Where Did the Zzzz's go? Perimenopause & sleep

Sleep, or rather the lack thereof, is such a common perimenopausal symptom that it merits its own category.

Online groups are flooded with women bemoaning their lack of sleep, just as much as hot flashes.

Perimenopausal women, who’ve never had sleep issues before, suddenly may begin experiencing issues falling asleep (sleep onset) and staying asleep (sleep disruption), either with or even in the absence of night sweats or hot flashes. Even with “sleep hygiene” and over-the-counter medications, many find little to no relief until they try other solutions, like hormone replacement or other medications.

​This is because sleep issues during perimenopause have practically nothing to do with lifestyle habits, sleep hygiene, diet, willpower or much else besides the erratic nature of hormones during this time, which also influences pivotal brain and adrenal functions, too. Combined, these all tie into sleep and one’s ability to attain it.

Note: This list of resources is continually updated.

Antidepressant Management of Insomnia Disorder in the Absence of a Mood Disorder – Pargol K. Nazarian, PharmD, Susie H. Park, PharmD, Mental Health Clinician, 2014 – https://meridian.allenpress.com/mhc/article/4/2/41/37095/Antidepressant-management-of-insomnia-disorder-in

Can Magnesium Supplements Really Help You Sleep? – Anahad O’Connor, The New York Times, Aug. 31, 2021 – https://www.nytimes.com/2021/08/31/well/mind/magnesium-supplements-for-sleep.html

Correlation between Estrogen and Sleep Disturbances – Winona, Nancy L. Belcher, Ph.D., Oct. 8, 2021 – https://bywinona.com/journal/estrogen-and-sleep-disturbances

Decrease in Melatonin Precedes Follicle-Stimulating Hormone Increase during Perimenopause – O. Vakkuri, A. Kivela, J. Leppaluoto, M. Valtonen, A. Kauppila, European Journal of Endocrinology, Aug. 1996 - https://pubmed.ncbi.nlm.nih.gov/8810731/

Effects of Estrogen Therapy on PostMenopausal Sleep Quality Regardless of Vasomotor Symptoms: A Randomized Trial – Climacteric, April 2015 - https://pubmed.ncbi.nlm.nih.gov/25242569/

Effect of Short-Term Transdermal Estrogen Replacement Therapy on Sleep: A Randomized, Double-Blind Crossover Trial in Postmenopausal Women – Clinical Trial, May 1999 - https://pubmed.ncbi.nlm.nih.gov/10231049/

For Some Women, A Connection May Exist Between Poor Sleep and Hormones – The Washington Post, Leigh Weingus, Sept. 18, 2021 – https://www.washingtonpost.com/health/sleep-hormones-link/2021/09/17/603c5534-f538-11eb-9738-8395ec2a44e7_story.html

How Menopause Affects Sleep – The Sleep Doctor, Dr. Michael Breus, Jan. 5, 2018 - https://thesleepdoctor.com/2018/01/05/menopause-affects-sleep/

How to Get Better Sleep during Menopause – Sally Turner, Patient.Info, June 21, 2021 - https://patient.info/news-and-features/how-to-get-better-sleep-during-menopause

Insomnia and Adrenal Fatigue: Why Can’t I Sleep When It’s Time to Go to Bed? – Michael Lam, MD; Justin Lam, Dr. Lam Coaching, 2020 - https://www.drlamcoaching.com/blog/insomnia-and-adrenal-fatigue/

Insomnia Is a Common Side Effect of Menopause: If It’s Happening to You, Here’s Your Action Plan – Parade, Kaitlin Vogel, Aug. 9, 2021 – https://parade.com/1243685/kaitlin-vogel/menopause-insomnia/

Italian Association of Sleep Medicine (AIMS) Position Statement and Guideline on the Treatment of Menopausal Sleep Disorders – Maturitas, November 2019 - https://www.maturitas.org/article/S0378-5122(19)30630-9/fulltext

Longitudinal Study of Insomnia Symptoms Among Women during Perimenopause – Colleen Ciano, Tonya S. King, Robin Redmon Wright, Michael Perlis, Amy M. Sawyer, Journal of Obstetrical Gynecology and Neonatal Nursing, Sept. 5, 2017 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5776689/

Melatonin: A Precious Molecule that Decreases with Age – Cultura Pierpaoli, Dr. Walter Pierpaoli - https://culturapierpaoli.ch/melatonin/?lang=en 

Melatonin for Menopausal Sleep Disorders and Quality of Life – Judith L. Balk, MD, Relias Media, Aug. 1, 2011 - https://www.reliasmedia.com/articles/131643-melatonin-for-menopausal-sleep-disorders-and-quality-of-life

