Sleep Is Essential for Protecting Heart Health in Postmenopausal Women, Study Shows

• Participants were evaluated using the American Heart Association’s (AHA) Life’s Essential 8 — This system evaluates eight core areas of cardiovascular health, namely diet, physical activity, nicotine exposure, sleep, body mass index (BMI), blood lipids, blood glucose, and blood pressure.

Each category is scored from 0 to 100, with a combined total score that reflects overall heart health. Researchers calculated scores at the start and again years later to track how changes in these areas influenced long-term outcomes.

• Researchers tracked outcomes over time to link habits to risk — Over the course of the study, 213 women had a cardiovascular event and 161 died. Researchers compared these outcomes with each woman’s health scores to see which habits were protective and which increased risk. By looking at both the starting scores and how they changed over time, the study identified patterns that revealed how cardiovascular health progressed through and after menopause.

• Only a small fraction of women reached ideal scores — Just 21% of the women consistently achieved ideal overall scores on the LE8 scale. Most fell short in one or more areas, and those who started with low scores or whose scores declined over time were found to be more likely to develop heart disease or die. This pattern held across the entire study population, underscoring the importance of midlife as a window for preventive action.

• Some health factors had stronger protective effects — Women with higher scores in blood pressure regulation, glucose control, and avoidance of nicotine had consistently better cardiovascular results. These areas have long been recognized as important to heart health, and the study reaffirmed their importance during the menopausal transition. However, the data also pointed to another area that had not been given equal weight in most preventive strategies — sleep.

• Sleep quality is a significant predictor of long-term heart health — Women who entered midlife with higher sleep scores or who improved their sleep during the study period were less likely to experience major heart-related events or die from any cause.

This association held even when adjusted for other risk factors, and its impact was strongest in the context of long-term outcomes rather than early-stage vascular changes. In particular, sleep was not strongly tied to carotid artery thickening, a subclinical marker of vascular aging, but showed a clearer relationship to more advanced events.

• Midlife sleep targets are specific and actionable — The sleep component of LE8 is based on a target of seven to nine hours of sleep per night, averaged across time. Ziyuan Wang, Ph.D. candidate at the University of Pittsburgh and first author of the study, noted that the link between sleep and heart health, as well as longevity, should be explored further in clinical trials.

Senior author Samar R. El Khoudary, Ph.D., M.P.H., professor of epidemiology at Pitt’s School of Public Health, also added, “With heart disease being the leading cause of death in women, these findings point to the need for lifestyle and medical interventions to improve heart health during and after menopause among midlife women.”⁴

• Menopause often brings chronic sleep disruption — A 2017 review published in Current Sleep Medicine Reports compiled findings from multiple SWAN publications to document how sleep changes across the menopausal timeline. Difficulty falling asleep, staying asleep, and waking too early were common, and these disturbances often persisted into postmenopause.⁵

The review also detailed how sleep disturbances often track with vasomotor symptoms such as night sweats and hot flashes. Women with frequent vasomotor symptoms were more likely to report poor sleep, and those sleep problems tended to become more persistent as menopause progressed.⁶

• Sleep trajectories predict future heart risk — Another study, this time published in Circulation in January 2024, tracked women’s sleep over time and found that persistent insomnia symptoms significantly increased the risk of cardiovascular events. Women with long-standing sleep trouble were 71% more likely to develop heart disease than those with consistently low symptoms.

Those who also had short sleep duration (averaging five hours per night) faced even greater risk. Women with both persistent insomnia and short sleep had a 75% higher risk of heart problems than those who slept longer and had fewer symptoms. These findings held even after accounting for hot flashes, snoring, and depression.⁷

• Poor sleep was widespread across multiple dimensions — Half the participants reported sleeping fewer than seven hours per night. Nearly 80% had poor sleep quality, one-third were at high risk for obstructive sleep apnea, more than half reported symptoms of insomnia, and 12% were classified as having an evening chronotype (night owl). Peri- and postmenopausal women were more likely than premenopausal peers to report poor sleep quality across the board.

