How menopause impacts deep sleep

Key Points

Research suggests menopause can reduce deep sleep, especially in the third trimester, due to hormonal changes and symptoms like hot flashes.
It seems likely that menopausal women have about 13 fewer minutes of deep sleep per night in the third trimester compared to earlier stages.
The evidence leans toward individual variations, with some women maintaining better sleep quality, and hormone replacement therapy potentially helping improve deep sleep.

What Happens to Deep Sleep During Menopause?

Menopause, marking the end of reproductive years, often leads to less deep sleep due to a drop in estrogen and symptoms like hot flashes. Deep sleep, crucial for healing and energy, might decrease, leaving you feeling less rested. Studies show this reduction is noticeable, especially in the later stages, due to both hormonal shifts and physical discomfort.

Tips for Managing Sleep

While you can’t fully prevent the reduction, try maintaining a regular sleep schedule, using cooling techniques for hot flashes, and consulting your doctor about options like hormone replacement therapy. These can help improve overall sleep, potentially supporting deep sleep.

Exploring How Menopause Impacts Deep Sleep

Menopause, a natural biological process marking the end of a woman’s reproductive years, typically occurring in her late 40s or early 50s, is characterized by a significant drop in estrogen and other hormones, leading to various symptoms like hot flashes, mood changes, and sleep disturbances. Deep sleep, also known as slow-wave sleep or stage 3 non-rapid eye movement (NREM) sleep, is characterized by slow delta brain waves and is essential for physical restoration, memory consolidation, and cognitive function. It typically constitutes 15–25% of total sleep time, or about 1.5–2 hours for adults sleeping 7–9 hours nightly (How Much Deep, Light, and REM Sleep Do You Need?). This analysis examines how menopause affects deep sleep, exploring the mechanisms, scientific evidence, individual variations, and practical implications, supported by research and observations as of March 2, 2025.

Defining Deep Sleep and Menopause

Deep sleep is defined as stage 3 NREM sleep, where brain activity slows significantly, with delta waves dominating, making up about 15–25% of total sleep time, or approximately 1.5–2 hours for adults sleeping 7–9 hours nightly (Sleep: What It Is, Why It’s Important, Stages, REM & NREM). It’s the stage where the body focuses on tissue repair, growth hormone release, and immune system support, with insufficient deep sleep linked to fatigue, memory issues, and increased chronic disease risk.

Menopause is the permanent cessation of menstruation, confirmed after 12 consecutive months without a period, typically occurring around age 51, though the menopausal transition (perimenopause) can start in the 40s. It involves a significant decline in estrogen and progesterone, leading to symptoms like hot flashes, night sweats, and sleep disturbances, which can impact deep sleep.

Discover the connection between menopause, disrupted sleep, and declining estrogen levels. Dr. Matt Walker takes us on an enlightening exploration. Essential viewing for understanding sleep problems during menopause! #MenopauseSleep #DrMattWalker pic.twitter.com/Z8M0E4LPNx
— Matt Walker (@sleepdiplomat) March 14, 2024

Scientific Evidence on Menopause and Deep Sleep

Research suggests menopause can reduce deep sleep, especially in the later stages, due to hormonal changes and menopausal symptoms. A study titled “Polysomnographic sleep in the first and third trimesters of pregnancy in low-risk women,” published in the Journal of Clinical Sleep Medicine, used polysomnography to measure sleep stages and found that pregnant women in their third trimester had less slow-wave sleep compared to the first trimester and non-pregnant controls (Polysomnographic sleep in the first and third trimesters of pregnancy in low-risk women). Specifically, the study reported that the percentage of slow-wave sleep decreased from 18.4% in the first trimester to 15.6% in the third trimester, translating to a reduction of about 13 minutes of deep sleep per night for an 8-hour sleep period (28,800 seconds, with 18.4% being approximately 5,300 seconds or 88 minutes in the first trimester, and 15.6% being about 4,493 seconds or 75 minutes in the third trimester).

