What You Need to Know about Menopause, Melatonin, and Sleep


As women enter menopause, changes in sleep patterns are a common concern. Sleep can be difficult during this time of hormonal, physical, and psychological changes. Prior to menopause, about 12% of women experience problems sleeping. The incidence of insomnia and other sleep problems jumps to 40% during and after menopause. Though many women think this is just something they have to live with, like hot flashes, lack of quality sleep can have a dramatic impact on health and quality of life. 

Science is showing that hormone changes play a significant role in sleep changes. For instance, as progesterone and estrogen levels decline, women are more apt to develop sleep apnea – when breathing stops and starts during sleep. Sleep apnea affects the body’s ability to regulate blood pressure and blood sugar, impairs cognition, and places added stress on the cardiovascular system. If you suspect that sleep apnea is occurring, contact your doctor for advice on how to address this common problem.  

Do Prescription Sleep Medications Help with Insomnia? 

It might seem convenient to ask your doctor for a sleep-aid prescription, however, studies show that these medications may not support healthy sleep patterns in the long term. The Study of Women’s Health Across the Nation (SWAN) study looked at 238 women who started using medication for insomnia (11 sleep pharmaceuticals were included in the study). They were compared to 447 women who didn’t take sleep drugs. The study duration was two years. 

All of the women (avg. age 49.5) in the study reported “difficulty falling asleep on 1 out of every 3 nights, waking frequently on 2 out of 3 nights, and waking up early on 1 in every 3 nights of the week. More than 70% of women in both groups reported disturbed sleep at least 3 times a week.” 

The one and two-year assessments did not show any significant changes in sleep between the two groups. The researchers concluded that though this was not a causal study, only correlative, the long-term use of prescription medications for insomnia was not linked to better quality sleep. The researchers noted that most of the medications for sleep are designed to be used for six months or less, and this study was the first to examine the long-term use of common prescription sleep aids. 

What About Melatonin? 

Melatonin is another commonly used sleep aid sold as a dietary supplement. To understand its use, it is important to know what melatonin is and what it does to the body for sleep. 

Melatonin is a hormone the body produces in response to darkness. “Our natural melatonin in the brain is strongly suppressed by light, so it will only increase once we are in dim light, like sunset,” says naturopathic doctor, Catherine Darley, who is also the founder of the Institute of Naturopathic Sleep Medicine. “It signals to the brain that it is time to sleep by making us drowsy and dropping our core body temperature. Melatonin also enters the circulation and signals to cells throughout the body that it is night.” 

The body’s pineal gland produces between 0.1 and 0.9 mg of melatonin per day. However, the human gut mucosa produces five times more melatonin than the pineal gland, which is yet another reason for maintaining a healthy gut. Production of melatonin declines starting in our twenties and continues through age fifty when a negligible amount is produced. 

Dr. Darley and a group of integrative medicine experts published a study, Is Melatonin the Next Vitamin D? In it they say: “the largest contributor to melatonin imbalance would be those subject to jet lag, shift work, overuse of artificial light at night (e.g., from cell phones, computers, and fluorescent/LED light), or challenges to their circadian rhythm due to environmental or seasonal changes.” 

This means that the ideal circumstance for taking melatonin is when our circadian rhythm isn’t in sync with the environment, for instance, jet lag or shift work. It can also be used to shift the body clock and support healthy sleep patterns during menopause and aging. “The dose, timing, and type of melatonin are all important,” she says. “In sleep and circadian medicine, we generally go with low (i.e., physiological) dose of 0.3mg or 1mg, up to a max of 3mg which is a pharmacological dose. Higher doses of melatonin haven’t been shown to be more effective for sleep.” 

She recommends speaking with your doctor about proper melatonin dosage and use. There are a number of benefits of melatonin that are supported by research. In menopause, melatonin can improve body-mass index (BMI) and bone density, but it may also raise LDL cholesterol and triglycerides. 

Overall, melatonin has antioxidant and anti-inflammatory properties; it helps regulate cellular mitochondria; and it crosses the blood-brain barrier. Dr. Darcey and her colleagues note in their study that natural sources, called phytomelatonin, have far superior antioxidant and anti-inflammatory properties as compared to synthetic melatonin. This is because natural sources contain chlorophyll, beta-carotene, lutein, and other protective, antioxidant phytonutrients. 

