Sleep deprivation poses a critical threat for women beyond age 45
Poor sleep quality during and after menopause has been identified as a significant risk factor for cardiovascular disease (CVD) and all-cause mortality in women. This connection is largely due to the combined effects of hormonal changes and sleep disturbances common in menopause.
Menopause triggers a sharp decline in estrogen and progesterone, hormones that protect cardiovascular health by promoting vasodilation, improving lipid profiles, and reducing insulin resistance and abdominal fat. The loss of these hormones leads to higher blood pressure, increased vascular stiffness, accumulation of visceral fat, and worsened lipid profiles, all of which elevate CVD risk.
At the same time, fluctuating and declining estrogen disrupts sleep patterns, causing issues like insomnia, frequent awakenings, and sleep apnea, which become more prevalent during menopausal transition and beyond. Poor sleep itself contributes to cardiovascular disease by worsening autonomic nervous system regulation, endothelial function, metabolic balance, inflammation, and clotting—all key mechanisms in atherosclerosis, hypertension, and arrhythmia. Both short (less than 6 hours) and long (more than 9 hours) sleep durations are linked with increased coronary heart disease and stroke risk.
This interplay creates a vicious cycle: menopause-related hormonal decline worsens sleep quality, and poor sleep further accelerates cardiovascular risk. Poor sleep also correlates with higher all-cause mortality during and after menopause, likely through its impact on heart health and related metabolic processes.
Because poor sleep is a modifiable risk factor, addressing sleep disturbances via lifestyle, medical evaluation, and possibly hormone replacement therapy (if appropriate) can help reduce menopausal women’s elevated risk of cardiovascular disease and mortality. Clinicians also need to consider the effects of medications on sleep quality in this demographic to optimize cardiovascular outcomes.
The American Heart Association recommends Life's Essential 8 (LE8) to lower the odds of heart disease. This includes eating better, being more active, quitting tobacco, getting healthy sleep, managing weight, controlling cholesterol, managing blood sugar, and managing blood pressure. Maintaining a healthy weight, with a BMI between 18.5 and 25, is important for heart health. A healthy diet should include whole foods, fruits and vegetables, lean protein, nuts, seeds, and non-tropical oils such as olive oil. The AHA recommends 2 1/2 hours of moderate or 75 minutes of vigorous physical activity each week.
The hypothesis that improving sleep can contribute to women's heart health and longevity by lowering their cardiovascular risks should be tested in a future clinical trial. Certain fruits and vegetables can help improve sleep quality, making them valuable additions to a heart-healthy diet.
References:
- The menopause transition and cardiovascular disease
- Sleep and cardiovascular disease in women
- Sleep disturbances and cardiovascular disease in postmenopausal women
- Sleep and cardiovascular disease
- Sleep and cardiovascular disease: the vicious cycle
The decline in estrogen during menopause, a hormone crucial for cardiovascular health, can lead to sleep disturbances and worsen sleep quality. These sleep issues, in turn, contribute to the elevated risk of cardiovascular disease (CVD) and all-cause mortality, reinforcing a vicious cycle. Adhering to the American Heart Association's Life's Essential 8 (LE8), which includes maintaining healthy sleep, can aid in reducing the increased risk of CVD and mortality for women during menopause. Certain fruits and vegetables, such as those often included in a heart-healthy diet, may also improve sleep quality, making them valuable ingredients for women's heart health and longevity. Addressing this interplay between menopause, sleep, and health-and-wellness, particularly cardiovascular health and women's health during menopause, is a crucial area for future scientific research.