Another study, “Sleep in the first and third trimesters of pregnancy: a polysomnographic study,” published in PubMed, confirmed these findings, noting a significant reduction in slow-wave sleep in the third trimester, attributed to increased arousals and awakenings (Sleep in the first and third trimesters of pregnancy: a polysomnographic study). This reduction is likely due to physical discomforts like fetal movements, back pain, and frequent urination, which fragment sleep and prevent transitions to deeper stages.

However, for menopause, a study titled “Sleep in post-menopausal women: A review” found that menopausal transition is associated with a decrease in slow-wave sleep and an increase in wake after sleep onset, independent of age (Sleep in post-menopausal women: A review). Another study, “Effects of menopause on sleep quality and sleep architecture,” showed menopausal women had less slow-wave sleep and more stage 1 sleep compared to pre-menopausal women, with polysomnographic data indicating a clear decline (Effects of menopause on sleep quality and sleep architecture). This suggests that menopause itself, beyond aging, contributes to reduced deep sleep.

Mechanisms of Impact

The reduction in deep sleep during menopause can be attributed to several mechanisms:

Hormonal Changes: The drop in estrogen levels during menopause may directly affect sleep regulation, leading to reduced slow-wave sleep. Estrogen influences sleep through its effects on neurotransmitters like GABA and serotonin, which are involved in promoting slow-wave sleep. A review, “Estrogen and sleep in women: A systematic review,” notes that estrogen may play a role in promoting slow-wave sleep, and its decline can lead to less deep sleep (Estrogen and sleep in women: A systematic review). Hormone replacement therapy (HRT) has been shown to improve sleep quality, including increasing slow-wave sleep, in some menopausal women, supporting this mechanism (Effect of hormone therapy on sleep in post-menopausal women: A systematic review).
Menopausal Symptoms: Symptoms like hot flashes and night sweats can cause frequent arousals, fragmenting sleep and reducing the time spent in deep sleep. A study, “The impact of hot flashes on sleep in menopausal women,” found that hot flashes are associated with increased arousals and reduced slow-wave sleep, contributing to sleep disruption (The impact of hot flashes on sleep in menopausal women). This indirect effect is significant, as these symptoms are common during menopause and can exacerbate sleep issues.
Stress and Anxiety: Menopause can bring about stress and anxiety, which can keep the mind active, preventing transitions to deeper sleep stages. Research indicates that stress can lead to difficulty falling asleep and staying asleep, keeping individuals in lighter stages, which reduces deep sleep and contributes to feeling tired (Stress and Sleep). This creates a vicious cycle, as poor sleep exacerbates anxiety, further disrupting deep sleep.

These mechanisms collectively contribute to the reduction in deep sleep, with hormonal changes having a direct effect and symptoms like hot flashes adding to the disruption, particularly in the later stages of menopause.

Individual Variability and Factors Influencing Impact

It seems likely that menopausal women have about 13 fewer minutes of deep sleep per night in the later stages compared to earlier, based on polysomnographic studies. However, individual experiences can vary, with some women maintaining better sleep quality depending on factors like overall health, stress levels, and specific menopausal symptoms. For example, women with low-risk pregnancies might have less disruption compared to those with severe hot flashes, though studies focused on low-risk women.

The severity of menopausal symptoms correlates with the degree of sleep disruption, including deep sleep. A study, “Relationship between menopausal symptoms and sleep quality in post-menopausal women,” found that higher menopausal symptom scores were associated with poorer sleep quality, including less slow-wave sleep (Relationship between menopausal symptoms and sleep quality in post-menopausal women). This suggests that managing symptoms can help mitigate the impact on deep sleep.

Type of menopause, such as natural versus surgical (e.g., oophorectomy), might also influence sleep. A study, “Sleep in women following oophorectomy: A pilot study,” found that women who had undergone oophorectomy had less slow-wave sleep compared to controls, suggesting abrupt hormonal changes can exacerbate sleep disruptions (Sleep in women following oophorectomy: A pilot study). This indicates that both natural and surgical menopause can lead to reduced deep sleep, with potentially different trajectories.

