How menopause affects sleep: tips and exercises for better rest

It’s 3 a.m. and you’re staring at the ceiling. You count backward from 60. You sing the ‘Twinkle Twinkle’ song in your head. Then you curse menopause nice and loud, wondering if you’ll ever sleep through the night again. That’s because — on top of hot flashes, mood swings, and weight gain — menopause can also affect your sleep.  

Research shows that 40 to 69 percent of women experience sleep disturbances during menopause. But that doesn’t mean you just have to deal with menopause and insomnia. There are steps you can take to help you get better rest again. Read on to learn how menopause affects sleep, common menopause sleep problems, and the best ways to improve your sleep with exercise and lifestyle strategies from our Hinge Health physical therapists.

How does menopause affect sleep?

Shifting hormones play a role. Perimenopause — or the time leading up to menopause — usually begins in your mid-to-late 40s and lasts an average of four years. (Menopause officially means that it’s been a year since your last period.) During this transition, your body stops producing as much of the hormones estrogen and progesterone, both of which affect your sleep.

Estrogen works to block chemicals that keep you awake, so you can fall asleep faster and sleep longer. It also helps lower body temperature for better sleep. Progesterone activates calming brain chemicals to help improve deep sleep, and may help reduce anxiety and support breathing during sleep. 

During menopause, fluctuations in these hormones can disrupt sleep patterns and reduce sleep quality, says Renee Bullis, PT, DPT, a physical therapist at Hinge Health.

Other menopause-related changes that can impact sleep include: 

• Hot flashes and night sweats. These sudden sensations of extreme heat are brought on by hormone changes. When they happen at night, they can wake you up and disrupt your sleep. An analysis found that women with moderate or severe hot flashes were nearly three times more likely to experience frequent night-time awakenings.

• Mood changes. Low estrogen levels can impact the production of serotonin, a brain chemical linked to mood and energy, says Dr. Bullis. Depression and anxiety — more common in menopause — are linked to sleep disorders.

• Joint pain. Estrogen affects your musculoskeletal system. It helps maintain muscle mass, keeps joints healthy, and plays a role in preventing inflammation. When estrogen levels dip, cartilage and other joint tissues lose some of their protection and inflammation can occur more easily. “Increased joint pain and stiffness during menopause can impact sleep, as well as mood,” says Dr. Bullis.

Other medical conditions that become more common after menopause — such as heart disease, poor blood sugar control, and bladder problems — can contribute to sleep issues. Talk to your healthcare provider to determine the factors that are affecting your sleep.

Common sleep problems during menopause

Menopause sleep issues vary from person to person. Sleep problems associated with menopause include: 

• Insomnia. When you have insomnia, you may find it hard to fall asleep or stay asleep throughout the night. Insomnia also can cause you to wake up too early and not be able to get back to sleep. You may still feel tired when you wake up.

• Obstructive sleep apnea (OSA). This sleep-related breathing disorder causes breathing to repeatedly stop and start during sleep. OSA can reduce sleep quality, which can lead to daytime sleepiness and mood changes and contribute to other health problems. Women in menopause have a higher risk of sleep apnea than premenopausal women.

• Restless legs syndrome (RLS). This condition causes an irresistible urge to move your legs. Uncomfortable sensations in your legs typically occur at night, when you’re sitting or lying down. Moving eases the discomfort — but only for a short time, which can make it difficult to sleep. While RLS is not directly linked to menopause, the condition becomes more common with age.

Exercise for better menopause sleep

Physical activity can help you fall asleep faster and stay asleep longer during menopause, says Dr. Bullis. It can also improve sleep quality and reduce insomnia. That’s because, in part, moderate exercise increases the production of melatonin, a hormone that regulates sleep. As you age, your body makes less melatonin, and during menopause, it drops even more. “Exercise also promotes deeper, slow-wave sleep, which tends to decline with age,” she adds.  Regular exercise may also improve other symptoms of menopause that impact sleep by:

• Easing stress and anxiety

• Boosting daytime alertness and energy

• Decreasing joint pain and stiffness

• Helping regulate body temperature

• Helping manage hot flashes and night sweats

Regular, moderate-intensity exercise appears to be the most effective for improving sleep. That means moving in ways that raise your heart rate and make you break a sweat for 30 or more minutes most days of the week. But any amount of movement is helpful: “Even if you only have 10 minutes, every little bit can help increase your sleep quality,” says Dr. Bullis. One note: For some people, vigorous exercise too close to bedtime can make it harder to fall asleep. Experiment with the best time of day for you.

You can exercise on your own to improve sleep during menopause, but working with a physical therapist (PT) can be helpful, too. A PT can personalize your exercise program to address many different body changes that can affect health during the menopause transition, including bone density, joint pain, and pelvic floor and bladder issues. They can also empower you with tools and tips to help you rest better. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

To help improve sleep during menopause, your PT may recommend exercises like these in the module below:

These exercises can improve menopause sleep by reducing tension and promoting relaxation, which can help prepare your body for more restful sleep.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

More tips for better sleep during menopause

In addition to exercise, there are a range of lifestyle changes and other treatment options that may help. 

Sleep hygiene

This refers to your sleep environment and daily habits that influence sleep quality. Good sleep hygiene includes strategies to help your body and mind prepare for rest:

• Stick to a consistent sleep schedule.

• Keep your bedroom dark, quiet, and cool.

• Don’t watch TV or scroll through your phone before bed.

• Limit daytime naps to 20 minutes.

• Avoid large meals, alcohol, and caffeine close to bedtime.

Breathing and mindfulness

Research shows breathing and mindfulness can effectively treat insomnia and sleep problems during menopause. Breathing techniques help calm your nervous system, reduce feelings of anxiety, and lower your heart rate and blood pressure, which can help you relax and get better sleep. Mindfulness practices — such as cognitive behavioral therapy for insomnia (CBT-i) — can help you relax, shift your thinking, and feel more calm and in control, making it easier to fall (and stay) asleep. A bonus: Mind-body relaxation techniques have also been shown to help relieve the severity and frequency of hot flashes during perimenopause and menopause.

Go outside

“Sunshine and vitamin D play a role in quality sleep,” says Dr. Bullis. Getting natural sunlight early in the day tells your brain it’s time to be awake. It also sets a countdown for your body to feel sleepy at night.

Medications or supplements

They’re not a replacement for other sleep hygiene and lifestyle changes, but they can be part of your treatment. Discuss the benefits and side effects of medications and supplements with your healthcare provider.

• Menopause hormone therapy (MHT) may improve sleep, especially for those with hot flashes, by reducing night sweats and improving sleep quality. Effectiveness varies by hormone type and delivery method. 

• Antidepressants can address insomnia, particularly if it’s linked to depression, and may also reduce menopause symptoms like hot flashes. They may be an alternative for those who can’t use MHT.

• Prescription sleep medications like zolpidem (Ambien) and eszopiclone (Lunesta) may help with falling and staying asleep by slowing brain activity. While effective short-term, they can cause side effects like drowsiness, memory issues, increased fall risk, and dependence.

• Sleep supplements like melatonin may help but aren’t well-regulated. Use only with provider guidance to ensure safety and proper dosing.

PT tip: Small changes can add up

There’s no single solution for menopause sleep problems. “Everyone’s recipe for good sleep can vary, and it can take some time to figure out the best recipe for you,” says Dr. Bullis. “Experiment, keep an open mind, and monitor your sleep over time to determine what helps improve sleep for you.”

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

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