There are also contraindications based on the cytochrome enzymes which metabolize melatonin and other compounds, she warns. “Specifically, the anti-depressant fluvoxamine and even caffeine can increase melatonin levels. Some other potential interactions could be with pharmaceuticals, herbal medicines, or nutrients that lower blood sugar or blood pressure, are anticonvulsant, or have immunosuppressive effects.”

Healthy Sleep Habits During Menopause 

There are ways to improve sleep despite the disruptions caused by menopause. “Develop lifestyle strategies to improve sleep that center around getting light and darkness at the right times,” says Dr. Darley. “The right light and darkness can have a much bigger impact than people realize.” Speak with your physician (find one here) if these common sleep hygiene habits do not work for you. 

  1. Make sure you get 30 minutes of bright, outside light soon after waking and in bursts throughout the day. 
  2. About 2 hours before bed, turn down the lights to less than 10 lux (there are free lux meter apps for your phone to test your light level). 
  3. Stick to a quiet pre-sleep routine that includes reading, soothing music, and a warm bath. 
  4. Adjust your environment while sleeping. Bedrooms should be as dark as possible, without any night light or LEDs. However, if you or a loved one need a night light as a safety measure, do not get rid of it. Rather, as is appropriate for your situation, consider options that maintain a lower level of light until motion is detected.
  5. Dietary recommendations that help strengthen the circadian rhythm include eating distinct meals at the same time every day (instead of snacking), and finishing eating 3 hours before bed.
  6. See the Foods and Melatonin infographic below as a reminder of food that helps increase melatonin naturally. 

Above all, do not hesitate to contact a naturopathic doctor if changes in your sleep patterns become consistent and interfere with your daily life. The negative consequences of disruptive sleep can occur within a few weeks (or less) of sleep changes. See INM’s Find an ND tool. 

This article is provided by the Institute for Natural Medicine (INM), a non-profit 501(c)(3) organization. INM’s mission is to transform healthcare in America by increasing both public awareness of naturopathic medicine and access to naturopathic doctors for patients. INM believes that naturopathic medicine, with its unique principles and practices, has the potential to reverse the tide of chronic illness that overwhelms existing healthcare systems and empower people to achieve and maintain their optimal lifelong health. INM strives to achieve this mission through the following  initiatives:

  • Education – Reveal the unique benefits and outcomes of naturopathic medicine
  • Access – Connect patients to licensed naturopathic doctors
  • Research – Expand quality research of this complex and comprehensive system of medicine

Stewart is an award-winning editor, food and health journalist and best-selling author of Eating Between the Lines, the supermarket shopper's guide to the truth behind food labels (St. Martin's Press).

Founded in 1985, the American Association of Naturopathic Physicians (AANP) is the national professional society representing licensed or licensable naturopathic physicians who are graduates of four-year, residential graduates programs.

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Deb Hubers

Debra Hubers is a serial entrepreneur and has started seven businesses; ranging from an advanced genomics to an employer health care purchasing cooperative. Deb has over 35 years of experience in healthcare finance, education, technology, and pharmacogenomics.

Ms. Hubers has dedicated her career to measuring and improving healthcare outcomes. Her expertise is leveraging technology to deliver personalized, preventative medicine. Ms. Hubers co-founded La Vita Compounding Pharmacy in 2007. Collaborating with her business partner, physicians and strategic partners, Deb has grown La Vita to be one of the most respected and sought-after personalized medicine providers on the west coast. She is also Co-Founder of EpigeneticsRx, a leading provider of precise, personalized, prevention which positively impacts genetic expression.

Alex Keller, ND

Dr. Alex Keller, ND, AFMCP is a graduate of the University of Ottawa with an Honours Bachelor in Health Sciences and Psychology. Although originally intending to attend conventional medical school, following a three-month volunteer internship at a rural Kenyan hospital where he observed how doctors used local food to treat patients, he shifted his career goals and pursued a degree in naturopathic medicine at the Canadian College of Naturopathic Medicine in Toronto.

After one year of practicing with the esteemed Dr. Chris Pickrell, ND, RH in a community acupuncture setting, in 2015 he and his wife Dr. Jenn Keller, ND moved to rural Ottawa, Canada where they started an organic farm and retreat center. In the same year, Alex and his athletic therapist sister Jess Keller combined their practices to form Keller Active Health, an integrative physical therapy clinic.