• Poor sleep quality tripled the odds of poor cardiovascular health — Women with poor sleep quality had three times the odds of scoring low on overall LE8 cardiovascular health metrics compared to women with better sleep, even after adjusting for age, race, education, and menopause status. High-risk sleep apnea and evening chronotype also raised the odds of low cardiovascular scores nearly threefold.

• Specific sleep problems linked to specific LE8 categories — Poor sleep quality increased the likelihood of low scores on the diet component of LE8. Insomnia symptoms were associated with lower BMI scores. Women at high risk for sleep apnea were significantly more likely to show poor results in the blood pressure, blood glucose, and BMI categories. Most strikingly, women suspected of having sleep apnea had more than 11 times the odds of a poor BMI score.

• Menopause may reflect estrogen excess, not deficiency — Although estrogen levels decline in blood during menopause, tissue levels often remain stable or even increase due to local production via aromatase. This creates a state of functional estrogen dominance, especially in women who experience chronic symptoms like poor sleep, weight gain, or inflammation.⁸

• Estrogen disrupts mitochondrial energy production — Rather than promoting balance, unopposed estrogen impairs mitochondrial function and shifts cells toward aerobic glycolysis. This weakens energy production and raises oxidative stress, which interferes with metabolic and neurological processes that support sleep integrity.⁹

• Thermoregulatory dysfunction fragments sleep — Hot flashes and night sweats are tied to hypothalamic instability, which is worsened by low progesterone and excess estrogen. Even minor temperature fluctuations trigger sympathetic nervous system activity, raising heart rate and shattering sleep continuity.¹⁰

• Progesterone loss removes a key neural stabilizer — Progesterone supports deep, restorative sleep by activating GABA receptors that calm brain activity. As progesterone falls during perimenopause, women often experience delayed sleep onset, increased nighttime awakenings, and heightened emotional reactivity at night. Unlike estrogen, progesterone has a direct sedative effect that helps initiate and maintain sleep.¹¹

1. Get bright sunlight within 15 minutes of waking up — Morning light is your body’s primary cue that the day has started. It anchors your circadian rhythm, boosts serotonin, and helps regulate cortisol so it doesn’t stay elevated into the night.

Go outside without sunglasses or windows between you and the light; even five minutes makes a difference. If you wake up before sunrise, consider using a dawn simulator or bright light lamp to mimic the effect.

2. Avoid blue light completely after sunset — Melatonin levels are already lower in menopause due to hormonal changes.¹² Exposure to blue light from screens suppresses it even further, keeping your brain alert and delaying the natural transition into sleep. Shut off all screens at least an hour before bed.

If that’s not possible, wear amber-tinted glasses or adjust device displays to emit the warmest, dimmest light. This helps your system recognize nightfall and begin slowing down. At night, use blackout curtains, cover LEDs, and avoid night lights. The room should be fully dark — enough that you can’t see your hand in front of your face.

3. Keep your sleeping environment cool — During menopause, the body’s internal temperature regulation becomes more sensitive and unstable. Your core temperature needs to drop to initiate and maintain deep sleep, and a warm room makes that harder.

Set your bedroom to 60 to 68 degrees F (15 to 20 degrees C). Choose breathable, moisture-wicking bedding that doesn’t trap heat. Supporting this thermoregulation helps your body move into slow-wave sleep, which is essential for metabolic and cardiovascular recovery.

4. Eliminate sources of electromagnetic fields (EMFs) from your room — Unplug devices near your bed, turn off your Wi-Fi router, and put your phone in another room or on airplane mode. If you’re willing to go further, consider turning off the bedroom circuit breaker at night. Less background stimulation means fewer signals pulling your nervous system back into alert mode.

5. Consider taking progesterone — I take three hormones that I believe most adults can benefit from — progesterone, DHEA, and pregnenolone. For perimenopausal and menopausal women, progesterone may be especially useful. In one study, progesterone supplementation significantly improved night sweats and sleep quality among perimenopausal women.¹³ If you’re considering this option, I explain how to use progesterone safely and effectively in the section below.