Night sweats. Insomnia. A racing mind. Middle-of-the-night awakenings that last for hours. If you are a woman in your 40s, you may be experiencing some new nighttime sensations. And you are far from alone. Research shows that a whopping 40-60% of middle-aged women experience sleep problems around menopause, but 39-47% of women experience sleep challenges in perimenopause. These sleep issues can persist for years, making for prolonged periods of sleep deprivation. The lack of sleep can have dramatic impacts: Not getting a good night’s sleep can impact your physical and mental health and your ability to work and function well in your daily life.
If you are experiencing ongoing sleep disruptions in your 40s, you are probably looking for answers. You might want to know what is causing all the physical changes, how the menopause transition may be contributing, and most of all, what you can do to fix the problem and get your sleep back on track.
We caught up with a sleep specialist and two women’s health experts to give us some much-needed answers — and (fingers crossed!) some much-needed sleep.
What sleep issues are 40-something women experiencing?
“My superpower used to be sleeping,” says Annemarie Cancienne, a 46-year-old mom of two from the U.K. “I slept through storms, babies crying, husband shaking my shoulders in frustration. With perimenopause, my sleep began going off a cliff five days before my period.” Cancienne shared that the day before her period begins, she often finds herself awake as early as 3 a.m., and nothing she does seems to be able to settle her body and mind back to sleep.
For many women in their 40s, Cancienne’s descriptions probably sound eerily familiar. Indeed, hormonal and physiological changes can cause ongoing sleep issues for women at this point in their lives. “I’ve observed that sleep-related complaints among 40-year-old patients are quite common,” says Dr. Molly McBride, a gynecologist at Elite Gynecology in New York City.
Many of McBride’s midlife patients report difficulty falling asleep and staying asleep. “Some of these patients describe their sleep as being restless or fragmented, with frequent awakenings that leave them feeling unrefreshed in the morning,” McBride says. “Others have reported experiencing nightmares, night sweats, or vivid dreams that disrupt their sleep quality.”
Hot flashes and night sweats are often the first symptoms that spring to mind as women’s most common sleep complaints, but research has found that the most common sleep complaint women in the menopause transition period is frequent nighttime awakenings, whether brought on by temperature variations or not.
Research has also found that about a quarter of all women in this age group suffer from insomnia disorders. And yes, those wretched hot flashes are certainly part of the picture: About 80% of menopausal women experience them, and while they don’t always interfere with sleep, they are a very common sleep-related complaint for this demographic.
How do perimenopause and menopause worsen sleep?
Your 40s are a time of many hormonal and bodily changes. True menopause — which is defined as having no periods for at least 12 months — doesn’t usually happen till women are in their early 50s. The average age of menopause to start is 51. But the years leading up to menopause, referred to as “perimenopause,” can affect our moods, bodies, and sleep. The average age for perimenopause to begin is about 45, though some women experience the changes earlier or later than that.
Perimenopause and menopause definitely do contribute to the sleep disturbances women experience in their 40s, says Dr. Tara Scott, OB-GYN and medical director at Forum Health Akron. According to Scott, you can blame hormonal changes for much of this. As you age, she explains, your egg quality decreases, and hormone production changes as a result. Though melatonin is the hormone most commonly associated with sleep, all hormones contribute to the quality of your nightly sleep. “Progesterone starts to decline first, often in your late 30s, and progesterone generally helps you fall asleep,” Scott explains.
As perimenopause progresses, estrogen starts to decline as well. “Estrogen generally helps you stay asleep,” Scott says. “In addition, the stress hormone cortisol can also affect your sleep by causing you to wake up around 3 a.m. with your mind racing and thinking about all the stress you have.”
These hormonal changes also contribute to some of the physical discomforts women of this age experience that tend to disturb sleep, says McBride. “Hormonal fluctuations during these transitional phases can lead to a range of symptoms that can interfere with sleep, including hot flashes, night sweats, and mood disturbances,” she describes. Changes in hormone production also disrupt the body’s natural sleep-wake cycles, she adds, causing issues with falling and staying asleep.
Finally, the hormonal changes that occur during menopause can increase the risk of obstructive sleep apnea, starting around age 45.
What else contributes to sleep issues at 40?
Hormones aren’t the only thing to blame here, says Jade Wu, Ph.D., a behavioral sleep medicine psychologist and sleep advisor to Sleep.com. Your 40s are a particularly stressful decade, especially if you’re a woman, she says. “It's a culmination of life responsibilities — multiple kids, aging parents, the beginnings of health problems, managing households, having more responsibilities at work, the peak of monthly expenses (mortgage/rent, tuition, healthcare, feeding a whole family, retirement savings, etc.),” she describes.
