Given the complex relationship between sleep and symptoms of menopause, it makes a lot of sense to consider ways to address these issues together, with therapies that can benefit both. 

Today I’ll be focusing some more on natural and non- or minimally-invasive forms of therapy. 

Let’s look more closely at some of the mind-body therapies that have been studied for their effectiveness in treating sleep and menopause symptoms: 

Massage. It’s easy enough to think of massage as an indulgence – and a great massage certainly does feel good! Massage also has important therapeutic value, including for women in menopause. Therapeutic massage stimulates blood circulation, activates the body’s lymphatic system, reduces fluid-retention and swelling throughout the body, and releases tension in muscles and joints. It can improve flexibility, and reduce pain. Massage also calms the nervous system, and can help reduce stress, alleviate anxiety, and pave the way for better sleep. A 2011 study of the effects of regular massage (2 times a week for 16 weeks) on postmenopausal women found it significantly improved symptoms of depression and anxiety. The study also found that massage benefited sleep by improving sleep quality, shortening the time it takes to fall asleep, and contributing to feeling more refreshed after a night’s rest. Postmenopausal women who received massage also moved more quickly into REM sleep and spent more time in deep, slow-wave sleep. These stages of sleep are critical for mental and physical restoration and rejuvenation. 

Yoga. Yoga has been shown to significantly reduce overall symptoms of menopause and help with hot flashes and night sweats, muscle and joint pain, anxiety and other mood problems associated with the menopausal transition. Across a range of studies, menopause symptoms showed improvement by as much as 36 to 80 percent. Research also shows yoga can improve cognitive function, boosting memory, focus, and attention. 

Yoga can also provide substantial improvements to sleep problems. In scientific studies, yoga has been shown to:
• Elevate sleep quality
• Shorten the time it takes to fall asleep
• Diminish nighttime awakenings
• Improve sleep efficiency (that’s a measurement of the time you spend sleeping compared to the total amount of time you spend in bed)
• Reduce reliance on sleep medications
• Increase daytime energy 

Tai Chi. Like yoga and other mind-body therapies, tai chi has been shown to have broad benefits for health and quality of life. For women in menopause, tai chi may be helpful in improving a range of symptoms and lowering risks for disease. Studies show tai chi may have a protective effect on metabolic and cardiovascular health, helping to reduce the risk of insulin resistance, lowering inflammation, and improving cardiovascular function. Tai chi can lift and balance mood, reducing symptoms of depression, anxiety, and stress. It also improves physical strength, balance, and flexibility in women — even more effectively than brisk walking, according to research – and has been shown to increase bone strength. 

A study of the effects of tai chi in postmenopausal women found it aided weight loss, increased strength and balance, and lowered blood pressure. 

This ancient, gentle exercise that focuses on breathing and slow, deliberate movement also delivers some real benefits for sleep. Research indicates tai chi can help reduce the symptoms of insomnia, help you fall asleep more quickly, sleep more soundly, and get more sleep overall. 

Cognitive Behavioral Therapy (CBT)

Many women during menopause wrestle with sleep problems and symptoms of depression, anxiety, or other issues with mood. I see this in a number of my patients who feel frustrated and debilitated by changes in mood and sleep that often accompany menopause. I explain to my patients that sleep problems and mood disorders often go hand in hand. A significant majority —roughly three-quarters or more — of people coping with depression also have difficulty with their sleep. And poor, insufficient sleep makes people more vulnerable to depression, anxiety and other problems with mood. Add the hormone changes associated with menopause to the mix, and it’s not surprising that so many women in menopause suffer dual issues of sleep and mood. 

Remember, estrogen and progesterone help to stabilize mood and keep stress in check. Fluctuations and declines in these important mood-regulating hormones can bring about symptoms of depression and anxiety even in women who haven’t experienced these conditions before. 

As a clinical psychologist specializing in sleep, I use cognitive behavioral therapy as a core element of my work with patients. What is CBT? A form of therapy that brings awareness and change to thoughts, feelings, and actions or habits related to an issue or set of unwanted symptoms. There’s a specifically designed version of CBT for insomnia (CBT-I) that has been shown a tremendously effective tool for sleep problems, working as well or often better than sleep medication. CBT is also effective at addressing menopause symptoms, both on their own and in conjunction with sleep issues. Studies show: 

• CBT can help improve sleep and relieve symptoms of depression in menopausal women who experience both

• CBT can be used to reduce the discomfort of hot flashes and night sweats

• In women who experience menopause symptoms after undergoing treatment for breast cancer, CBT can help to improve sleep, mood, and hot flashes or night sweats 

• CBT can improve insomnia symptoms in women suffering from chronic pain, and reduce the degree to which pain interferes with their ability to function at their best during the day. For women in menopause who have muscle and joint pain, or other types of pain that interfere with sleep and quality of life, CBT can help. 

This form of therapy has a lot of advantages as a treatment for sleep and menopause symptoms. Typically, CBT targeting these symptoms involves a short course of treatment. Research shows benefits to sleeplessness and other menopause symptoms in as few as 4-8 CBT sessions. Individual and group CBT sessions are options available to women—and so are guided self-help versions of the therapy, using apps, CDs, and books.

Make sure you’re relying on a well-trained, certified and experienced therapist, whether in group or individual sessions or in guided self-help treatment. 

Sweet Dreams,

Michael J. Breus, PhD, DABSM