2.1 Insomnia and the menopause

Insomnia is simply a sleep disorder where individuals either find it difficult to fall asleep or to stay asleep. There are two main types of insomnia: initiation insomnia, which is difficulty getting to sleep, and maintenance insomnia, which is difficulty staying asleep and is characterised by frequent waking or waking in the early hours and being unable to get back to sleep. Both can affect people in menopause who have previously slept well. Either they can’t get to sleep, or they can fall asleep easily but wake after just one or two ‘sleep cycles’ (a sleep cycle is usually around 1.5–2 hours).

Problems with getting to sleep are commonly caused by:

• restlessness
• joint and muscle pain
• inability to ‘switch the brain off’ – more common in menopause due to the increased anxiety that can be a feature at this time of life
• difficulties in getting comfortable, sometimes due to hot flushes that can intensify towards the evening and night. Some report hot flushes happening the minute they get into bed and put the light out!

Sometimes there are no clear causes of frequent waking or waking very early and being awake for hours, meaning that this maintenance insomnia can be extremely frustrating for those unfortunate enough to suffer from it. There are some obvious causes such as:

• hot flushes or night sweats
• waking up with bladder discomfort and having to go to the toilet
• restlessness.

But the key underlying factors in maintenance insomnia are related to hormone balance. Low levels of progesterone can make sleep more difficult.