Hormonal causes

Sleep disturbances are among the most common symptoms of the menopause, being reported by 35-60% of post-menopausal women.

The most common symptoms are trouble falling asleep and difficulties maintaining sleep.

The aetiology of sleep problems in the menopause is uncertain, but may be due to:

• A decline in oestrogen levels. Oestrogen is involved in the metabolism of serotonin and other neurotransmitters that affects the sleep-wake cycle. Oestrogen also has a direct effect on mood and regulation of body temperature, keeping the central body temperature low at night.
• A decline in progesterone levels. Progesterone has both sedating and anxiolytic features. It stimulates the release of GABA, a sedating neurotransmitter that can facilitate sleep cycles. In addition, progesterone also acts as a respiratory stimulant, which may benefit sleep apnoea.
• Menopausal symptoms such as hot flushes, night sweats, palpitations, mood changes or urinary problems.
• Worsening restless leg syndrome. This increases in severity after menopause, regardless of the use of HRT.
• An increased incidence of sleep-disordered breathing during the menopause transition, although the mechanism of this is not clear.