All of this means that it’s nearly impossible to carve out any personal time for self-care: time to relax or take care of your own physical and mental health needs, Wu says. A stressed-out body and mind mean poor quality sleep. “The types of things women tend to worry about, given gender roles, are also the type that never end (e.g., household schedule management, meal planning), so it's no wonder women go to bed with to-do list items still swirling in their heads,” Wu says.
Seven expert tips on getting better sleep in your 40s
It’s one thing to understand why your sleep has tanked in your 40s, but it’s another thing to fix the problems at the root of the issues. While certain aspects of aging, including sleep changes, can’t be completely fixed, there are effective things you can do to help yourself fall asleep and feel more rested when you wake up.
Here are some expert-recommended tips for perimenopausal women:
1. Get into a good sleep-habits groove
The basis for a good night’s sleep starts with establishing healthy, sleep-promoting daily routines. Scott shares her top tips for quality sleep hygiene:
- Sleep schedules are important: Try to go to sleep and get up at the same time each day.
- Stop eating about two to three hours before going to bed.
- Reduce screen time about two hours before bedtime or consider blue-light-blocking glasses.
- Exercise helps, though if you can only exercise in the late hours before bed, keep it to something soothing, like yoga.
2. Get light exposure and exercise every day
Wu believes daily exercise is an important foundation for ensuring a good night’s sleep. It’s even better if you can do it outside because early light exposure each day is another key to better quality sleep each night. “Don't dwell in a cave,” Wu says. “Get outside and let your brain know through the light exposure that it's daytime, so it can help you be more alert during the day and sleep better at night.”
3. Allow for changes in your sleep patterns
One problem that many insomniacs have is rigid and unrealistic expectations about sleep, Wu explains. Perimenopausal women might need to adjust their expectations around sleep. The bedtime and sleep quality you used to take for granted may not be right for you anymore.
“We tend to become more early birds as we get older, so it's okay if you are waking up earlier than you used to,” Wu explains. “Listen to your body for sleepiness, which will tell you if you're generally getting enough sleep or not.”
4. Consider medication
If behavioral changes don’t work, there are medical solutions available for women struggling with sleep disturbances in middle age. “Hormone replacement therapy (HRT) can be effective in reducing symptoms of menopause, such as hot flashes and night sweats, which can disrupt sleep,” McBride says. “Additionally, certain medications, such as low-dose antidepressants, can help improve sleep quality.”
McBride does note that medications shouldn’t be the first thing you try to solve your sleep issues. “Lifestyle changes, such as regular exercise, stress reduction, and a balanced diet, can also help improve sleep quality and overall health,” she says.
5. Get screened for sleep apnea
We tend to focus on the hormonal changes that happen in our 40s that interfere with sleep, but Wu says sleep apnea is another medical condition that increases in middle-aged women. Indeed, research has found that at menopause, women are 3.5 times more likely to have sleep apnea than they were before menopause.
“If you snore, hold your breath during sleep, wake up with dry mouth or headache, or feel sleepy during the day, please ask your doctor about screening for sleep apnea,” Wu recommends. “This is stereotypically an older male disease, but that's only because medical research has traditionally focused on men.”
6. Schedule daily worry time
Our 40s are often a time of intense worrying. We worry about our kids, parents, spouses, jobs, our futures… the list goes on. Scheduling your worries — so they don’t follow you to bedtime — can work wonders, according to Wu.
“Set aside at least 15 minutes to do nothing but worry or plan,” she suggests. During that time, no distraction or multi-tasking will be allowed! “Get the worrying and to-do listing out of your system during this time, and it will be easier to mentally put things down during the night,” she says.
7. Get out of your head and into your body
If you wake up with racing thoughts, or if racing thoughts make it impossible to fall asleep, try not to engage with those thoughts, Wu says. “Don't fight to clear your head,” she says. “It doesn't work.” Instead, you can allow your thoughts to swirl around but watch them as if from a distance. “When you're ready, set the thoughts gently down to the side and bring your attention to your physical sensations,” she advises.
Of course, although employing some of these tips can be super helpful and certainly worth exploring, nothing is a substitution for meeting with a physician to discuss your concerns about sleep in your 40s. Never hesitate to reach out to a physician about sleep or any other health issues that come up during this time in life.
