Tiredness in the menopause: how to rest well  

Our body’s response to falling hormone levels looks different for each person, which is why menopause symptoms vary so much between individuals. Some women may have a range of symptoms, but only mildly. Others may deal with one or two issues but at extreme levels. There’s no way of knowing how menopause will affect us but certain symptoms, when triggered by that drop in hormone levels, will also affect sleep.

“There are a range of factors that disrupt sleep during menopause,” Robinson explains. “First of all, we have the hormonal side. Oestrogen and progesterone both decline steeply, and progesterone is one of the hormones that can act on the brain and help induce sleep. 

“REM sleep, which is good for recovery, for memory and concentration, is aided by oestrogen. As that falls it’s harder to regulate the body during sleep – you might be dealing with nighttime awakenings – and it’s also harder to regulate body temperature. Melatonin is another hormone that regulates the sleep cycle. That also declines with age.” 

Hot flushes are a relatively common symptom of menopause. They arrive randomly and without warning, causing an almost unbearable level of heat to course through the body. If these come at night, sleep can be seriously disrupted.  

“Hot flushes or night sweats cause a spike in core body temperature,” Robinson says. “They will impact every woman differently, but they can be significant enough to wake a person up, thereby disrupting sleep.”  

Have you ever been so stressed you can’t sleep, and then you find yourself more stressed because you can’t sleep? It’s a common cycle to be stuck in. Oestrogen plays a large role in brain function and the production of serotonin, so when those levels fall, we can experience rising anxiety or stress.  

“Because menopause alters the hormones that have an impact on mood and anxiety, that will make emotions a little bit different for some people. So, if someone is genuinely feeling more anxious or stressed, sleep, again, becomes another aspect affected. 

“Cortisol is our stress response hormone, and that can increase around menopause as well. So that may compound those feelings of stress and anxiety when we don’t need them. There is also some evidence that cortisol can spike after a hot flush, so again, that might make you a bit more wired when you’re trying to get back to sleep.”  

If you’re struggling with menopause symptoms, it’s a good idea to talk to your doctor or make an appointment at a menopause clinic. If tiredness is a problem for you, or you’re having issues getting to or staying asleep, the following tips might help.

“It’s really important to make sure there’s a good bedtime routine in place to start with,” Robinson says. “It can be difficult, but as far as possible try and begin winding down 90 minutes to two hours before bed.” 

A relaxing bath or shower is a great way to relax before bed, and try and keep the house as calm as possible during your wind-down time, too. Having a regular sleeping and waking schedule can also help, as it encourages your circadian rhythm. Over time, you will naturally begin to feel sleepy around the same time each day.

A big part of an effective bedtime routine involves a break from screens – and not just mobile phones. “Stop watching programmes or films around two hours before bed,” Robinson advises. “But also put down your mobile. Anything that can cause added stress.”  

It’s not just the light from screens that can affect sleep – though it’s worth keeping screens on a low light if you can. Often when we pick up our phone to check something, we end up accidentally losing a large chunk of time, possibly looking at social media, reading the news or doing other things that might increase cortisol, such as checking bank accounts.  

“Reading can be really good before bed,” Robinson says. “You can focus your brain on the book so it’s not wandering to all your worries or anxieties.”  

If focusing on a page is too much, or reading isn’t your thing, you could try meditation. If you’re unsure of where to start, a guided meditation app can be helpful. This will help quieten your mind before sleep, with the gentle narration having a soothing effect.  

Headspace is a great app for mental wellness and offers a range of meditations. There are lots of sleep apps too, with an array of calming music or audiobooks to listen to. 

“Exercise in menopause can be helpful,” Robinson says. “But don’t exercise too close to sleep – you don’t want to get the adrenaline going too close to bedtime. Try exercising a bit earlier in the day, or early evening, to help regulate hormones so you feel tired later on.”  

Exercise doesn’t have to be an all-out effort, either. If you’re dealing with aching joints, gentle yoga can be soothing, while Pilates helps build strength without being too demanding on the joints.

We are all different, and a room that’s too hot for one person may be too cold for another, but if you’re suffering with night sweats or hot flushes, keeping your bedroom cool (for you) might help you sleep better.  

“Make sure that the room isn’t cold but cooler, especially in summertime,” Robinson says. “Even in the winter, turn the heating off at night so the actual room is cool and helps to induce good sleep.” 

Keeping your room dark can also help the brain to relax and recognise the signal to sleep. Investing in blackout curtains or a blackout blind might be useful, especially if you find daylight wakes you earlier than you’d like.

Caffeine and alcohol can affect sleep both by keeping you awake and disturbing your rest, and Robinson recommends avoiding both near to bedtime. Studies have shown that having caffeine up to six hours before bedtime can disrupt your sleep pattern, so stopping tea and coffee from the early afternoon onwards may help.  

Drinking alcohol close to sleeping may disrupt the second half of your sleep cycle by causing more wakefulness – an even bigger issue if menopause symptoms are already unsettling your rest. Aim to drink alcohol in moderation, avoiding it too close to when you usually go to sleep.

Hormone replacement therapy (HRT) can help to ease many menopause symptoms. If you’re dealing with sleep disruption, Robinson suggests trying the tips above to see if that helps, then making an appointment with your GP or medical provider if you want to explore HRT as an option.  

“You don’t have to go on any hormone treatment,” she stresses. “Have a chat with a doctor about it. Some people might need HRT to help with sleep, but some won’t. It’s always worth looking at all the other aspects too.”  

As well as the tips above, melatonin is available on prescription. This is a hormone that helps your body to regulate sleep. “That’s something you can often talk to your doctor about because it’s a natural version of a hormone that we produce anyway,” Robinson says. “Your doctor may consider it in the short term to try and help.”