Written by Clare Widzgowski
During perimenopause, the transition period before menopause, changes in the hormones estrogen and progesterone can trigger changes in sleep patterns and insomnia. Insomnia is the inability to fall asleep and stay asleep. Across various studies, 40-56% of perimenopausal women self-report difficulties with sleep with 26% experiencing insomnia that impacts their daytime functioning.
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Sleep is critical for all functions in the body. Not getting enough quality sleep leads to increased hunger signaling, increased food consumption and decreased exercise. Weight gain is a common symptom of menopause and can lead to other health problems such as insulin resistance, diabetes, and high blood pressure (hypertension). Not getting enough sleep reduces your ability to consolidate and remember long-term memories, leading to forgetfulness or brain fog. Luckily, there are a variety of insomnia treatments during perimenopause, such as pharmaceutical and lifestyle changes, that can help you catch some much needed sleep.
Behavior Changes Through Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is a therapy technique that helps patients to recognize how negative thoughts and feelings impact their negative behaviors and how to shift into positive thinking and positive behaviors. Having a regular sleep schedule, exercising regularly, avoiding late day caffeine and naps, and managing stress can help curb insomnia. Alcohol can reduce the quality of your sleep and lead to a tolerance requiring more and more to have the same effect. You should never consume alcohol with any sleep medications. See more tips and tricks to help your sleep here and here.
Over-the-counter Sleep Aids
OTC sleep aids are often a combination of antihistamines and painkillers that can help you get 8-9 hours of sleep if taken early enough. They are inexpensive and readily available, however, they may cause excessive drowsiness or a “sleep hangover” in the morning if taken too late at night.
Prescription sleep medications
After trying lifestyle changes, your doctor may recommend a sleeping pill for short term use to help falling and staying asleep. Benzodiazepine medications such as Valium, Xanax, and Ativan may help with winding and calming down before sleep. These medications are best for short-term use as they are addictive and become less effective over time. Non-benzodiazepine medications like Ambien and Lunesta have fewer side effects and Lunesta was shown to be safe for up to six months of use. You should never combine painkillers with a sleeping pill as it can cause respiratory depression and death.
While antidepressant medications like SSRIs have not been approved by the Food and Drug Administration for insomnia treatment, they are widely used among those with mood disorders and insomnia. Some antidepressant medications can cause insomnia and worsen depression and anxiety. It is important to talk with your doctor about if your antidepressant medication is causing your insomnia and better alternatives.
Insomnia in perimenopause can be difficult to manage, but there are lifestyle changes and medications that may help. Speak with your doctor about what treatments are best for you.
- Baker, F. C., de Zambotti, M., Colrain, I. M., & Bei, B. (2018). Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nature and Science of Sleep, 10, 73–95. https://doi.org/10.2147/NSS.S125807
- Bracy, K. (2022, July 28). Meds to help you sleep better during menopause. Verywell Health. https://www.verywellhealth.com/insomnia-medications-for-menopause-2322786
- Mayo Foundation for Medical Education and Research. (2019, March 16). Cognitive behavioral therapy. Mayo Clinic. https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610
- U.S. Department of Health and Human Services. (2022, March 24). Why is sleep important?. National Heart Lung and Blood Institute. https://www.nhlbi.nih.gov/health/sleep/why-sleep-important
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