Sleep and Brain Function at Menopause

Research Summary

Around one‑third of our life is spent asleep which is an internally regulated universal biological function of life. Sleep disturbances and cognitive difficulties, often termed as brain fog, are common complaints during menopause. Research reveals that these symptoms are intricately linked to neuroendocrine changes, particularly the decline in estrogen levels. Sleep is considered healthy for an adult if it is adequate, timely, regular, and without disturbances. There is a risk of adverse health outcomes if the duration of sleep is <7 h such as weight gain and obesity, diabetes, hypertension, heart disease, stroke, depression, impaired performance, and increased errors. The prevalence of insomnia is 6%–10% and higher in women, older age, and lonely people. At least 6–7 h of sleep is considered a normal sleep duration, and the odds of associated diabetes and hypertension are 3 and 5, respectively, for the short sleep duration. Insomnia of menopause is the chronic insomnia disorder characterized by chronic sleep‑onset or sleep‑maintenance complaints with an associated daytime impairment that occurs at least three times a week persisting for at least 3 months and is not due to other morbid conditions.[1] Dr. Ruchika Garg, Editor in Chief The Neuroendocrine Menopause Dr. Atul Munshi, Editor in Chief Changes in Estrogen has far‑reaching effects on brain function, supporting synaptic plasticity, neurotransmitter regulation, and neuroprotection. Estrogen deficiency during menopause can significantly impact cognitive performance, mood, and sleep. Synaptic plasticity in the hippocampus and prefrontal cortex, regions critical for memory and executive function are promoted by estrogen.[5] The decline in estrogen during menopause is associated with a reduction in synaptic density, leading to cognitive challenges such as brain fog, memory lapses, difficulty concentrating, and decreased mental clarity.[6] Insomnia at menopause is the disequilibrium due to the inadequacy of sex hormones. It has a causeeffect relationship. This hormonal imbalance produces multiorgan symptoms and may result in multiple symptomatic medical interventions. Sleep disorders are hormone‑specific concerning the phases of reproductive life like the luteal phase of menstruation, pregnancy, and menopause. Increasing nocturnal awakenings or wake‑after‑sleep onset are common. There is an increased risk for insomnia in the luteal phase; an increased risk of restless legs syndrome and sleep apnea in the third trimester of pregnancy; and a high prevalence of insomnia and sleep‑disordered breathing in menopause.[2]