Sleep

Sufficient restorative sleep – which is quality sleep that leads to better functioning during daytime – is essential for the peak functioning of all body systems.

Poor quality sleep, and disordered sleep (which includes disorders such as insomnia, sleep apnoea and restless leg syndrome) can increase health risks particularly for women navigating menopause transition.

There is growing evidence about the links between restorative sleep and non-restorative sleep, and cognitive, bone, cardiovascular, metabolic and mental health during perimenopause and menopause.

Sleep and cognitive health

Brain fog, memory and concentration difficulties are cognitive symptoms of perimenopause and menopause – and sleep problems are increasingly seen as a contributing factor to these symptoms.

That said, sleep difficulties are one of the more commonly reported perimenopause-menopause symptoms, alongside cognitive symptoms. A review in 2022 confirmed consistent links between menopause-related sleep difficulties and reduced cognitive performance.

The growing evidence seems to strongly suggest that restorative sleep supports cognitive performance during perimenopause and menopause.

Sleep and bone health

Recent research indicates that sleep difficulties may increase the risk of fracture during and after menopause – directly through influencing bone turnover, and indirectly through falls and other pathways.

Several studies conducted in the United States of America, point to links between sleep difficulties and an increased risk of fractures in menopausal women as well as increased risk of recurrent falls and therefore fractures (as most fractures are caused by falls). An Indian study similarly found that poor sleep quality forecasted or predicted an accelerated drop in bone mineral density, which leads to osteoporosis.

Sleep and cardiovascular health

Sleep is widely recognised as a key pillar of cardiovascular health. This is because sleep is important for various critical functions including regulating blood pressure, vascular function and metabolic processes.

Sleep that is not restorative is also understood to contribute to cardiovascular disease risk.

Studies suggest that poor sleep quality and insomnia symptoms are linked with increased risk of coronary heart disease, stroke and and cardiovascular-related deaths in menopausal women.1

There are non-drug (non-pharmacological) strategies for achieving restorative sleep. This includes maintaining a consistent sleep schedule, avoiding stimulating activities before bed, limiting screen time and blue light exposure, limiting alcohol and caffeine use before bed, and engaging in consistent physical activity during the day. For more information on other options for achieving restorative sleep.

My Menopause SA

Evidence-based menopause information for South African women.

Page last reviewed: 1 March 2026
Next review due: 1 March 2027

Back to Symptoms

All Symptoms

Footnotes

1 That said, these associations weaken after adjustments were made for conventional risk factors. This suggests that poor sleep plus lifestyle variables (diet, physical activity) act to raise cardiovascular disease risk (Beverly Hery et al, 2020). ↩

Anekwe, C. V., Cano, A., Mulligan, J., Ang, S. B., Johnson, C. N., Panay, N., … Nappi, R. E. (2025). The role of lifestyle medicine in menopausal health: a review of non-pharmacologic interventions. Climacteric, 28(5), 478-496. https://doi.org/10.1080/13697137.2025.2548806

Bertisch, S. & Joffe, H. (2025). Sleep and menopause (Pt 727-729). Menopause, 32(8). https://doi.org/10.1097/GME.0000000000002585

Beverly Hery, C. M., Hale, L., & Naughton, M. J. (2020). Contributions of the Women’s Health Initiative to understanding associations between sleep duration, insomnia symptoms, and sleep-disordered breathing across a range of health outcomes in postmenopausal women. Sleep Health: An Official Publication of the National Sleep Foundation, 6(1), 48-59. https://doi.org/10.1016/j.sleh.2019.09.005

Cherian, K. E., Kapoor, N., & Paul, T. V. (2022). Disrupted Sleep Architecture Is Associated With Incident Bone Loss in Indian Postmenopausal Women: A Prospective Study. Journal of Bone and Mineral Research, 37(10), 1956-1962. https://doi.org/10.1002/jbmr.4662

Guarnieri, B. (2019). Sleep disorders and cognitive alterations in women. Maturitas, 126, 25-27. https://doi.org/10.1016/j.maturitas.2019.04.214

Matthews, K. A., Everson-Rose, S. A., Kravitz, H. M., Lee, L., Janssen, I., & Sutton-Tyrrell, K. (2013). Do reports of sleep disturbance relate to coronary and aortic calcification in healthy middle-aged women?: Study of Women Across the Nation. Sleep Medicine, 14(3), 282-287. https://doi.org/10.1016/j.sleep.2012.11.016

Tandon, V. R., Sharma, S., Mahajan, A., Mahajan, A., & Tandon, A. (2022). Menopause and Sleep Disorders. Journal of Mid-Life Health, 13(1), 26-33. https://doi.org/10.4103/jmh.jmh_18_22

Zhu, C., Thomas, N., Arunogiri, S., & Gurvich, C. (2022). Systematic review and narrative synthesis of cognition in perimenopause: The role of risk factors and menopausal symptoms. Maturitas, 164, 76-86. https://doi.org/10.1016/j.maturitas.2022.06.010