Sleep Disorders in Pregnant and Menopausal Women
Reviewed by: HU Medical Review Board | Last reviewed: June 2020
The raging hormones and physical changes of pregnancy and menopause often cause sleep problems in women. Insomnia, in particular, is more common in women during these life phases.1
Sleep disorders in pregnancy
Insomnia, sleep apnea, and restless legs syndrome (RLS) all may appear for the first time or get worse during pregnancy.2
One in 10 women report problems sleeping in the first trimester. That increases to 2 in 10 during the second trimester and 6 to 8 out of 10 during the third trimester. The most common complaint is insomnia, or problems falling or staying asleep.2
The third trimester is an especially hard time for good sleep. Hormone changes and discomfort caused by the growing baby mean that almost all pregnant women wake often late in the third trimester. Insomnia often continues for the first year after childbirth. Postpartum insomnia is usually caused by fluctuating hormones, infant care, and relationship changes.1-3
Restless legs syndrome (RLS) appears in nearly 1 in 3 women during pregnancy, with symptoms getting worse in the third trimester. If a woman did not have RLS before pregnancy, it usually goes away after childbirth. If a woman had RLS before pregnancy, it can get worse until the baby’s birth.2
Between 10 percent and 25 percent of pregnant women develop sleep apnea during pregnancy. This may be caused by weight gain, swelling, nasal congestion, or the growing baby pushing against organs. Sleep apnea may get worse in women who had the sleep disorder before getting pregnant.2
Sleep disorders in menopause
Rates of insomnia, restless legs syndrome, and sleep apnea all increase in women during perimenopause and menopause. Some of this may be due to hormone changes, but weight gain, depression, anxiety, and stressful life events can play a role too.
About 6 out of 10 women report insomnia symptoms after menopause.3
During menopause, lower estrogen levels can lead to hot flashes and night sweats that can interrupt sleep. In fact, hot flashes and night sweats happen to 8 out of 10 women during menopause. Hot flashes last for about 1 year for most women, but 25 percent have hot flashes for many years. Night sweats that require getting up to change into dry nightclothes make sleep less restful.1-4
While sleep apnea is more common in men overall, menopause increases the chances that a woman will develop sleep apnea. Untreated sleep apnea decreases the quality of sleep and increases the chances of developing heart disease.1
Treatments for women with sleep disorders
More doctors now recognize the importance of treating sleep disorders in pregnant and menopausal women.
Treatments during pregnancy
Most women try to avoid taking drugs during pregnancy, so behavior changes are the first line of attack. Improving sleep habits and the sleeping environment may provide enough relief for an expectant mother to get enough sleep.
Women with RLS may need to take iron and folate supplements. There are also non-drug ways of treating RLS such as exercise, avoiding caffeine, and using foot wraps or vibration pads.1
Common prescription drugs used to treat RLS, such as pramipexole and ropinirole, have not been studied for safety to unborn babies.
A CPAP machine may be recommended to treat sleep apnea during pregnancy. Other ways to treat sleep apnea during pregnancy include using pillows to change sleeping position and avoiding gaining too much extra weight.1,2
Treatments during menopause
During menopause, hormone replacement therapy and other drugs may help ease the symptoms that cause hot flashes and night sweats. Like during pregnancy, improving sleep habits and the sleeping environment are the first non-drug options for treating insomnia. Iron supplements and exercise may help improve RLS symptoms during and after menopause. A CPAP machine may be needed to treat sleep apnea during perimenopause and menopause.1