The two main hormones that quickly decline around the perimenopause and menopause are oestrogen and progesterone.
Our natural progesterone has a mild sedating affect within the body so as the levels of this hormone begin to fall the natural sleep cycles within the body can be disturbed.
Progesterone also has an anti-anxiety affect and an overall positive effect on mood. Lower levels of progesterone at the perimenopause and menopause may contribute to mood changes and anxiety which in themselves can affect our ability to sleep.
Oestrogen has been shown to improve deep sleep and reduce the number of awakenings through the night. Oestrogen is also associated with other substances in the brain (neurotransmitters) that regulate the sleep cycle. In addition Oestrogen helps to control the body temperature at night and keeps the body cool which in turn improves sleep. Unfortunately the reverse of this is that without adequate oestrogen levels you are more likely to have lighter sleep with more spontaneous wakeups through the night.
The symptoms associated with oestrogen deficiency unfortunately can have a part to play- hot flushes, joint aches and multiple trips to the toilet to pass urine are not the secret to a restful night of snoozing.
Melatonin is a hormone that helps our body to know when we need to sleep and helps us to stay asleep. Melatonin production is linked to oestrogen and progesterone so as these two hormone levels falls, so too does melatonin.
Anxiety and depression
Mood disturbance is a common symptom of the menopause (see our mental health information) and there is good evidence to show that mood disturbance and anxiety can severely disrupt sleep.
Menopause affects mental health and sleep, mental health affects sleep, and insomnia worsens mental health- so you can see the washing machine effect that can ensue for women around this time. Its easy to see how improving sleep can have such a dramatic effect on quality of life and why its so important for us to address insomnia as a serious and at times debilitating consequence of the menopause for some women.
Sleep apnoea is a condition where your breathing briefly stops and then starts again during sleep. This leads to brief awakening though the night and less of the restorative sleep we all need to feel refreshed. Research has shown that women going through the menopause are more at risk of developing sleep apnoea. This may be in part due to perimenopausal weight gain in some women and there has also been a link to sleep apnoea and reducing levels of progesterone during the menopause transition. Sleep apnoea as a condition in itself can lead to fatigue, headaches, anxiety and depression.
Sensations of crawling and tingling at night are unlikely to help with sleep! Unfortunately restless legs is a common symptom of the menopause.