Sleeplessness in Perimenopause: Solutions for Better Sleep
- Rebecca Snow, MS, CNS, LDN, RH
- 11 minutes ago
- 4 min read
A common question amongst my midlife women friends is, “How are you all sleeping?” The question behind the question is really, “Is everyone having the same trouble I am?”
Somewhere in midlife, sleep stops being automatic. You go to bed tired but wake up at 3:05 a.m. staring at the ceiling, wondering why your body suddenly forgot how to sleep.
The truth is, I rarely talk to someone my age who doesn’t have some type of sleep issue during perimenopause or menopause. Here are some common scenarios:
A single mom is juggling so much that she doesn’t have time to go to bed until after midnight.
Another woman gets up to urinate twice every night.
A mom of two kids started having children at 35 and says she never slept well again after having kids.
A postmenopausal woman wakes at 3 or 4 a.m. and has trouble falling back asleep.
A friend who used to sleep like a rock now never feels rested.
If any of this sounds familiar, you’re not alone. Sleep problems in perimenopause are extremely common.
Why Sleep Changes During Perimenopause
Throughout perimenopause and menopause, the body is changing in ways that can directly impact sleep.
There are also age-related sleep changes that occur in both men and women, including lower melatonin production, increased nighttime urination, and shifts in brain chemistry that affect sleep quality.
Hormonal fluctuations add another layer.
Declining estrogen can trigger hot flashes and night sweats, which may wake you up repeatedly during the night. Estrogen also works in tandem with neurotransmitters such as serotonin, dopamine, and acetylcholine, which influence mood and sleep regulation.
Mood and sleep are closely connected—almost like the chicken and the egg. When one is off, the other often follows.
Progesterone also plays an important role. It boosts GABA, a neurotransmitter that has a calming effect on the brain. During perimenopause, progesterone levels may decline significantly, which is one reason many women notice increased anxiety or insomnia during menopause.
This is also why some women find that they sleep better when taking oral micronized progesterone as part of menopausal hormone therapy (MHT). Menopausal Hormone Therapy can be one strategy for addressing menopause-related insomnia, and it’s something you can discuss with your doctor if sleep issues become severe.
In the meantime, there are still many things within your control that can support better sleep during perimenopause.
The Frustration of Insomnia
Insomnia during perimenopause is uniquely frustrating because you can’t directly control sleep.
You can’t simply decide to fall asleep. Instead, you can only control the behaviors and conditions that influence sleep.
Insomnia often feeds on itself. When you start worrying about not sleeping, anxiety and stress increase, which makes it even harder to fall asleep. It becomes a bit of a mind game.
One strategy I find helpful is dividing sleep challenges into things I can control and things I can’t control. When sleep feels out of your control, focusing on the areas where you do have influence can be empowering.
What You Can Control
What time you go to bed
Room temperature
What clothing you wear to bed
Nighttime routines and wind-down practices
Screen time at night
Overcommitting yourself during the day
Time spent outdoors in natural light
Supplements or sleep supports
The timing of dinner
What You Can’t Control
How rested you feel when you wake up
A loud or snoring partner
Night shift work or heavy workload
Sudden difficulty falling asleep
Waking with hot flashes or night sweats
Early morning awakenings
Accepting what we can’t control may sound simple, but it can actually reduce the mental stress that makes insomnia worse. When sleep feels frustrating, focusing on supportive habits rather than forcing sleep can make the experience less stressful.
Strategies That Can Improve Sleep During Perimenopause
One of my favorite strategies for improved sleep is what I call daytime nervous system resets. These are rituals of calm or little moments of relaxation throughout the day to prepare your nervous system for sleep. The same way women lift weights to get strong muscles, you can practice relaxing your nervous system to get better and more restorative sleep.
These rituals of calm don’t have to be big, scheduled events. Who has time for that? These are 1 min resets. Easy simple. Schedule them on your phone. If I don’t write it down or schedule it, I won’t do it.
Daytime Nervous System Resets.
4-6-8 breathing
Breathe in for 4
Breathe out for 4
Breathe in for 4
Breathe out for 6
Breathe in for 4
Breathe out for 8.
Butterfly breathing - see link here
A few tips:
Put a drop of essential oil of lavender on your heart.
Close your eyes and take a few deep breaths.
Go outside for a few minutes to get light exposure; early morning is great for the circadian rhythm.
Earthing - go stand outside on the earth barefoot for a few minutes
Give a hug, receive a hug
Strategies to improve sleep
Schedule
If you are reluctant to go to bed, set a reminder on your phone about 30-60 min before the time you wish to get to bed. This is also good to help you keep a consistent sleep schedule; going to bed and waking at similar times helps train the body for better sleep.
Alcohol and Caffeine
Alcohol fragments sleep and can worsen night sweats during menopause. Aim to minimize it. Drink your cup of coffee before 12 pm
Protein and fiber with meals
Protein and fiber help to stabilize blood sugar during the day and overnight. Pay attention to the nighttime snacks that are higher in sugar or lower in protein.
Cool your body
Adjust room temperature, splash your face with cool water before bed, use cooling pillows, and wear lighter sleepwear.
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