Menopause Causes Insomnia and Sleep Apnea, if you don’t replace Testosterone and Estradiol

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The importance of replacing your testosterone and estradiol after menopause.

My of my patients who are listing their symptoms of menopause and low testosterone invariably check the box next to INSOMNIA. In addition to insomnia, they tell me that it is the one problem that they have that affects all their other symptoms of menopause such as difficulty thinking and memory, depression, restless legs, muscle aches, irritability, and generally sabotages their quality of life.  This subject has finally been studied in depth by the J or Endocrinology, and I want to share the information with you.

Insomnia is one of the symptoms that plagued me after my hysterectomy and removal of my ovaries.  When my sex hormones, estradiol, and testosterone were depleted, my sleep was significantly disrupted.  We spend 1/3 of our life sleeping, recharging and healing our brain and body. Prior to my hysterectomy I had always been able to sleep. For an OBGYN who is always sleep deprived, I was able to lie down between deliveries or surgeries and sleep for 20 minutes and wake up refreshed.  After my hysterectomy I couldn’t even sleep when I had a chance to at night!  I was literally the walking wounded, and medicine told me this was completely unrelated to hormones…..I had proof that it wasn‘t and no one would listen to me. I added estradiol to replace the only hormone that medicine accepted as a product of the ovary, but estrogen made me fatter (I gained 20 lbs after my hysterectomy) and didn’t help my sleep, it just decreased my hot flashes, but didn’t stop them.  My life path led me to Dr Gino Tutera who knew that I needed testosterone as well and the loss of T was the source of all my symptoms.  Voila! The first night after my pellets were inserted, I slept all night!  I woke rested and all my symptoms went away from that day on!  Medicine had failed me…and I began to question everything I learned.  The medical articles blamed insomnia on everything else that is downstream from T and E2 loss… flashes, anxiety, depression, worry, getting olde, or normal aging.

The latest research from the Endocrine Society confirms the findings that I discovered 20 years ago…that the loss of ovarian and testicular hormones cause insomnia.

There is emerging evidence that menopause-associated hormone loss contributes to this elevated risk, but age is also an important factor. The extent to which menopause-associated sleep disturbance persists into postmenopause above and beyond the effects of age remains unknown. Untreated sleep disturbances have important implications for cognitive health, as they are emerging as risk factors for dementia. Given that sleep loss impairs memory, an important knowledge gap concerns the role played by menopause-associated hormone loss in exacerbating sleep disturbance and, ultimately, cognitive function in aging women. In this review, we take a translational approach to illustrate the contribution of ovarian hormones in maintaining the sleep–wake cycle in younger and middle-aged females, with evidence implicating 17β-estradiol in supporting the memory- promoting effects of sleep.

 They now admit that insomnia is independent of aging, it occurs when ever sex hormones fall below the genetic normal for a patient.  We see this most acutely in patients who have their ovaries removed before menopause.

 So if sleep is vital to avoiding dementia and Alzheimer’s disease, and necessary to your ability to think and problem solve, and to prevent depression and anxiety how does this work?

The basic timing and duration of sleep is regulated by homeostasis (balance of the brain). A person has a necessary amount of sleep needed and everyone is unique.  As you are sleep deprived something called “sleep pressure” increase until you go to sleep and relieve this pressure. The second factor in timing and duration of sleep is circadian rhythm, aligning your sleep and wake cycles to the light and dark cycles of your environment. Estradiol and Testosterone affect both of these natural regulators of sleep.




Reference—Endocrinology, September 2020 Brown and Gervais Ovarian Hormones and Sleep in Females


Women in the fertile years 12-40 show normal sleep, and sleep cycles.  This is shown in the first column The second column is usually between age 40-menopause and it shows that sleep becomes abnormal during this time that testosterone becomes deficient, and estrogen associated with ovulation starts to be sporadic.  At this time insomnia is also sporadic and increases with the loss of T.  The menopause ends the production of E and T and insomnia becomes chronic. Women wake up multiple times a night and can’t go to sleep, they toss and turn and the resting of the body and brain stops….sleep is no longer rejuvenating.

PMS is secondary to loss of ovulatory progesterone production and can happen at any time in a woman’s life.  The more Estradiol and less Progesterone PMS occurs.  This also decreases regenerative sleep, so Progesterone is vital to the sleep process too.

Peri/post-menopause is associated with increased prevalence of insomnia (characterized by difficulty falling and/or staying asleep), restless leg syndrome (characterized by uncontrollable leg movement), and sleep apnea (characterized by interrupted breathing)

This research proves what I have been treating for pre menopause, loss of testosterone, and menopause for 20 years. In my office   I get to witness the change in women who now have their hormones back and no longer have insomnia, depression, memory problems, restless legs, hot flashes, sleep apnea, obesity and aging of the skin.  They look alive and beautiful!

If you have insomnia, and are not rested when you wake up, even if you don’t feel hot flashes, then estradiol and testosterone, and sometimes progesterone. Getting restful sleep and enough of it can slow aging and prevent dementia…..just by replacing what you are missing , E and T, you can save your brain and your life!


This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author. • (314) 993-0963. Please subscribe to our YouTube channel and please check “ Like “.  Follow us on Facebook and Instagram at BioBalanceHealth.

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