A narrative review of literature published between January 2015 and March 2026 sets out what actually disturbs sleep across the menopausal transition and postmenopause. Alongside insomnia it names three other primary sleep disorders that become commoner in this population: obstructive sleep apnoea, restless legs syndrome and periodic limb movement disorder. Sleep disruption is more prevalent in perimenopausal and postmenopausal women than in premenopausal women, and the review is explicit that the size of that difference shifts with menopausal stage, with whether vasomotor symptoms are present, and with whether sleep was captured by self-report questionnaire or by objective measurement.
The clinical problem this creates is attribution. A woman in her late forties who says she is not sleeping has an obvious explanation available - the night sweats - and that explanation absorbs the consultation. Obstructive sleep apnoea in particular is under-recognised in women, presents less often with the classic loud-snoring picture, and does not improve because her vasomotor symptoms are treated.
The practical response is to separate the question in two. Ask what wakes her, and ask what she is like during the day. Sleep that is broken by heat and settles again points one way; unrefreshing sleep of apparently normal duration, morning headache, or a bed partner's account of pauses in breathing points somewhere else entirely. The review's contribution is to make the differential explicit rather than leaving it to be inferred, which is worth something in a clinic where menopause and sleep medicine rarely meet.
- Ask separately about sleep onset, night waking and daytime sleepiness rather than recording 'poor sleep'
- Screen for obstructive sleep apnoea in any woman with unrefreshing sleep, regardless of body mass index
- Ask directly about the urge to move the legs at rest in the evening, which patients rarely volunteer
- Note the menopausal stage in the record, since prevalence differs between perimenopause and postmenopause
- Reassess sleep after vasomotor symptoms are controlled; what remains is a different diagnosis
Why it matters
A plausible explanation for a symptom is the main obstacle to finding the real one.
Don't overread it
A narrative review describes the landscape; it does not establish how often each disorder is missed in practice.
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