Sleep Like Your Life Depends on It—Because During Menopause, It Just Might
Elizabeth Yuko
Between night sweats and insomnia, menopause isn’t exactly known as a time of restful sleep. Sleep disturbances are common during this transition period, and can start during perimenopause. But according to a new study published in the journal Menopause, sleep during menopause is crucial for long-term cardiovascular health.
The researchers used the eight components of the American Heart Association’s health-assessment tool—nutrition, physical activity, smoking abstinence, sleep, body mass index, blood lipids, blood sugar and blood pressure—to determine midlife women’s cardiovascular risk. Out of those eight measurements, poor sleep turned out to be the best potential predictor for long-term effects of cardiovascular disease events and death from any cause.
Here’s what to know about why sleep is so important during menopause, and how to improve your sleep quality.
Why Is Sleep So Important During Menopause?
Sleep plays a central, and often underappreciated, role in how the body navigates menopause, says Dr. Bronwyn Holmes, a physician and member of the medical advisory board at virtual metabolic health clinic Eden.
“The hormonal shifts that occur in perimenopause and beyond, particularly declining estrogen and progesterone, directly impact sleep quality,” she explains. “These same hormones also have protective cardiovascular functions, so their decline increases a woman’s baseline risk for both disrupted sleep and heart health issues.”
Sleep is also important in menopause because it allows our body to recover and sets us up for the next day, says Dr. Suzanne Bovone, an OB-GYN specializing in menopause at Pediatrix Medical Group in San Jose, California.
“Poor sleep will not allow your body time to rest and recover from the day’s activities and stress,” she explains. Plus, inadequate sleep also affects mental health, Bovone says, and if you don’t get quality sleep, it can worsen depression and anxiety.
“Good sleep also supports recovery, mood stability and reduces the overall stress burden during a time when hormone levels are in flux,” says Dr. Janet Choi, an OB-GYN, reproductive endocrinology, infertility specialist and the chief medical officer of Progyny, a leading women’s health benefits solution.
Sleep is also a time when the body regulates inflammation, restores metabolic balance and repairs the vascular system, Holmes says. “Disrupted or insufficient sleep during this stage of life can aggravate blood pressure, insulin resistance and even cholesterol patterns—all of which are cardiovascular risk markers.”
What’s the Connection Between Sleep and Heart Health During Menopause?
As previous research has demonstrated, estrogen has a cardioprotective effect—meaning it offers some protection against heart disease and heart-related events. So, as estrogen levels decline during menopause, the risk for heart disease goes up, Choi says.
Poor sleep quality during perimenopause or menopause can also increase someone’s risk of heart disease or stroke, Bovone says.
“Perimenopause and menopause can disrupt sleep to the point that deep sleep is at a fraction of what it should be,” she explains. “With this, the healing and restoration of our bodily functions is narrowed to a point that when it happens over and over again [leads] to chronic inflammation and disease. Seeking help to restore adequate sleep should be a priority all throughout life but especially during perimenopause and menopause.”
According to Choi, the risk of cardiovascular events is even higher for those who go through menopause before age 45 or experience premature ovarian insufficiency before age 40.
“While hormone therapy may be helpful for those groups, it’s not recommended just for heart health in women who reach menopause at the typical age,” she says. “That’s why healthy habits like getting good sleep are so important; they can help support heart health during this time of hormonal change.”
How to Improve Sleep Quality During Menopause
The team behind the recent study in found that at midlife, getting enough sleep—seven to nine hours for most adults—may contribute to women’s heart health and longevity: a hypothesis that should be tested in future research, says Ziyuan Wang, a PhD candidate at Pitt Public Health and first author of the study. But for many people going through perimenopause or menopause, that’s easier said than done.
Sleep during menopause can be a vicious cycle, Holmes says. “Hormone changes lead to poor sleep, and poor sleep worsens hormone dysregulation, mood, weight and inflammation,” she explains. “That’s why a multi-pronged approach is best.”
Here are some expert tips for improving sleep quality during menopause.
Stick to a Sleep Routine and Schedule
Give yourself time to wind down at the end of the day—whether that means taking a shower or bath, reading a book (ideally not on some kind of screen) or doing mindfulness exercises.
Along the same lines, try to keep a regular sleep schedule, Bovone says. “We think ‘catch up’ sleep will equalize the sleep we didn’t get during the week or on the weekend,” she explains. “But our bodies need consistent sleep. It means going to bed at the same time—plus or minus 20 minutes—and getting up at the same time.”
Get Morning Sunlight
Exposure to sunlight as soon as you wake up in the morning can help you feel more awake, refreshed and alert, setting you up for the rest of the day.
“Just 15 minutes of natural light in the morning can help realign your circadian rhythm and stimulate melatonin production later in the evening,” Holmes says.
Avoid Sleep Disruptors
Poor sleep quality leads to daytime sleepiness, fatigue and brain fog, so it’s no wonder people reach for caffeinated products late in the day or take a “catch up” nap to compensate and try to stay awake, Bovone says. The problem is that caffeine after 2 p.m. or long naps can then prevent you from falling asleep that night.
“It’s a vicious cycle,” she notes.
Cool Your Sleep Environment
Open your window or set your thermostat to a lower temperature at night.
“A drop in core body temperature is essential for initiating sleep, and many women in perimenopause are more heat-sensitive at night due to vasomotor symptoms, like night sweats,” Holmes says. In addition to the temperature of the room, there are also plenty of products dedicated to helping you have a more comfortable night’s sleep, including cooling pillows, cooling sheets and cooling pajamas.
Balance Blood Sugar During the Day
Holmes recommends avoiding high-sugar and low-protein meals, which cause glucose spikes, and are followed by crashes that can disrupt sleep hormones like melatonin and cortisol. Instead, eat a more balanced diet throughout the day, and avoid heavy meals right before going to sleep.
Move Your Body
According to Choi, exercise may be a helpful tool in improving your sleep quality. Aside from all the usual health benefits, physical activity has been shown to help regulate body temperature and improve sleep quality—both of which are important for managing hot flashes and night sweats.
Exercise Your Mind
Mind-body exercises like yoga may be particularly beneficial for improving sleep quality, “as they are low impact and can help lower cortisol, a stress hormone that interferes with restful sleep,” Choi says.
Talk to Your Doctor About Hormone Replacement Therapy
If you’re going through perimenopause or menopause and haven’t done so already, you may want to talk to your doctor about hormone replacement therapy (HRT). “In perimenopause, hormone replacement with estrogen and progesterone can work wonders to reduce or eliminate night sweats so that people sleep better,” Bovone says. “A bioidentical progesterone also aids sleep.”
Ultimately, improving your sleep quality won’t just make your day-to-day life better, but it can also help reduce the risk of cardiovascular events in the long run.
“Sleep isn’t a luxury during menopause,” Holmes says. “It’s a foundational part of how a woman’s body processes hormonal change and how well she moves through that transition over the long term.”
