longer consultations. The principles of treatment, including sleep habits, CBT and hormone options, are the same.