Sleep disturbances are one of the most disruptive and least discussed symptoms of menopause.

Sleep physician Dr Anup Desai explains what is happening in your body - and how to reclaim your rest.

Remember, always seek professional help if symptoms are persistent, distressing or unexplained.

If you are lying awake at 3am wondering why sleep has become so elusive, you are not alone. Over 60 percent of postmenopausal women report insomnia symptoms -- nearly double the rate of the general adult population. The hormonal shifts of menopause are directly and measurably disrupting the way women sleep.

The Role of Hormones

Oestrogen plays a quiet but significant role in sleep. It supports the metabolism of serotonin, helps the body cool down at sleep onset, and has a mild anti-depressant effect. As oestrogen declines during menopause, each of these functions is compromised. Progesterone which has a natural sedative quality also falls. Melatonin, the hormone that governs our sleep-wake cycle, also decreases with age.

Hot Flushes and Night Sweats

Prior to a hot flush, body temperature rises and blood flow surges to the face and skin — releasing adrenaline at precisely the moment your body needs to be winding down. Both the arousal from the flush itself and the associated temperature changes can disrupt sleep significantly. Temperature regulation is, as Dr Desai notes, intricately

linked to sleep quality. Sleeping in a cool room, wearing light natural- fibre sleepwear, and avoiding heavy bedding can all make a meaningful difference.

Dr Anup Desai

MBBS , FRACP, PhD Sleep and Respiratory Physician

Dr Anup Desai is one of Australia's leading sleep physicians, with specialist expertise in insomnia, sleep apnoea, parasomnias, restless legs, and narcolepsy. He trained at Royal Prince Alfred Hospital before completing a PhD in Sleep Medicine at the University of Sydney -- awarded with multiple research grants and prizes.

He conducted post-doctoral research at St Thomas' Hospital London and established the largest sleep laboratory in Birmingham before returning to Sydney in 2004. He was the Head of the Sleep Medicine Clinical Trials Unit at the Woolcock Institute of Medical Research and holds senior clinical roles at the Prince of Wales Hospital and in private practice.

Dr Desai has built up a strong multi-disciplinary team around him at Sydney Sleep Centre and has close relationships with other local experts, such as ENT surgeons.

Insomnia

Disrupted sleep, night-time awakenings, and increased wakefulness after sleep onset are the most common sleep complaints of menopause. These insomnia symptoms can be due to one or a number of causes — vasomotor symptoms, sleep fragmentation from sleep apnea, and mood disturbances related to menopause.

After insomnia initially develops — for example, in association with physical symptoms such as hot flushes — it can become conditioned or habitual, persisting even when the acute cause improves. This in turn creates anxiety and further dissatisfaction about sleep, worsening the insomnia still further.

Chronic insomnia can be very distressing, with major impacts on sleep quality and daytime functioning, and can exacerbate mood disturbances. Early recognition of insomnia developing with menopause, understanding its causes, and prompt intervention are all important.

Sleep Apnoea – An Overlooked Risk

Postmenopausal women are two to three times more likely to develop sleep apnoea than premenopausal women — yet it frequently goes undiagnosed. The hormonal changes of menopause affect upper airway collapsibility and shift fat distribution toward the abdomen, both of which can trigger or worsen obstructive sleep apnoea. Women with sleep apnoea do not always snore loudly, and daytime fatigue is often attributed to menopause rather than investigated further. If you are persistently exhausted despite adequate time in bed, speak to your doctor about a sleep study.

Steps to Better Sleep

• Wake at the same time every day -- consistency anchors your sleep cycle.
• Avoid caffeine and alcohol from 2pm. Alcohol disrupts deep sleep.
• Exercise regularly. Morning light suppresses melatonin and promotes daytime alertness.
• Keep your bedroom cool. Aim for 18–19 degrees Celsius.
• Daytime naps are fine -- keep them under 20 minutes and before 3pm.

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