Sleep Disturbances During Menopause Linked to Lower Quality of Life

Sleep disturbances are highly prevalent among women during and after the menopause transition, and their effects extend well beyond nighttime discomfort.¹ A large systematic literature review of studies published between 2013 and 2023 found that poor sleep in peri- and postmenopausal women is consistently associated with worse health-related quality of life (HRQOL), including higher rates of depression, anxiety, pain, and reduced work productivity, even among women who do not experience vasomotor symptoms (VMS) such as hot flashes.

From 5122 records initially identified, investigators screened 954 full-text articles and ultimately included 55 publications: 29 reporting epidemiologic outcomes of sleep disturbances and 28 examining associations between sleep quality and HRQOL. Across 26 country-specific and 3 multinational studies, sleep disturbances—including difficulty initiating or maintaining sleep, reduced duration, and fragmented sleep—were highly prevalent. Reported prevalence ranged from 9% in North America to as high as 73% in Asia; South America reported 56%, and European estimates ranged from 24% to 69%. In multinational cohorts of women aged 40 to 65 years, overall prevalence was 55%, varying from 39% in Italy to 67% in Canada.

Menopausal status was a consistent risk factor. Compared with premenopausal women, perimenopausal women had higher odds of poor sleep (OR, 1.50-1.75; P < .05), as did postmenopausal women (OR, 1.23-1.73; P < .05). Notably, menopause without VMS remained independently associated with worse sleep. In one study, menopausal status without VMS was linked to higher global Pittsburgh Sleep Quality Index (PSQI) scores (β, 1.54; 95% CI, 1.14-1.95; P < .001) and greater odds of being classified as a poor sleeper (OR, 1.45; 95% CI, 1.03-2.05; P < .05), even after adjustment for cardiometabolic and lifestyle factors.

Age at menopause also influenced risk. Each additional year in age at menopause was associated with a lower likelihood of trouble falling asleep (OR, 0.97; 95% CI, 0.96-0.99), nighttime awakenings (OR, 0.98; 95% CI, 0.97-0.99), and nonrestorative sleep (OR, 0.97; 95% CI, 0.95-0.99; all P < .05). Chronic pain further compounded risk: moderate to severe pain interference was associated with significantly higher insomnia risk, with risk ratios ranging from 1.35 to 1.64 (all P ≤ .004).

Sleep disturbances were strongly linked to diminished quality of life. Women with sleep complaints had significantly worse Menopause Rating Scale scores than those without sleep problems (mean, 71.1 [95% CI, 61.0-79.8] vs 54.3 [49.8-58.6]; P < .001). Difficulty sleeping correlated with poorer menopause-specific QOL (β, 0.411; P = .001). Frequent sleep disturbances were negatively associated with both physical and mental components of the 36-Item Short Form Health Survey (β, −0.67 and −0.79, respectively; P < .0001) and with 12-Item Short Form Health Survey mental scores (β, −0.612; P < .001). Among osteoporotic and osteopenic postmenopausal women, impaired sleep quality was significantly associated with lower QOL, with Pearson correlation coefficients of 0.433 and 0.308, respectively (both P < .001).

Emotional health outcomes were similarly affected. Poor sleep increased the odds of depressive symptoms on the Beck Depression Inventory (adjusted OR, 4.65; 95% CI, 1.82-11.88; P < .05) and on the Self-rating Depression Scale (OR, 11.5; 95% CI, 5.39-24.66; P < .001). Greater depression severity correlated with reduced sleep efficiency (r = −0.333; P = .001), quality (r = −0.219; P = .001), latency (r = −0.326; P < .001), and duration (r = −0.337; P < .001). Anxiety increased in a graded fashion with worsening sleep, with moderate, severe, and very severe sleep disturbances associated with 3.31-fold, 4.69-fold, and 16.6-fold higher anxiety levels, respectively.

Work productivity was also affected. In real-world surveys, 90.8% of women reported VMS-related sleep disruption, and 83.1% reported sleep-related productivity impairment. Sleep disturbances were significantly associated with reduced occupational QOL and greater work and activity impairment.

Taken together, the findings underscore that sleep disturbances are common throughout the menopause transition and are independently associated with meaningful declines in emotional well-being, physical health, and daily functioning. However, the authors noted the reciprocal relationship between sleep disturbances and depression has implications extending beyond QOL and occupational functioning to include morbidity, mortality, and life expectancy among postmenopausal women, according to previous research.²

“The results of this systematic literature review show that sleep disturbances are highly prevalent and represent a significant burden in menopausal women, impacting QOL, emotional health, and work outcomes,” the authors concluded.¹ “Although sleep quality in postmenopausal women can be influenced by the presence and severity of VMS at night, it is now known that a significant proportion of postmenopausal women experience sleep disturbances even in the absence of VMS.”

References

1. Soares CN, Bajbouj M, Schoof N, Kishore A, Caetano C. Impact of sleep disturbances on health-related quality of life in postmenopausal women: a systematic review. Menopause. 2026;33(1):118-128. Published 2026 Jan 1. doi:10.1097/GME.0000000000002633
2. Korhonen K, Moustgaard H, Tarkiainen L, et al. Contributions of specific causes of death by age to the shorter life expectancy in depression: a register-based observational study from Denmark, Finland, Sweden and Italy. J Affect Disord. 2021;295:831-838. doi:10.1016/j.jad.2021.08.076