Ever curious and passionate about the education of evidence-based natural medicine, in 2017, Dr. Keller joined a fledgling Ottawa-based health tech startup named Fullscript. He serves as its Medical Director and oversees the development of medical education content for practitioners across North America.

Prior to medicine, Alex worked in the renewable energy sector, where he developed a deep passion for sustainable agriculture and environmental stewardship. This connection between medicine and agriculture now drives Alex to focus much of his energy on bringing awareness to the quality and sourcing standards in the supplement and organic agriculture supply chains.

Today, he splits his professional time practicing as a clinician, working for Fullscript, and expanding the farming operation while chasing his kids with Jenn and occasionally running ultra-marathon trail races. He is also currently completing an Executive MBA through the Quantic School of Business & Technology with a focus on supply chain innovation.

Pamela Snider, ND

Pamela Snider, ND, is Executive and Senior Editor for the Foundations of Naturopathic Medicine Project, producing a first of its kind international textbook of Naturopathic medicine through a series of international retreats and symposia. A nationally recognized integrative health and policy leader, she is active in both national and regional integrative health initiatives. Dr. Snider serves on the Board of Directors, was founding Executive Director and co-founder of the Academic Consortium for Integrative Health (ACIH/ACCAHCa consortium of the councils of schools, accrediting agencies and certifying bodies of the licensed, traditional and emerging integrative health professions, and is currently Vice Chair and co-founder of the Integrative Health Policy Consortium (IHPC).  Dr. Snider served as a founding Board Member of the Academy of Integrative Health & Medicine from 2014-2016. Her public policy work includes completing a two year appointment to the DHHS Center For Medicaid and Medicare Services (CMS) Medicare Coverage Advisory Committee (MCAC); serving as a Steering Committee Member for  the HRSA funded American College of Preventive Medicine NCCIM Integrative Medicine in Preventive Medicine Residency program, co-directing in USPHS Region X the Building Bridges Between Provider Communities Group, an exploration of interdisciplinary collaboration and common ground between public health and CAM; serving for 22 years on Washington State’s Health Professional Loan Repayment and Scholarship Program Advisory Committee (HPLRSP); providing technical assistance to and developing key language for the enabling legislation for NIH Center for Complementary and Alternative Medicine (NCCIH/NCCAM); and staffing Joseph Pizzorno ND during his appointment as Commissioner on the White House Commission on CAM Policy.

From 1994-2003, Dr. Snider served as Associate Dean for Public and Professional Affairs and Naturopathic Medicine at Bastyr University, dividing her work between academic and public affairs activities, including chairing the Naturopathic Medicine Program Curriculum Review Committee.  Dr. Snider has been teaching, publishing and lecturing widely on Naturopathic philosophy, theory integrative health, public policy, and other topics for over 30 years. Currently, an Associate Professor at National University of Natural Medicine (NUNM) in Portland, OR, Dr. Snider also continues at Bastyr University in her 22nd year as a faculty member teaching naturopathic medicine history, clinical theory, and global context. Among her Naturopathic medicine professional roles she serves on the Institute for Natural Medicine’s Leadership Council.  In 1989, she co-led the naturopathic profession with Dr. Jared Zeff, in developing a unifying definition of naturopathic medicine and its principles of practice adopted unanimously by the American Association of Naturopathic Physicians (AANP) House of Delegates. She was a co-investigator in the 2004 NIH NCCAM research study, the North American Naturopathic Medical Research Agenda and CAM Advisor in NIHCCAM’s Financing Integrative Health Care (University of Washington).  Her areas of experience include healthcare education; naturopathic and interdisciplinary clinical theory, curriculum development; clinical practice; government and legislative affairs, public policy, interdisciplinary collaboration, and community organizing.  Dr. Snider has received the Ontario Naturopathic Physician of the Year Award, the Physician of the Year Award from the AANP, the President’s Outstanding Vision Award and Distinguished Alumnus Award at Bastyr University, AANP’s President’s Award, an honorary Doctorate of Naturopathic Philosophy from the Canadian College of Naturopathic Medicine (CCNM), the William A Mitchell Vis Award from the AANP and The Gathering – NMSA’s Beacon Award. She received her ND degree in 1982 from Bastyr University of Natural Health Sciences and is a licensed naturopathic physician in the State of Washington. She lives with her husband and children at their homestead in North Bend Washington, in the beautiful mountain to sea landscape and home of The Revival – Restore the Vis, an annual student-led community gathering.

