Hot flashes poorly impact sleep quality


James A Simon, MD, discusses the link between hot flashes and poor sleep quality, and how clinicians can help their patients manage sleep disorders.

Contemporary OB/GYN:

Can you describe your presentation at The Menopause Society 2023 Annual Meeting?


  • Sleep disturbances, including sleep deprivation, fatigue, and cognitive dysfunction, are prevalent among women going through menopause. These issues can significantly affect their quality of life.
  • Sleep problems actually start in the early perimenopause phase, which occurs before menopause. These issues tend to worsen as women approach menopause, especially for those who undergo surgical menopause.
  • Bed partners can contribute to sleep disturbances. Snoring, restless leg syndrome, and differing sleep schedules can disrupt a woman's sleep. Recommending a "sleep divorce," where partners sleep in separate bedrooms, can sometimes be beneficial for better sleep.
  • Hot flashes and night sweats can worsen sleep problems, and treating these menopausal symptoms should be a priority. However, some women may also have primary insomnia disorders that require separate treatment.
  • Clinicians can advise patients to create a sleep-friendly environment by keeping the bedroom dark, cool, and quiet. They should also discourage alcohol consumption before bedtime, as it can disrupt sleep.

James A Simon, MD:

So, I'm Dr. Jim Simon. I'm a reproductive endocrinologist in Washington, DC, and I focus on menopause and sexual function. So how did I get to sleep? Well, it turns out that sleep is incredibly problematic at the time of menopause, and sleep deprivation, leading to fatigue, cognitive dysfunction, mood changes, et cetera, is really bad for sex. So, you put it all together, and they asked me to give a lecture on sleep as it relates to menopause. And I think it's a really important and often neglected subject because all of us to one agree or another in these busy lives that we have, have sleep interruption, sleep deprivation, and other problems related to sleep.

Contemporary OB/GYN:

What adverse events might a woman in menopause face because of being unable to remain asleep or sleeping poorly?

James A Simon, MD:

Yeah, so let's take it back a notch. The questions are the right questions, but let's take it back a notch because those problems actually begin in early perimenopause, long before the last menstrual period, and long before we consider a woman to be menopausal. And the study of women across the nation, the SWAN study, demonstrated very nicely that these problems of sleep actually begin much earlier than the actual menopause. They just get worse as women get closer to and following menopause, and they get much worse in women who have surgical menopause. So, this is a pretty universal problem for women as they approach their menopause and beyond. Here's the real issues that we discussed in this lecture. First, but not foremost, but first is we commonly have a bed partner, or at least women who are partnered have a bed partner, and that partner can really screw up their sleep. That's something that is important to consider when talking to women about sleep problems, regardless of their age, regardless of the timing, relative to menopause. If the partner is snoring, has restless leg syndrome, got different hours that they sleep, then maybe recommending a sleep divorce is a good idea. You know, you can still plan to have sex, or plan to have cuddling, or plan to have some other kinds of intimacy, but the answer is when it comes to sleep, different bedrooms, not within earshot of one another, separate bathrooms, and sleep is really important to both of you. Separate from that, getting to the issues about perimenopause and menopause, women are often dismissed, or they don't appreciate the impact of their poorly restorative sleep on their daily lives ,on their mood, etc. And mood changes actually make hot flashes worse, hot flashes make night sweats worse, night sweats disturb sleep, and we have this vicious circle where everything is feeding on itself and making the situation worse. So those of us who are OBGYNs, even primary care docs, you got to treat the hot flashes first, night sweats first, and then see what's left. Many times, women have primary undiagnosed insomnia disorder, which has a very clear definition, is not treatable with estrogen, it's a separate thing, and they need to separate intervention. And then completely separate from hot flashes and insomnia disorder, sleep gets worse as we age regardless, and some interventions, mostly in the psychosocial arena, cognitive behavioral therapy is the primary focus for those treatments unrelated to menopause, specifically, that persist after you've treated insomnia disorder. You've treated menopausal symptoms that can help women and probably men, although I'm not an expert there, achieve better, more restorative sleep.

Contemporary OB/GYN:

Do you have any advice for clinicians to provide to their patients for improving their quality of sleep?

James A Simon, MD

Yeah, so, the bed partner is, as I've mentioned, important. Keep the room dark, cooler than you think. The human body needs to cool off during sleep, it's part of the importance of sleep. Keep it quiet, keep it dark, keep it cool. And those are the very basics. No alcohol, alcohol disturbs sleep, both quality and quantity and is associated with early morning waking. Those of you who have been to a cocktail party and had a little bit too much to drink know that the next day, not only might you have a hangover, but you haven't slept, and you woke up at 3:00, 4:00 in the morning and didn't fall back to sleep and have restorative sleep. Plus, you probably got up to pee because you drank all that liquid containing the alcohol. So, alcohol is very bad for sleep quality. See a sleep professional. Ask your bed partner if you have one, whether you snore, whether you stop breathing, whether you're moving around in bed, might you have restless leg syndrome. In addition to insomnia disorder, sleep disturbance with hot flashes and night sweats, these are other underlying sleep problems that have treatments and they are pretty common. Even though we in obstetrics and gynecology are not well trained in those arenas, I guarantee you, if you live in a metropolitan area in the United States, Canada, even Mexico, you are going to have experts in sleep medicine within a few miles of where you practice that can help your patient or her bed partner with those primary sleep problems, and everybody will be happier.

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