Menopause and Insomnia Medications

Menopause and insomnia seem to go hand-in-hand. Many women struggle with sleep during the menopause transition. Fortunately, there are many medication options for women dealing with menopause and insomnia.

A senior woman dealing with insomnia.
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Menopause and Insomnia

It’s two o’clock in the morning, and you're deciding whether to toss for awhile more, get up and do a sudoku puzzle, put on the shopping channel — or just scream and get it over with. You have insomnia, and it started when you entered the menopausal years.

There are many women struggling with the same frustration, but that isn’t much comfort when all you want is just a few more minutes of sleep before that alarm goes off. And once your mind is engaged, there are so many worries and responsibilities to choose from that it can be impossible to get back to sleep.

Chronic insomnia can really affect your quality of life. Daytime sleepiness and fatigue will make every task harder and can begin to erode your mood.

Let’s assume that you have tried hot baths before bed, you can’t seem to get the knack of progressive relaxation and you have already cut back on caffeine. If you are still caught in a pattern of habitual wakefulness it may be time to consider medications to turn your sleep cycle around.

Medications to Help You Sleep Better

Here are some of the choices you might consider.

Over-the-Counter Sleep Aids

Usually, OTC sleep aids are some sort of antihistamine, sometimes combined with pain medication. Because you don’t need a prescription, they are readily available, inexpensive and are pretty effective at helping you get to sleep.

They tend to give you a “sleep hangover” though, and that can make you feel groggy in your morning, or interfere with motor tasks like driving.

But if you take them early in the evening and can sleep for a full eight or nine hours, they may be a good choice for you.

Sedative Hypnotics

The group of medications called “benzodiazepines” is often prescribed for anxiety and for sleep. These drugs, like Valium, Xanax, Ativan, and others, are quite effective in calming you and helping you sleep. There are newer, shorter-acting benzodiazepines like Restoril and ProSom that are effective for treating temporary insomnia and don’t have as many side effects.

Be aware that all of the benzodiazepine medications can create dependence, and some cause memory and other cognitive problems during the day. These medications tend to become less effective over time, so short periods of use are better than long-term use.

There are also non-benzodiazepine hypnotic medications, such as Ambien, Sonata and Lunesta, that are proving to be very effective without the side effects of benzodiazepines. Lunesta appears to be safe even when used for up to six months.


Many types of antidepressants, including tricyclic antidepressants and some of the SSRI antidepressants, are used to treat sleep disturbances. Because these medications also treat depression and anxiety, they can be good choices if you suffer from a mood disorder with insomnia.

It’s good to be aware, though, that some antidepressants actually cause insomnia, which can intensify your depression or anxiety.

If you are currently on an antidepressant and are also having insomnia, talk to your medical provider to see whether your medication is causing insomnia and whether another one might be a better choice.

Hormone Therapy

If your insomnia is due to menopause symptoms like night sweats or hormone swings causing wakefulness, you might be a good candidate for a course of hormone therapy. Sometimes a small dose of estrogen or estrogen/progestin therapy can get you through the most dramatic menopause symptoms, and then can be tapered and stopped.

But hormones have their own risks. Check with your healthcare provider or practitioner to discuss the hormone options and their safety concerns.

Pain Medications

When pain wakes you in the night it's hard to get back to sleep. By the time you take something for the pain and wait for it to work, you may be up for the night.

If you're having ongoing pain and you aren’t sure what's causing it, make an appointment to find out. There are many conditions that involve pain around midlife. Anything from arthritis to gallbladder problems could be the culprit.

Once you know what's causing the pain, talk to your medical provider about the best way to manage it. There may be ways to minimize your pain overnight by taking long-acting medications before you go to bed. Taken properly, non-prescription pain medications, like ibuprofen, acetaminophen, naproxen or aspirin, may be all you need.

Talk to Your Healthcare Provider

Check in with your medical provider if you have been having sleepless nights more than a couple of times a week. He or she can offer several options of medication that might pull you out of that pattern and restore your energy and mood.

Be sure to discuss what you think might be causing the sleeplessness, since it may be possible to treat the underlying problem rather than insomnia alone and solve both problems at once.

Depression, anxiety, pain, restless leg syndrome, night sweats, and sleep apnea are all conditions that can rob you of your sleep and that can be treated in ways that help you get back to a restorative sleep routine.

Menopause, Insomnia, and Alcohol

It's tempting to use alcohol to relax and feel sleepy, especially after a hard day. But using alcohol at bedtime will actually erode the quality of your sleep. It can also lead to tolerance, requiring more and more to achieve the same effect. And it can be dangerous, even deadly, to combine alcohol with sleep medications.

So, steer clear of alcohol for sleep. It causes more problems than it solves.

Remember these points if you want to treat your insomnia successfully:

  • If you are on any regular medication, check first to see whether sleep disturbance is a side effect. If it is, talk to your healthcare provider about other choices.
  • Treat any underlying causes of your sleep problems. If you're anxious or depressed, or if you have ongoing pain, there may be ways to treat these problems and eliminate your sleep troubles.
  • Use medications as a last resort, after you have tried other methods for dealing with your sleeplessness.

No doubt about it, you need your sleep. Menopause offers enough challenges all by itself, and insomnia can make it seem impossible to manage. Find the best way to get to sleep and stay asleep so you will have the energy to meet your day, every day.

Frequently Asked Questions

  • How do I stop night sweats caused by antidepressants?

    You may be able to stop night sweats caused by antidepressants by lowering the drug's dosage or switching to a different antidepressant. If altering medication isn't possible, using benztropine or cyproheptadine may help reduce sweating. One group study concluded that cognitive behavioral therapy (CBT) can lower night sweats during menopause. This may be worth bringing up with a healthcare provider if night sweats are persistent.

  • Should Prempro be taken in the morning or at night?

    Prempro should be taken according to your healthcare provider's instructions, which they may decide is best in the morning or at night. The hormone replacement therapy's effects should be the same regardless of when it is taken. It's important to take Prempro at the same time each day; if you miss a dose, take it as soon you remember, unless the next dose needs to be taken soon afterward.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Kate Bracy, RN, NP
Kate Bracy, RN, MS, NP, is a registered nurse and certified nurse practitioner who specializes in women's health and family planning.