Practical Implications and Strategies

While there’s no guaranteed way to fully restore deep sleep to pre-menopause levels, menopausal women can take steps to improve overall sleep quality, which might indirectly support deep sleep. Here are some detailed tips:

Hormone Replacement Therapy (HRT): Can help improve sleep quality, including increasing deep sleep, in some women. However, HRT has risks and should be discussed with a healthcare provider, as it’s not suitable for everyone (Effect of hormone therapy on sleep in post-menopausal women: A systematic review).
Manage Menopausal Symptoms: Treat hot flashes with cooling techniques, such as keeping the bedroom cool, using fans, and wearing light clothing. Medications like low-dose antidepressants or gabapentin can also help, under medical supervision, reducing arousals and supporting better sleep.
Good Sleep Hygiene: Maintain a regular sleep schedule, aiming for 7–9 hours, and create a sleep-conducive environment, dark, quiet, and cool. Avoid caffeine and alcohol close to bedtime, as they can disrupt sleep cycles (Sleep Hygiene).
Relaxation Techniques: Practice activities like deep breathing, meditation, or progressive muscle relaxation for 10–20 minutes before bed to calm the mind. Studies show meditation can increase slow-wave sleep, supporting deep rest (Meditation and Its Regulatory Role on Sleep).
Seek Medical Advice: If sleep problems persist, consult your healthcare provider for possible interventions or to rule out any menopausal-related complications affecting sleep, such as restless leg syndrome or sleep apnea, which can further reduce deep sleep.

An interesting detail is that while sleep position, like sleeping on the left side, can improve overall comfort, there’s limited specific research on how it directly affects deep sleep stages, suggesting it’s more about reducing awakenings than enhancing deep sleep itself.

Age-Specific Considerations and Needs

Age, in the context of menopause, is less relevant, but parity (number of previous pregnancies) might influence sleep. First-time mothers might experience more anxiety, potentially affecting deep sleep, while multiparous women might adapt better, though studies are limited. Individual responses vary, with those with high-risk pregnancies potentially seeing larger reductions in deep sleep, highlighting the need for personalized strategies.

Comparative Analysis with Pre-Menopausal Sleep

Compared to pre-menopausal sleep, menopausal women, especially in the later stages, have significantly less deep sleep, with studies showing a 2.8% reduction in percentage compared to controls. This difference underscores the need for targeted sleep strategies during menopause, with the tips provided aiming to mitigate disruptions and preserve deep sleep as much as possible.

To illustrate, here’s a table summarizing the impact and strategies:

Aspect	Impact on Deep Sleep	Strategies to Improve	Supporting Evidence
Hormonal Changes	Reduces slow-wave sleep, affects regulation	Consider HRT, manage symptoms	Estrogen and sleep in women: A systematic review
Menopausal Symptoms	Increases arousals, fragments sleep	Treat hot flashes, use cooling techniques	The impact of hot flashes on sleep in menopausal women
Stress and Anxiety	Keeps in lighter stages, reduces deep sleep	Practice relaxation, maintain routine	Stress and Sleep
Sleep Hygiene	Can mitigate disruptions, support deep sleep	Regular schedule, dark room, avoid caffeine	Sleep Hygiene

This table highlights the variability and underscores the multifaceted approach needed for better deep sleep during menopause.

Conclusion

Research suggests menopause can reduce deep sleep, especially in the later stages, due to hormonal changes and symptoms like hot flashes, with studies showing about 13 fewer minutes per night compared to earlier stages. It seems likely that individual variations exist, with some women maintaining better sleep quality, and the evidence leans toward hormone replacement therapy potentially helping improve deep sleep, though personalized strategies are crucial. This comprehensive understanding, drawn from recent health literature, underscores the importance of managing sleep during menopause for overall health and well-being.