Menopause and Insomnia – Healthline, Kimberly Holland, Sept. 10, 2020 - https://www.healthline.com/health/menopause/menopause-and-insomnia

Menopause and Melatonin – University of Utah, May 27, 2021 - https://healthcare.utah.edu/the-scope/shows.php?shows=1_1jocj3fc
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Mirtazapine vs. Trazodone for Sleep – Siestio - https://siestio.com/mirtazapine-vs-trazodone-for-sleep/

Progesterone and Sleep – Leigh Ann Scott, MD, May 1, 2018 - https://www.leighannscottmd.com/progesterone-sleep/

Progesterone Prevents Sleep Disturbances and Modulates GH, TSH and Melatonin Secretion in Postmenopausal Women – The Journal of Clinical Endocrinology and Metabolism, Anne Caufriez, Rachel Leproult, Mireille L’Hermite-Baleriaux, Miriam Kerkhofs, Georges Copinschi, April 2011, Vol. 96, Issue 4 - https://academic.oup.com/jcem/article/96/4/E614/2720877

Safety and Efficacy of Antidepressants in Menopausal Sleep Disturbances – Neurology Advisor, Amit Akirov, MD, Oct. 2, 2020 – https://www.neurologyadvisor.com/topics/sleep-disorders/safety-and-efficacy-of-antidepressants-in-menopausal-sleep-disturbances/

Serotonergic Antidepressants for Sleep Disturbances in Perimenopausal and Post-Menopausal Women: A Systemic Review and Meta-Analysis –  Yu-Shian Cheng, Cheuk-Kwan Sun, Pin-Yang Yeh, Ming-Kung Wu, Kuo-Chuan Hung, Hsien-Jane Chiu, Menopause, Sept. 4, 2020 – https://pubmed.ncbi.nlm.nih.gov/32898019/

Sleep Disturbance and the Menopause – Australasian Menopause Society, Sept. 2018 – https://www.menopause.org.au/hp/information-sheets/sleep-disturbance-and-the-menopause2

Sleep Disturbances during the Menopausal Transition – Geena Athappilly, MD, and Hadine Joffe, MD, NEJM Journal Watch, March 11, 2014 – https://www.jwatch.org/na33784/2014/03/11/sleep-disturbances-during-menopausal-transition

Sleep During the Menopausal Transition: A 10-Year Follow-Up – Nea Kalleinen, Jenni Aittokallio, Laura Lampio, Matti Kaisti, Paivi Polo-Kantola, Olli Polo, Olli J. Heinonen, Tarja Saaresranta, Sleep, Vol. 44, Issue 6, June 2021 - https://academic.oup.com/sleep/article/44/6/zsaa283/6039192

Sleep, Melatonin and the Menopausal Transition: What Are the Links? – Sleep Science, Shazia Jehan, et. al., Jan-May 2017 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611767/

Sleep Problems during the Menopausal Transition and Early Post-Menopause: Observations from the Seattle Midlife Women’s Health Study – Nancy Fugate Woods, RN, PhD; Ellen Sullivan Mitchell, PhD, Sleep, Volume 33, Issue 4, April 2010 - https://academic.oup.com/sleep/article/33/4/539/2454668

SSRIs for Hot Flushes and Insomnia – Australasian Menopause Society, April 30, 2012 – https://www.menopause.org.au/members/ims-menopause-live/ssris-for-hot-flushes-and-insomnia

Treatment of Insomnia, Insomnia Symptoms and Obstructive Sleep Apnea during and after Menopause: Therapeutic Approaches – Joshua Z. Tal, Sooyeon A. Suh, Claire L. Dowdle, Sarah Nowakowski, Current Psychiatry Review, Vol. 11, Issue 1, 2015 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607064/

When Does Estrogen Replacement Therapy Improve Sleep Quality? – American Journal of Obstetrics and Gynecology, P. Polo-Kantola, R. Erkkola, H. Helenius, et. al., May 1998 - https://pubmed.ncbi.nlm.nih.gov/9609575/

Why Can’t She Sleep? The Gold-Standard Cure for Insomnia You’ve (Probably) Never Heard Of – Margaret Brady, Verily, Sept. 18, 2019 – https://verilymag.com/2019/09/how-our-hormones-affect-our-sleep-insomn

Women, Are Your Hormones Keeping You Up at Night? – Yale Medicine, Jennifer Chen, July 10, 2017 - https://www.yalemedicine.org/news/women-are-your-hormones-keeping-you-up-at-night

Ladies, how are you dealing with sleeplessness? Tell us your strategies in the comments below.

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