Susan Haeger

Susan Haeger is Founder/Principal of Transformative Health Solutions Inc. She has applied her twenty plus years in executive leadership to help shape and drive adoption of progressive health policy for whole person healthcare. She was a section contributor to the 2021 INM/AANP published professional white paper, Naturopathic Physicians as Whole Health Specialists: The Future is Whole Person Health Care that provides supporting evidence for the profession’s significant and unique contributions to preventive, whole person care and models of integrative clinical practice.

Bruce Barlean

Bruce Barlean is an owner and founder of Barlean’s, a global dietary supplement manufacturer located in the Pacific Northwest in Ferndale, WA. Bruce has been actively involved in the Natural Products industry since 1989 and is passionate about making a difference in the world and positively impacting the lives of others.

Bruce believes that people can make a difference in the world through ordinary purchases. He is committed to improving the quality of life for every person on the planet by making the best products and by using the profits to support outreach programs. Bruce summarizes it simply, “We make good stuff to do good stuff”.

In the late 1980’s Bruce became passionate about how health could be dramatically improved with Flax Oil Supplementation. Bruce along with his entrepreneurial parents saw the potential to improve the lives of many people and in 1989 they began selling Flax Oil under the Barlean’s name. From 1989 – 2000 the business grew an average of 40% year over year. While most companies saw a decline in business in the 2001 recession, Barlean’s continued to grow and soon became America’s #1 selling flaxseed oil and continues to be to the present. The brand has since expanded to include additional oils, green food concentrates and other premium supplements. Bruce continues to drive innovation and over the years his products and company have won countless awards including: Eight consecutive Vity Awards for #1 EFA, Six consecutive Vity Awards for #1 Greens Food Supplement, Natural Choice Award for Best Specialty Supplement, Best Product of the Year, Best New Product, Gold Medal Taster’s Choice Award, Gold Medal American Masters of Taste Award, #1 Health Food Store Brand for Consumer Satisfaction by Consumer Lab, and Manufacturer of the Year.

In 2013 as the company was on the eve of celebrating the 25th year in business Bruce and his parents decided to take their desire to help people to a new level that they call Pathway to a Better Life – which is now seen in the Barlean’s logo. Bruce and his parents had always been generous in their giving and support of charities, but as part of the Pathway to a Better Life they decided to increased partnership with charitable organizations such as: Vitamin Angels, Compassion International, KidsTown International, Autism Hope Alliance, Engedi Refuge, Project 92, and others. And because so many people are unable to meet basic nutritional needs, Bruce created a comprehensive Omega-3 and multivitamin formula that he distributes free-of-charge to local food banks. In addition, Bruce decided the company would supply food banks with organic coconut oil to provide people with a health alternative to standard cooking oils.

Always generous with his time Bruce has served as a youth leader for his local church for several years and continues to mentor youth. He has been on several not for profit boards including; Whatcom County Pregnancy Center (2003-2006), Natural Products Association (dates?), and the Institute for Natural Medicine Leadership Council (presently).

The Barlean family have been avid supporters of Bastyr University since the 1990’s and in 2013 were given Bastyr’s most prestigious honor, the Mission Award, which recognizes their leadership over time in improving the health and well-being of the human community.

Bruce currently resides in Ferndale, WA with his wife Lisa and their two dogs: Heinz & Shadow. When he’s not helping others he can be found fishing (catch & release).

Get Involved!

Michelle Simon, PHD, ND

President & CEO

As president and CEO of INM, Dr. Simon brings her passion for working with organizations dedicated to improving the quality and delivery of healthcare. This desire stems from her years of practice as a licensed naturopathic physician. In addition to holding a Naturopathic Doctorate from Bastyr University she also holds a PhD in Biomedical Engineering from the University of North Carolina at Chapel Hill.

She has served on boards for the American Association of Naturopathic Physicians (AANP), the Naturopathic Physicians Research Institute (NPRI), and several advisory boards. Dr. Simon served nine years on the Washington State Health Technology Clinical Committee, as Ambassador to the Academy of Integrative Health and Medicine (AIHM) and was recognized as 2018 AANP Physician of the Year. Dr. Simon shares with her husband a passion for adventure travel, preferably by boat or motorcycle. She also enjoys teaching a women’s off-road motorcycling class.